Main Causes Of Maternal Mortality Research Articles

Exploring the Socio-personal Factors Associated with the Prevalence of Symptoms of Reproductive Tract Infections among Sexually Active Married Women in Ernakulam District of Kerala, India

Abstract Background: Reproductive Tract Infections (RTIs)/Sexually Transmitted Infections (STIs) are the main cause of maternal mortality and morbidity in India. The prevalence of the symptoms of RTIs was found to be very high in community-based studies. However only a few studies have explored the factors associated with it. This study aims to determine the socio-personal factors associated with the prevalence of symptoms of RTIs among sexually active married women in Ernakulam district of Kerala. Material and Methods: The study adopted a cross-sectional approach and was conducted among 640 married women in the reproductive age group. Results: The prevalence of the symptoms of RTIs was found to be 56.9% and about 60.16% of them had experienced multiple symptoms. Multivariate analysis showed that those women living in the urban areas (OR: 0.49, 95% CI: 0.334, 0.719), having no previous history of obstetric/gynecological risk factors (OR: 1.89, 95% CI: 1.119, 3.19) and using both clothes and sanitary pads interchangeably during menstruation (OR: 0.46, 95% CI: 0.282, 0.734) were found to be at less risk of contracting RTIs. Conclusion: The use of sanitary pads along with cloth pads can be enhanced rather than only using reusable cloths during menstruation. Also, efforts to improve the reproductive health of the women and reduce the obstetric/gynaecological risk factors should be devised to curtail the peak of RTIs.

Curriculum Development for the South African Essential Steps in Managing Obstetric Emergencies (ESMOE) Anesthesiology Training Module: A Delphi Study.

The United Nations Sustainable Development Goal 3 (SDG3) for 2030 aims at <70 maternal deaths per 100,000 live births. South Africa (SA) falls short of this goal and most deaths occur in district and regional hospitals. Due to low anesthesiologist (specialist anesthetist) numbers in the public sector, the anesthetic workforce in these hospitals consists mainly of nonspecialist (general practitioner) junior doctors with limited supervision. The Essential Steps in Managing Obstetric Emergencies (ESMOE) training program for interns was introduced in 2008 to reduce maternal deaths in SA. Training is not consistently offered at all intern-training institutions and it has not been recently revised. This study sought expert suggestions to guide a revision of the regulation, pedagogy, and content of the ESMOE anesthetic module. A 3-round consensus-seeking modified Delphi technique was used whereby experts rated current and suggested learning outcomes as well as pedagogical- and regulatory aspects of the ESMOE anesthetic module in an anonymous, online, Likert-scale questionnaire. Consensus was defined as ≥70% agreement. Open-ended questions sought motivations for decisions and further suggestions for program improvement. Between March 4, 2021 and August 18, 2021, a total of 17/24 (71%), 16/17 (94%), and 15/16 (94%) consenting experts completed the first, second, and third rounds, respectively. During the 3 rounds, the panel achieved consensus on all but 2 questionnaire items. The panel agreed that ESMOE anesthesia training should be mandatory and that it should be offered through a blended learning model. They further concurred that the current learning outcomes should be retained, and suggested additional outcomes based on the most common causes of maternal mortality in SA. Attendance of the ESMOE anesthesia module should be mandatory. Its pedagogy should be updated to a blended learning style to benefit the current digital native intern generation. The content should be updated to address the main causes of maternal mortality in SA in line with SDG3. A national obstetric anesthesia guideline should be considered, and lea-dership and collaboration are required to improve the alignment of undergraduate, internship, and junior doctor anesthesia training in SA. The content, process, and stakeholder engagement suggestions in this study can assist short-course-based anesthesia workforce training in similar global contexts.

