Antenatal care practices and pregnancy outcomes among referred and booked patients with pre-eclampsia at Pumwani maternity hospital:A retrospective cohort study

Abstract

Background: Hypertensive disorders are the most common medical complication occurring in 12-22% of all pregnancies and contribute significantly to both maternal and perinatal morbidity and mortality. Early identification and effective management in addition to timely referral to higher level facilities for specialized management plays a significant role in ensuring good maternal and perinatal outcomes. Despite the availability of screening tools and management guidelines, severe pre-eclampsia and eclampsia continues to be a major cause of severe maternal and perinatal complications especially so in developing countries. Antenatal care is a key instrument in the detection of pregnant women at high risk of developing pre-eclampsia and instituting proper management to control the disease before complications arise. Objective: To determine and compare the pregnancy outcomes of patients with preeclampsia who received antenatal care at Pumwani Maternity Hospital and those who received antenatal care at its referring health facilities. Study design: A retrospective cohort study, where exposure of interest was antenatal clinic attendance at Pumwani Maternity Hospital. Methods: Study population consisted of 224 patients diagnosed with pre-eclampsia who delivered at Pumwani Maternity Hospital from June 2009 to June 2014 in two equal cohorts of 112 patients each, namely, those who attended ANC at Pumwani and those who attended ANC at its referring health facilities. Data was extracted from patient records using a structured questionnaire. Results: Data was retrieved from a total of 224 patients files, 112 files were from patients who received antenatal care at Pumwani Maternity Hospital and the other 112 files were from patients who received antenatal care outside Pumwani Maternity Hospital. ANC attendance at PMH was associated with development of fewer maternal complications (12.5%) compared to attendance at its referring health facilities (26%) p-value=0.011. There was no significant difference in neonatal outcomes in both cohorts with similar newborn complications in both cohorts including admission to newborn unit at 50% in Pumwani and 41.7% from its referring facilities and perinatal death of 8% from PMH and 10.6% from its referring facilities. ANC attendance at PMH was associated with better screening, appropriate investigations and timely institution of medical management compared to attendance at its referring facilities. Antenatal care practices contributed most significantly towards the development of adverse pregnancy outcomes. Conclusion and Recommendations: Antenatal care practices play a significant role in the early diagnosis and management of pre-eclampsia thus greatly affecting pregnancy outcomes. Facilities at all levels in the health care system (level 1-6) require targeted support to improve their antenatal service provision for management of pre-eclampsia especially so for lower level facilities (level 1-4) that cater for the majority of pregnant women in the community.