THE PROGNOSIS OF HYPERTENSIVE DISEASE OF PREGNANCY ACCOMPANIED BY INTRAUTERINE GROWTH-RETARDATION IN RELATION TO PARITY

Twenty-two primiparous women with hypertensive disease of pregnancy (HDP) associated with intra uterine growth retardation (IUGR) were compared with 20 parous women in whom HDP associated with IUGR appeared for the first time in a second or a later pregnancy. Both groups of women were followed up for 10-13 years. The course of the disease among the parous women was more severe as compared to the primiparous women; the mean gestational age at the first increase in blood pressure and gestational age at delivery were significantly earlier in the parous group (33.3 weeks +/- 3.5 v.s. 35.3 +/- 3.2 weeks, p < 0.01, 36.2 weeks +/- 2.2 v.s. 37.6 +/- 1.9 p < 0.01 accordingly). Maternal indication for induction of labor because of uncontrollable hypertension was present in 77% of the cases in the parous group as compared to 31% in the primiparous group (p < 0.05). These complications were present in 66% of subsequent pregnancies in the parous group as compared with 31% in the primiparous group (p < 0.05). Chronic hypertension developed in 33% of the parous group as compared with 20% in the primiparous group. These differences show that the manifestation of HDP is more severe in women in whom HDP with IUGR occur for the first time in a second or a later pregnancy than in those in whom this complication occurs for the first time in their first pregnancy. The long term prognosis of the first group is also more severe than in the later group. These findings suggest that pregnant women who for the first time develop HDP associated with IUGR in a later pregnancy belong to a special high risk group which warrants a close follow up concerning recurrent complications in subsequent pregnancies and the risk for developing chronic hypertension in the future.