Assessing post-abortion care using the WHO quality of care framework for maternal and newborn health: a cross-sectional study in two African hospitals in humanitarian settings

BackgroundAbortion-related complications remain a main cause of maternal mortality. There is little evidence on the availability and quality of post-abortion care (PAC) in humanitarian settings. We assessed the quality of PAC in two hospitals supported by an international organization in Jigawa State (Nigeria) and Bangui (Central African Republic, CAR).MethodsWe mapped indicators corresponding to the eleven domains of the WHO Maternal and Newborn Health quality-of-care framework to assess inputs, processes (provision and experience of care), and outcomes of PAC. We measured these indicators in four components of a cross-sectional multi-methods study: 1) an assessment of the hospitals’ PAC signal functions, 2) a survey of the knowledge, attitudes, practices, and behavior of 140 Nigerian and 84 CAR clinicians providing PAC, 3) a prospective review of the medical records of 520 and 548 women presenting for abortion complications and, 4) a survey of 360 and 362 of these women who were hospitalized in the Nigerian and CAR hospitals, respectively.ResultsAmong the total 27 PAC signal functions assessed, 25 were available in the Nigerian hospital and 26 in the CAR hospital. In both hospitals, less than 2.5% were treated with dilatation and sharp curettage. Over 80% of women received blood transfusion or curative antibiotics when indicated. However, antibiotics were given to about 30% of patients with no documented indication. Among discharged women in CAR, 99% received contraceptive counseling but only 39% did in Nigeria. Over 80% of women in Nigeria reported positive experiences of respect and preservation of dignity. Conversely, in CAR, 37% reported that their privacy was always respected during examination and 62% reported short or very short waiting time before seeing a health provider. In terms of communication, only 15% felt able to ask questions during treatment in both hospitals. The risk of abortion-near-miss happening ≥ 24h after presentation was 0.2% in Nigeria and 1.1% in CAR. Only 65% of women in the Nigerian hospital and 34% in the CAR hospital reported that the staff provided them best care all the time.ConclusionOur comprehensive assessment identified that these two hospitals in humanitarian settings provided lifesaving PAC. However, hospitals need to strengthen the patient-centered approach engaging patients in their own care and ensuring privacy, short waiting times and quality provider-patient communication. Health professionals would benefit from instituting antibiotic stewardships to prevent antibiotic-resistance.

Giant Intrauterine Mass Because of Puerperal Infection: A Case Report.

Background: Puerperal infection is one of the four main causes of maternal mortality. A giant intrauterine mass caused by puerperal infection is a rare form of infection. The delay in treatment may result in the removal of the uterus. Case Presentation: We report a case of a large intrauterine mass resulting from puerperal infection, in which the uterus was salvaged through antibiotic treatment and curettage. The patient was a 27-year-old female, who presented with a large intrauterine mass, accompanied by fever and abdominal pain 35 days after vaginal delivery. The large intrauterine mass was ultimately pathologically confirmed to be necrotic smooth muscle tissue instead of residual pregnancy tissue. Conclusion: In most cases, the intrauterine mass after pregnancy is residual pregnancy tissue. Early identification and management are critical to ensure a good prognosis for patients. Obstetricians and pregnant women should be fully aware of the hazards of puerperal infections.

The possibilities of predicting of the preeclampsia on the modern level (literature review)

The preeclampsia is one of the main causes of maternal mortality. For this reason the issues of early diagnosis, and most importantly individual prediction are currently one of the most urgent aim for practical obstetrics. To the last years many ways has been attempted to creating methods of a personalized approach to the prognosis of the preeclampsia. However, until this day, the problem remains unresolved. This review article presents the most significant methods of individual prognosis of preeclampsia at the preclinical stage based on genetic, immunological and biochemical markers.

Maternal delay for institutional delivery and associated factors among postnatal mothers at Southeastern Ethiopia: a cross sectional study.

