Initial recruitment, diagnosis, conservative management, maternal and perinatal outcomes of hypertensive disorders of pregnancy

Hypertensive disorders of pregnancy (HDP) constitute a group of conditions characterized by elevation of blood pressure detected for the first time after 20 weeks of gestation, with a global prevalence estimated at nearly 10% of all pregnant women. To evaluate the clinical evolution and perinatal outcomes of pregnant women identified with a first elevation of blood pressure after 20 weeks of gestation, from the diagnostic confirmation of the type of HDP, until the termination of pregnancy under conservative management in the hospital. Observational analytical cohort study in pregnant women attended at the Social Security Fund hospital of Panama, from July 1, 2023, to December 31, 2024. Pregnant women ≥20 weeks of gestation were included, identified for presenting a first elevation of blood pressure (140/90 mmHg), who were subsequently confirmed with an HDP diagnosis through a second elevated blood pressure measurement found in a minimum of 4 hours or a maximum of 7 days. During the 18 months of the study, 191 pregnant women were admitted to confirm or rule out HDP. It was confirmed that 20 (10.4%) had white coat hypertension, in 11 (5.8%) chronic hypertension without superimposed preeclampsia was diagnosed, confirming pregnancy-associated hypertensive disorder in 160 (83.8%). 51.2% with a diagnosis of HDP without severity criteria under conservative management developed severity criteria. The pregnancy prolongation time with conservative management was 3 weeks. The average gestational age at the time of termination was 35 weeks and 30% of the newborns were admitted to the intensive care unit. There were 8 (5%) perinatal deaths: one in utero and 7 neonatal deaths associated with prematurity. This study shows that one in ten patients with an initial elevation in blood pressure ultimately has a diagnosis of white-coat hypertension, and that nearly half of pregnant women identified with a first elevation in blood pressure after 20 weeks of gestation develop severe features during conservative inpatient management. HDP are dynamic and evolving entities that may progress unpredictably, leading to high rates of prematurity and maternal and perinatal complications.