Prevalence and Risk of Adverse Outcomes of Hypertensive Disorders in Pregnancy at Pumwani Maternity Hospital in 2018-2019,

Abstract

Background: About 500,000 women die yearly due to pregnancy-related causes and 99% of these occur in low and middle-income countries. Hypertensive disorders in pregnancy (HDP) are the second leading cause of maternal deaths. Preeclampsia (PE) results in 76,000 maternal deaths and 500,000 perinatal deaths per annum globally. HDP affects 5-10% of pregnancies word wide, in Australia affects 9.8%, in Africa, most studies found a higher prevalence of HDP at 13% while that in Kenya is 10% and limited data according to the United States National Discharge survey suggests an upward trend. PE with severe features affects 51.9% and eclampsia 23.4% of pregnancies with HDP. Globally the rate of adverse maternal and perinatal outcomes in HDP stands at 40%. In the US the most common adverse outcomes in PE were; placenta abruptio 10%, neurological deficits 7%, aspiration pneumonia 7%, pulmonary edema 7%, cardiac arrest 4%, Acute kidney injury (AKI) 4%, and maternal death 1%. In Tanzania, the prevalence of eclampsia has been estimated at 1.6% and the perinatal mortality rate was 30%. In Kenya Wasiche at Kenyatta National Hospital (KNH) reported maternal complications in 67% of patients with eclampsia, with the commonest complications being sepsis 40.4%, pulmonary edema 25.3%, AKI 10.4 %, and cerebral hemorrhage 10.4%. Objective: This study aimed to determine the prevalence of HDP and the risk of adverse maternal and perinatal outcomes among pregnant and postpartum women who received care at Pumwani Maternity Hospital between January 2018 and December 2019. Methodology This was a cross-sectional study in which records of 3990 patients were sampled from 39,711 maternal deliveries during the study period. The study population was described by summarizing socio-demographic and obstetric characteristics into percentages and means or medians for categorical and continuous variables respectively. Prevalence of HDP was calculated out of the total admissions and 95% confidence interval was presented while that of adverse maternal complications and neonatal outcomes was calculated out of all women with HDP and 95% confidence interval was presented. Factors associated with HDP, adverse maternal outcomes, and neonatal outcomes was determined using; chi square test for categorical variables and comparison of means using independent t test for continuous data. Odds ratios were calculated to estimate the odds of developing the outcomes associated with each independent variable. P value of <0.05 was considered statistically significant. Data was presented in tables, pie charts, and bar graphs.

Results: Between January 2018 and December 2019, a total of 3990 records were reviewed and data extracted. A total of 338 were excluded, 159 due to missing LNMP, 66 due to missing BP, 25 due to missing LNMP and BP, and 88 due to missing of greater than 5%of data. The mean age of all participants was 26 years and median (IQR) of 25.0 (22.0-30.0). Nearly all (99.2%) attended ANC and 78.4% had SVD. The prevalence of HDP was 14.5% (95% CI13.3-15.6%), n=528 out of 3124 while that of PE was 49.8% (n=154) of patients with HDP. We had 47.5% n=251 of patients with HDP who were unclassified. The mean birth weight of the neonates was 3042.8g. Among women with HDP, the prevalence of maternal complications was 3.2% (95%CI1.7-4.9) n=17 out of 528, and post-partum hemorrhage was the leading cause n=8 out of 17 thus 47.1%. The prevalence of adverse neonatal outcomes was 16.9% (95%CI13.7-20.0) reported in 16.9 % (13.5-20.1 %) and birth asphyxia was the leading cause n=48 out of 89 thus 53.9%. Conclusion: The prevalence of HDP among pregnant and postpartum women at PMH from January 2018 to December 2019 was 14.5% and the prevalence of adverse maternal outcomes among women with HDP was 3.2% while that of adverse neonatal outcomes was 16.9%. We had 47.5% of patients with HDP who were unclassified. There were no factors that were significantly associated with HDP in this setting during our study period. Recommendations: There is a high prevalence of HDP at PMH hence the need for heightened awareness, the institution of prevention measures, to ensure the provision of good quality care and enhance the achievement of good maternal and perinatal outcomes