Maternal delay in timely seeking health care, inadequate health care and the inability to access health facilities are the main causes of maternal mortality in low and middle income countries. The three-delay approach was used to pinpoint responsible factors for maternal death. There was little data on the delay in decision making to seek institutional delivery service in the study area. Therefore, the aim of this study was to assess the extent of the first maternal delay for institutional delivery and its associated factors among postpartum mothers in the Bale and east Bale zones. An institutional-based cross-sectional study was conducted among 407 postpartum mothers from April 6 to May 6, 2022. A systematic sampling technique was used to select study participants. The data were collected electronically using an Open Data Kit and exported to SPSS window version 25 for cleaning and analysis. Both bivariate and multivariable analysis was done by using binary logistic regression model to identify factors associated with maternal delay for institutional delivery services. Statistical significance was declared at P-value < 0.05. In this study, the magnitude of the first maternal delay in making the decision to seek institutional delivery service was 29.2% (95% CI: 24.9, 33.9). Previous pregnancy problems (AOR = 1.8; 95% CI: 1.06, 3.08), knowing the danger signs of labor and childbirth (AOR = 1.78; 95% CI: 1.11, 2.85) and decision-making (AOR = 0.42; 95% CI: 0.20, 0.85) were significantly associated with the first maternal delay. This study identified a significant number of postnatal mothers experienced delay in making decisions to seek institutional delivery service in the study area. Promoting women's empowerment and building on key danger signs should be emphasized.

Validation of the Paykel Suicide Scale and the Plutchik Suicide Risk Scale in Spanish Women during the Perinatal Period

Introduction. No specific instruments are available to detect the risk of suicide in women during the perinatal period. Suicide in perinatal women is little studied despite being one of the main causes of maternal mortality. Its prevalence has increased by 100% in the United States in a decade. Moreover, it has consequences for the mother and the newborn. Objective. To validate the Paykel Suicide Scale and the Plutchik Suicide Risk Scale in Spanish women during the perinatal period. Materials and Methods. Cross‐sectional study with Spanish women who were pregnant or who had given birth less than 18 months ago. Information was collected on sociodemographic variables, obstetric variables, and the newborn. A questionnaire that included both suicide scales and the Edinburgh Postnatal Depression Scale (EDPS) was used. An exploratory factor analysis (EFA), convergent and criterion validation, as well as internal consistency analysis, were performed. Results. In total, 237 women participated. The EFA determined that in the Plutchik Suicide Risk Scale 4 components explained 54.8% of the variance, while in the Paykel Scale, a single component explained 53.0% of the variance. In the convergent validity, the risk of suicide or suicidal ideation was related to the Plutchik Suicide Risk Scale and the Paykel Suicide Scale, respectively, with the variables: perception of low social support, risk of intimate partner violence, level of anxiety, history of mental pathology, and having experienced a stressful event in the last year, among others (p &lt; 0.05). The area under the receiver operating characteristic curve for the Plutchik Suicide Risk Scale scores was 0.88 (95% CI: 0.82–0.93), and for the Paykel Scale, it was 0.90 (95% CI: 0.85–0.95). The value of Cronbach’s alpha (α) was placed for the Plutchik Suicide Risk Scale at 0.806 and for the Paykel Suicide Scale at 0.766. Conclusion. Both scales presented adequate psychometric characteristics to be used as a screening instrument for suicide risk in Spanish women in the perinatal period.

Modern management of pregnancy and childbirth with placental attachment disorder

One of the main causes of maternal mortality in the 21st century is postpartum uterine hemorrhage. The period of euphoria in the obstetric community associated with successes in the treatment of hypotonic and coagulopathic hemorrhages ended with the emergence of a new problem - placental invasion into the uterus in the postoperative scar. Placenta increta is the result of abnormal implantation into the decidua or myometrium. This condition is rarely diagnosed in obstetric practice, but it is associated with about 7% of maternal mortality. With the increase in the number of cesarean section surgeries, the incidence of placenta increta is increasing. Diagnosis and treatment are important clinical issues. Since there is no standard clinical treatment protocol, the choice of tactics should be carefully and individually considered.

