1044: A search for modifiable risk factors of severe maternal morbidity in hypertensive diseases of pregnancy

Abstract

To identify modifiable risk factors for organ dysfunction (OD) in women with hypertensive diseases of pregnancy (HDP) using the definition of organ dysfunction by the International Society for the Study of Hypertension in Pregnancy (ISSHP). We performed a retrospective case control study of pregnant women who received care at the Regional hospital in Accra, Ghana. The hospital receives referrals from 108 facilities that account for 91% of transfers. Women presenting with hypertension; chronic, gestational, pre-eclampsia or eclampsia over nonconsecutive 10-week period from 2016-2017 were included for analysis. Medical records were systematically reviewed to identify antepartum and intrapartum factors, and maternal and neonatal outcomes. Women meeting criteria for organ dysfunction (creatinine > 1.02 mg/ dL (90 umol/L), transaminitis ± right upper quadrant or epigastric pain, neurological complications, thrombocytopenia, coagulopathy, or hemolysis (ISSHP definition) were statistically compared to women without these factors, and a third indeterminate group. There were 1125 gravidas admitted to the labor ward during the study period and 117 had HDP (10.4%). Organ dysfunction was present in 51 (43.6%) and no OD in 19 (16.2%) women. There were 47 (40.2) indeterminate women with HDP. Factors associated with OD were multiparity (p= 0.01), history of HDP (p= 0.01), gestational age at delivery (p= 0.02), preterm delivery (p= 0.01), antihypertensive medication prior to transfer (p= 0.01), and diastolic blood pressure at time of transfer (p= 0.04). Multiple other factors were not associated with OD (Table). This study, in a middle resource country, suggests that gestational age at delivery is a potential modifiable risk factor for organ dysfunction and diastolic blood pressure prior to referral to the tertiary center is a modifiable risk factor.View Large Image Figure ViewerDownload Hi-res image Download (PPT)