Predictive Performance of Hypertensive Disorders of Pregnancy Gestosis Score for Preeclampsia: A Retrospective Case–Control Study

Abstract

Aim and background:Preeclampsia (PE) is one of the most significant causes of perinatal morbidity and mortality in India, contributing to 7% of maternal deaths. Recognizing and managing hypertensive disorders in pregnancy (HDP) and their complications in low-and middle-income countries are essential due to myths and misconceptions about pregnancy, challenges with transportation, low socioeconomic status, lack of accessible expert antenatal care requiring a multidisciplinary approach, and absence of accurate prediction methods. Identifying high-risk factors leading to HDP is critical for early intervention to prevent complications. This study aims to assess the predictive performance of the HDP gestosis score for PE/eclampsia. Materials and methods: This hospital-based retrospective case–control study was conducted over one year, involving 50 hypertensive cases (diagnosed with HDP) and 50 normotensive patients using hospital records from Chettinad Hospital and Research Institute. The study examines several factors: Obstetric scores, medical disease, anthropometric measurements, specific clinical questionnaires, laboratory parameters, and family history, with scoring of individual parameters ranging from 1 to 3 as recommended by FOGSI-GESTOSIS-ICOG as HDP gestosis score. A cumulative score is obtained through careful history-taking and assessments. When the total score equals or exceeds 3, a pregnant woman should be marked as “At risk for PE.” Results: The HDP gestosis score showed a significant association between gestosis scores and blood pressure status among cases and controls. Participants classified as normotensive had a mean gestosis score of 1.86 ± 1.21 (gestosis score <3). At the same time, those who were hypertensive showed a substantially higher mean score of 4.16 ± 1.95 (gestosis score ≥3), with a p-value of less than 0.0001. Our findings demonstrated a sensitivity of 88% and a specificity of 82%. The positive predictive value (PPV), negative predictive value (NPV), and predictive accuracy for the HDP gestosis score in this study were 83.02%, 87.23%, and 85%, respectively. Conclusion: The HDP gestosis score shows significant potential as a practical, objective, and accessible tool for the early identification of high-risk PE cases. Integrating widely used clinical parameters into a dynamic, simplified, and cost-effective scoring system offers a quantifiable means to stratify risk in HDP. The score facilitates timely interventions that could reduce perinatal morbidity and mortality, highlighting its value in improving maternal and fetal outcomes in resource-limited and high-risk populations. Clinical significance: By relying on routine clinical measurements, healthcare providers can systematically and consistently identify high-risk pregnancies, enhancing patient monitoring and resource allocation. The HDP gestosis scoring system will enable healthcare professionals to make informed, proactive care decisions, potentially improving long-term health outcomes for mothers and newborns.