Trajectory of blood pressure levels and weight gain in pregnant women: A group-based approach

Background and objectivesMorbidities associated with increased blood pressure levels during pregnancy represent one of the main causes of maternal mortality. The objective was to identify patterns of systolic blood pressure (SPB) trajectory in pregnant women undergoing prenatal care at the Unified Health System, and associations with weight gain trajectory, demographic, obstetric, anthropometric data, and health related behaviors. Methods and resultsCohort study with pregnant women using the public health services in Brazil. Data were collected through questionnaires and medical records. Trajectory patterns of SBP and weight gain were identified by a group-based trajectory model. For trajectory analysis, 460 women had SBP information available, totaling 2839 measurements, with an average of 6.2 measurements during pregnancy. Three SBP trajectory patterns were identified and classified as “Group 1” (48.0%), with a mean of 103 mmHg (95% CI 102.5–103.7 mmHg), “Group 2” (42.7%) with a mean of 114 mmHg (95% CI 113.7–114.9 mmHg), and “Group 3” (9.1%) with the highest mean SBP value of 130 mmHg (95% CI 128.8–131.5 mmHg). It was observed that regardless of the weight gain trajectory group, women classified in the group with the highest SBP had the highest SBP levels. The probability of being classified in Group 3 was higher among women with higher education, who started pregnancy presenting obesity, and who were using antihypertensive drugs. ConclusionThe probability of belonging to groups with a greater trajectory of SBP during pregnancy was associated with obesity, education, and hypertension under treatment.

Awareness of Preeclampsia among Antenatal Clinic Attendees in Northwestern Nigeria.

Background Preeclampsia (PE) is among the five main causes of maternal mortality in low resource countries. This study was designed to assess PE awareness and its socioeconomic determinants among antenatal clinic attendees in northwestern Nigeria. Methods Two hundred twenty-one antenatal clinic attendees in northwestern Nigeria were selected through systematic random sampling for this quantitative study. Women who were 9 months pregnant and had consented to participate were included; those with chronic illnesses such as diabetes mellitus were excluded. Data on respondents' sociodemographic variables, and PE awareness were collected using a validated questionnaire. Associations between variables were tested using chi-square test and multiple regression analysis. Results Ninety-one percent of respondents were aged 20 to 40 years, 53.9% were multiparous, 27% had no or low level of formal education, and 52% had attended antenatal care (ANC) at least four times in the index pregnancy. Only 37% ( N = 83) were aware of PE. Women with formal education were 3.8 times more likely (odds ratio [OR] = 3.8, 95% confidence interval [CI] = 1.4-10.3) to be aware of PE compared with those with no formal education ( p < 0.05). Also, women who experienced hypertension in their previous pregnancies were 2.8 times more likely (OR = 2.8, 95% CI = 1.37-5.71) to be aware of PE than those women who had not ( p < 0.05). Conclusion There was a low level of PE awareness among pregnant women in this study; being formally educated and having had hypertension in a previous pregnancy were positively associated with PE awareness. PE education should be part of ANC.

High severity of abortion complications in fragile and conflict-affected settings: a cross-sectional study in two referral hospitals in sub-Saharan Africa (AMoCo study)

