Maternal and perinatal outcomes among women with hypertensive disorders in pregnancy in Kumasi, Ghana.

Edward T Dassah,Alexander T Odoi,Eunice Kusi-Mensah,Emmanuel S K Morhe,Seth Adu-Afarwuah

doi:10.1371/journal.pone.0223478

Abstract

BackgroundData pertaining to maternal and perinatal outcomes associated with the complete spectrum of hypertensive disorders in pregnancy (HDPs) is sparse in low resource settings. This study aimed to determine adverse maternal and perinatal outcomes among women admitted with HDPs in a tertiary hospital in Ghana, and directly compare these outcomes among women with pre-eclampsia/eclampsia and those with chronic/gestational hypertension.MethodsAn analytical cross-sectional study was conducted among women who were admitted with HDPs to Komfo Anokye Teaching Hospital from July 1, 2014 to September 30, 2014. Data was collected on their socio-demographic and reproductive characteristics using a pretested structured questionnaire and review of their antenatal records. Crude and adjusted relative risks (RRs), with 95% confidence intervals (CIs), associated with adverse maternal and perinatal outcomes were compared using multivariable binomial regression. P ≤0.05 was considered statistically significant.ResultsA total of 451 women with HDPs were studied: 5.3%, 32.4%, 48.8% and 13.5% had chronic hypertension, gestational hypertension, pre-eclampsia and eclampsia respectively. Over 80% were either referrals or “self-referred” from other facilities. Overall, 87% had adverse maternal or perinatal outcomes. Women with pre-eclampsia/eclampsia were at increased risks of caesarean section (adjusted RR, 1.37; 95% CI, 1.01–1.87), preterm delivery at <34 weeks’ gestation (adjusted RR, 2.74; 95% CI, 1.40–5.36) and preterm delivery at <37 weeks’ gestation (adjusted RR, 1.89; 95% CI, 1.25–2.85), compared to women with chronic/gestational hypertension.ConclusionWomen with pre-eclampsia/eclampsia were at higher risk of adverse pregnancy outcome compared to those with chronic/gestational hypertension. Strategies for prevention and management of pre-eclampsia/eclampsia to improve pregnancy outcomes are required in this major maternity care centre.

Highlights

Hypertensive disorders in pregnancy (HDPs) comprising chronic hypertension, gestational hypertension, pre-eclampsia and eclampsia complicate 4–10% of pregnancies worldwide[1]
Data pertaining to maternal and perinatal outcomes associated with the complete spectrum of hypertensive disorders in pregnancy (HDPs) is sparse in low resource settings
Women with pre-eclampsia/eclampsia were at increased risks of caesarean section, preterm delivery at

Summary

Introduction

Hypertensive disorders in pregnancy (HDPs) comprising chronic hypertension, gestational hypertension, pre-eclampsia and eclampsia complicate 4–10% of pregnancies worldwide[1]. They account for about 15% of all maternal deaths globally, almost all (>99%) of which occur in developing countries[1]. About 25% of perinatal deaths in these settings are attributable to HDPs[2] These disorders have been reported as a leading cause of maternal mortality in subSaharan Africa, including most tertiary and rural hospitals in Nigeria[3] and major tertiary health facilities in Ghana as well as other countries[4, 5]. This study aimed to determine adverse maternal and perinatal outcomes among women admitted with HDPs in a tertiary hospital in Ghana, and directly compare these outcomes among women with pre-eclampsia/eclampsia and those with chronic/gestational hypertension

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Conclusion