Outcome of Hypertensive Disorders of Pregnancy and Associated Factors Among Pregnant Women Admitted to Jimma University Medical Center, Southwest Ethiopia

Abstract

Abstract Background: A Hypertensive disorder of pregnancy (HDP) is one of the most common obstetric complications that occur during pregnancy. It occurs generally in about 5 – 10 % of pregnancy and it accounts for 10 – 15 % of maternal death worldwide. It also accounts for perinatal mortality particularly from prematurity and associated complications. Even though there are few studies exploring HDP in Ethiopia, there was no study done on maternal and perinatal outcome of hypertensive disorders of pregnancy and associated factors in the study area. Hence, the aim of this study was to assess maternal and perinatal outcome of hypertensive disorders of pregnancy and associated factors in Jimma University Medical Center. Method: Hospital based prospective cross sectional study was conducted among 202 mothers admitted to Jimma University Medical center from January 01/2019 to June 30/ 2019. Consecutive sampling technique was employed using interviwer administed quetionnaires. The data were entered using Epidata 3.1 version and exported to SPSS version 21. Bivariate and multi-variable binary logistic regression was used at 95% CI and AOR to identify predictors at P-value of <0.05. Result: From 1980 total admission to labor ward and maternity ward, 202(10.2%) mothers were diagnosed with HDP. Preeclampsia with severity feature was the most common presentation (60 %) followed by eclampsia (10.4%). About one third (32 %) of the mother developed at least one maternal complication which could be considered as unfavorable maternal outcome. HELLP syndrome was the most common complications (38.5%) followed by aspiration pneumonia (20 %). Five mothers (2.4 %) of HDP died during the study period, three of them were due to eclampsia complicated by pulmonary edema and two were due to preeclampsia with severity feature complicated by acute kidney injury (AKI) with encephalopathy. There was statistically significant association between place of residency being rural area (AOR = 0.142, 95 % CI: 0.025, 0.801) and having eclampsia (AOR = 9.852, 95% CI: 2.963, 133) and unfavorable maternal outcome. Fifty percent of the fetuses developed unfavorable perinatal outcome with at least one complication. Prematurity and associated neonatal complications particularly hyaline membrane disease was the most common complication. There were 14.4 % still birth and 5.5 % ENND. Gestational age at delivery of 28 – 33 weeks (AOR = 10.11, 95 % CI : 1.635, 62.6), having eclampsia (AOR = 2.761, 95 % CI : 0.898, 8.487) and antepartum onset of HDP (AOR = 6.6 , 95% CI : 3.4,12.75) of the mother had statistically significant association with unfavorable perinatal outcome. Conclusion and recommendation: The presence of preeclampsia with severity features and eclampsia has been associated with poor maternal and perinatal outcomes which were manifested by increased maternal ICU admissions, maternal death, preterm delivery rate still birth and ENND. JUMC should give due emphasis for early recognition and management of mothers with HDP. Keywords: Hypertensive disorder of pregnancy, maternal outcome, perinatal outcome, associated factors, Jimma university medical center