BackgroundAbortion-related complications are one of the five main causes of maternal mortality. However, research about abortion is very limited in fragile and conflict-affected settings. Our study aims to describe the magnitude and severity of abortion-related complications in two referral hospitals supported by Médecins Sans Frontières and located in such settings in northern Nigeria and Central African Republic (CAR).MethodsWe used a methodology similar to the World Health Organization (WHO) near-miss approach adapted in the WHO multi-country study on abortion (WHO-MCS-A). We conducted a cross-sectional study in the two hospitals providing comprehensive emergency obstetric care. We used prospective medical records’ reviews of women presenting with abortion-related complications between November 2019 and July 2021. We used descriptive analysis and categorized complications into four mutually exclusive categories of increasing severity.ResultsWe analyzed data from 520 and 548 women respectively in Nigerian and CAR hospitals. Abortion complications represented 4.2% (Nigerian hospital) and 19.9% (CAR hospital) of all pregnancy-related admissions. The severity of abortion complications was high: 103 (19.8%) and 34 (6.2%) women were classified as having severe maternal outcomes (near-miss cases and deaths), 245 (47.1%) and 244 (44.5%) potentially life-threatening, 39 (7.5%) and 93 (17.0%) moderate, and 133 (25.6%) and 177 (32.3%) mild complications, respectively in Nigerian and CAR hospitals. Severe bleeding/hemorrhage was the main type of complication in both settings (71.9% in the Nigerian hospital, 57.8% in the CAR hospital), followed by infection (18.7% in the Nigerian hospital, 27.0% in the CAR hospital). Among the 146 women (Nigerian hospital) and 231 women (CAR hospital) who did not report severe bleeding or hemorrhage before or during admission, anemia was more frequent in the Nigerian hospital (66.7%) compared to the CAR hospital (37.6%).ConclusionOur data suggests high severity of abortion-related complications in these two referral facilities of fragile and conflict-affected settings. Factors that could contribute to this high severity in these contexts include greater delays in accessing post-abortion care, decreased access to contraceptive and safe abortion care that result in increased unsafe abortions; as well as increased food insecurity leading to iron-deficiencies and chronic anaemia. The results highlight the need for better access to safe abortion care, contraception, and high quality postabortion care to prevent and manage complications of abortion in fragile and conflict-affected settings.

Shock-Associated Systemic Inflammation in Amniotic Fluid Embolism, Complicated by Clinical Death.

Amniotic fluid embolism (AFE) is one of the main causes of maternal mortality in developed countries. The most critical AFE variants may be considered from the perspective of systemic inflammation (SI), a general pathological process that includes high levels of systemic inflammatory response, neuroendocrine system distress, microthrombosis, and multiple organ dysfunction syndrome (MODS). This research work aimed to characterize the dynamics of super-acute SI using four clinical case studies of patients with critical AFE. In all the cases, we examined blood coagulation parameters, plasma levels of cortisol, troponin I, myoglobin, C-reactive protein, IL-6, IL-8, IL-10, and TNF-α, and calculated the integral scores. All four patients revealed the characteristic signs of SI, including increased cytokine, myoglobin, and troponin I levels, changes in blood cortisol, and clinical manifestations of coagulopathy and MODS. At the same time, the cytokine plasma levels can be characterized not only as hypercytokinemia, and not even as a "cytokine storm", but rather as a "cytokine catastrophe" (an increase of thousands and tens of thousands of times in proinflammatory cytokine levels). AFE pathogenesis involves rapid transition from the hyperergic shock phase, with its high levels of a systemic inflammatory response over to the hypoergic shock phase, characterized by the mismatch between low systemic inflammatory response values and the patient's critical condition. In contrast to septic shock, in AFE there is a much more rapid succession of SI phases. AFE is one of the most compelling examples for studying the dynamics of super-acute SI.

Sulfosalicylic acid to detect proteins in urine of pregnant women

Preeclampsia is one of the main causes of maternal mortality in the Department of Puno, this complication is a hypertensive disease of pregnancy, it is a public health problem worldwide, for this reason it is necessary to make a timely and preventive diagnosis.An alternative, for the confirmation of this disease, is the rapid detection of proteinuria, using sulfosalicylic acid, which, due to its predictive value, can be used in establishments that do not have personnel or laboratories to carry out clinical examinations.•It is an easy-to-use reagent that uses the urine of the pregnant woman.•Support for the diagnosis of preeclampsia in pregnancy•In addition, it is used to detect proteinuria in systemic diseases.

