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