Perinatal mortality in mothers with hypertension in pregnancy admitted at Pumwani maternity hospital, Nairobi County, Kenya

Abstract

Background: Hypertension is the most common medical complication in pregnancy and complicates 6-9% of pregnancies globally. It is associated with an increased risk of maternal and perinatal morbidity and mortality. Research question: What are the determinants of perinatal morbidity and mortality among women admitted with hypertension in pregnancy at PMH? Objectives: To document perinatal morbidity and mortality in women with hypertension in pregnancy (HIP) and determine risk factors for adverse perinatal outcomes in these women. Methods: This was a descriptive cross-sectional study carried out in PMH on women with HIP. Ethical approval was granted from MOI-MTRH IREC and permission granted by the Hospital Research Board. One hundred and fifty seven (157) women were consecutively recruited between November 2011 and May 2012. Data was collected using a structured data abstraction form. The perinatal outcome was recorded during a scheduled postnatal visit, a home visit or through a follow-up phone call to the women. Data was analyzed using IBM SPSS V 19.0. Descriptive statistics were means and frequencies. A Chi-square test was performed on categorical variables and univariate logistic regression performed for continuous variables. A regression model was then developed to identify factors predictive of the perinatal outcomes. A p-value of < 0.05 was significant. Results: The perinatal mortality rate in women with hypertension in pregnancy was 203 per 1000 births. The incidence of hypertension in pregnancy was 287 per 10000 pregnancies. Half (74) of the neonates were born premature and 71 (47.97%) had low birth weight (weight <2500g). Small for gestational age (SGA) was prevalent in 58 (39.19%). Pre-eclampsia 74 (50.02%) and unclassified hypertension (38.5%) were the most prevalent hypertensive states. Women who were married or had attained post-primary education had better perinatal outcomes, (p values <0.05). A low fifth-minute APGAR score, prematurity at the time of birth, low birth weight, exposure to magnesium sulphate, severe maternal hypertension, presence of labour at admission, pre-eclampsia, proteinuria of more than 2+ on dipstick, a previous pregnancy loss and high parity were associated with increased risk of perinatal mortality, (P values < 0.05). Conclusion/Recommendations: Hypertension in pregnancy is associated with a high perinatal mortality rate. It is associated with a high rate of prematurity, birth asphyxia and small for gestational age. A low fifth-minute APGAR score, prematurity at time of birth, low birth weight, magnesium sulphate exposure, severe maternal hypertension, presence of labour at admission, pre-eclampsia, dipstick proteinuria >2+, previous pregnancy loss and high parity were identified as risk factors for perinatal mortality. Timely management of pre-term labour followed by appropriate care of premature neonates, proper monitoring during labour and the timely management of severe HIP in PMH are recommended. Clinicians need training on materno-fetal surveillance and timely use of corticosteroids in women with HIP. Studies to evaluate the effect of appropriate use of MgSO4 and the effect of fetal exposure on the perinatal outcome are recommended