Severe preeclampsia superimposed on secondary and resistant hypertension associated with methamphetamine use

Introduction: Preeclampsia (PE) is one of the three main causes of maternal mortality. It is called superimposed PE when, in a pregnant patient with a history of primary or secondary chronic arterial hypertension, blood pressure increases and de novo proteinuria appears or worsens and/or biochemical data such as thrombocytopenia or increased liver enzymes are added. Chronic arterial hypertension predisposes patients to developing it, with a higher risk of complications and severity. Case presentation: Here, we present the case of a 25-year-old patient with a history of crystal, crack, and cocaine use for 7 years and a diagnosis of high blood pressure since she was 22 years old, who developed severe PE resistant to antihypertensive drugs. Conclusions: The reported case showed severe hypertension in pregnancy (defined as systolic blood pressure ≥160 mm Hg or diastolic blood pressure ≥110 mm Hg), which persisted because severe hypertension continued despite the designated treatment, which, considering the patient’s age, forced us to suspect secondary hypertension. The incidence of secondary hypertension in patients with superimposed PE is rare. According to the American Heart Association, it occurs in 10% of the cases and is associated with greater maternal and fetal complications. This should be suspected in women &lt;35 years of age with severe or resistant hypertension, without a family history of hypertension, or with biochemical parameters for hypokalemia, hyperazotemia, and albuminuria in the early stages of pregnancy.

Experience of extracorporeal membrane oxygenation in a laboring woman with severe preeclampsia

Introduction. Hypertensive disorders during pregnancy are one of the main causes of maternal mortality in the world. Both premature detachment of the normally located placenta, which led to massive bleeding on the background of placental insufficiency, according to the theory of placental ischemia, and disruption of compensatory mechanisms, leading to multiple organ failure, can lead to an unfavorable outcome. The pathogenesis of lung damage in preeclampsia is based on the activation of lipid peroxidation. Therefore, one of the components of complex therapy of severe lung damage may be the use of venovenous extracorporeal membrane oxygenation (ECMO), which is a method of extracorporeal support of gas exchange function in patients with life-threatening acute respiratory failure, accompanied by severe arterial hypoxemia and hypercapnia. The aim of the work is to demonstrate the possibility of using extracorporeal membrane oxygenation in the complex therapy of severe lung damage in a patient with multiple organ failure caused by severe preeclampsia. Materials and methods. A clinical observation of the nature of the course of multiple organ failure and lung damage in a laboring woman with severe preeclampsia is presented, her life history, diseases, diagnostic and treatment methods used are analyzed. Results and discussion. The described clinical case demonstrates the possibility of successful application of extracorporeal membrane oxygenation in combination with early renal replacement therapy, respiratory therapy and nutritional support in a patient with severe lung damage against the background of multiple organ failure caused by severe preeclampsia. Conclusion. It is necessary to use extracorporeal replacement techniques of vital functions replacement as early as possible in patients with severe lung damage against the background of multiple organ failure caused by severe preeclampsia.

What is already done by different societies in reduction of maternal mortality? Are they successful at all?

Maternal mortality represents a major issue for every health system, especially in developed countries that aim on creating protocols to retain a declining pattern. With the appropriate medical supplies and training, some of these countries have made a remarkable progress in preventing maternal morbidity and mortality. On the contrary, developing countries have still made little or even no progress. Identifying determinants and designing strategies is of great importance in order to overcome such difficulties. The aim of this study is to identify the main causes of maternal mortality in the different societies.

Effect of Labetalol for Treating Patients with Pregnancy-Induced Hypertension

Pregnancy-induced hypertension (PIH) is one of the main causes of maternal mortality. Many first- and second-line drugs are available to treat the condition. Labetalol lowers blood pressure by blocking both α and β adrenergic receptors. It preserves uteroplacental blood flow efficiently. A systemic review was carried out to find the efficacy and safety of labetalol in the treatment of PIH. Three thousand twenty-six studies were retrieved in 20 years. Finally, 28 studies were selected after applying the review criteria. Twenty-three studies detected that labetalol had superior or similar action compared to other drugs in controlling hypertension in patients with preeclampsia and eclampsia. The systematic review concluded that labetalol is a safe, effective, first-choice of drug with few side effects in treating PIH.

Factors Associated with the Use of Skilled Birth Attendants in Indonesia

The maternal mortality rate in Indonesia of 305/100,000 live births is still far from the SDGs target in the year 2030, which is 70/100,000 live births. The WHO states that the main causes of maternal mortality are bleeding, infection, preeclampsia-eclampsia, complications of childbirth, and unsafe abortion. This can be prevented if the mother can access health services, especially the use of skilled birth attendants to overcome complications of pregnancy and childbirth. This study aims to determine the factors associated with the use of skilled birth attendants in Indonesia. This cross-sectional study with a total sample of 4.543 women aged 15-49 years who gave birth to the last child selected in a sample of secondary data Indonesia Demographic Health Survey (IDHS) 2017. The dependent variable of the study was a skilled birth attendants and the independent variable was sociodemographic factors (age, education, employment, area of residence), antenatal factors (antenatal care examiner, antenatal place, antenatal frequency), medical factors (pregnancy complications and birth complications). The results of this study indicate that the dominant factor in the selection of skilled birth attendants is pregnancy examiners. Pregnancy examiners who examine the pregnancy by an obstetrician have the opportunity to choose a permanent delivery at an obstetrician, which is 8.33 (95% CI 6,75 – 10,29) times compared to choosing a midwife after being controlled by other variables.

The effectiveness of psycho-educational counseling in pregnant women with preeclampsia: A systematic review.

Pre-eclampsia is one of the main causes of maternal mortality, premature birth and low birth weight in developing countries. In addition, this condition can lead to chronic diseases (including cardiovascular and renal diseases) in postpartum mothers. The purpose of this study was to review the effectiveness of psycho-educational counseling in pregnant women with preeclampsia. The methods of this study were using PRISMA guidelines, databases from Scopus, PubMed and ScienceDirect, were published 2016 until 2020, yielded 65 articles. The keywords were retrieved from Medical Subject Heading (Mesh). The results showed interventions were given during the treatment period ranges from cognitive-behavioral counseling group that received four 1.5-h counseling sessions and the solution-focused counseling that received three 1.5-h counseling sessions, which were held weekly. This systematic review concludes that improving prenatal empowerment and self-care enable mothers to experience fewer complications in this period of their life. Thus, psycho-educational provides an excellent opportunity for educating and counseling pregnant women to promote maternal and neonatal health and psychological well-being.

Results of a Prospective Registry of Patients with Hypertensive Disorders of Pregnancy in a Center of the City of Buenos Aires

Background: Hypertensive disorders of pregnancy (HDP) complicate 10% of pregnancies. They are the main cause of maternal mortality and require a multidisciplinary team to address them. Objectives: The aim of this study was to quantify the prevalence and define the characteristics and outcome of HDP in a center with a program focused on its management. Methods: This was a continuous and prospective registry from November 2019 to July 2021 that included all patients with HDP [chronic hypertension (CHT), gestational hypertension (GHT), early-onset preeclampsia (EPE), late preeclampsia (LPE), superimposed preeclampsia (SIPE) and eclampsia] who met the inclusion criteria. Patients without medical coverage that prevented longterm outpatient follow-up at the institution were excluded. Baseline characteristics and evolution, treatment and persistent HTafter puerperium were evaluated. The incidence of intrauterine growth retardation (IUGR), preterm delivery, maternal mortality and neonatal death within the first 28 days of life was analyzed. Results: Among a total of 5825 deliveries/caesarean sections, 152 patients with GHT (37.5%), EPE (19.7%), LPE (38.8%), SIPE (3.3%), and eclampsia (0.6%) who met the inclusion criteria were included in the study. Mean age was 36.4±5.6 years. Aspirin was administered to 38.1% of patients. The most commonly used antihypertensive drugs were labetalol (65.8%) and enalapril (44.1%) during pregnancy and puerperium, respectively. There was no maternal mortality, and neonatal mortality was 3.6%. Persistent HT was 20.0%. Conclusion: Late preeclampsia was the most frequent HDP in the population analyzed. More than half of the patients who developed HDP did not receive preventive treatment with aspirin, showing a deficit in the identification of the population at risk. One in 5 HDP patients remained with CHT after puerperium.