Maternal and perinatal outcomes of pregnant women admitted with hypertension in Mulago Hospital, Uganda

Abstract

Back ground Hypertensive disorders are major complications of pregnancy with an increased incidence in developing countries. They are responsible for adverse maternal outcomes such as altered mode of delivery, abnormal blood loss and poor general maternal condition. Adverse perinatal outcomes attributed to hypertension include, low Apgar score, low birth weight, preterm births and neonatal deaths. Maternal and perinatal outcomes may depend on type and severity of hypertensive disorders of pregnancy (HDP). Objectives of the study To describe maternal and perinatal outcomes of pregnant women admitted with hypertension in Mulago hospital. Materials and methods A hospital based prospective cohort study was conducted in May-July 2013 among 110 hypertensive pregnant women admitted in general labour ward. Data was collected at recruitment, 4 to 6 hours after and within 24 hours after delivery using a semi-structured questionnaire. It was through review of clinical records, interviewing women and examining their blood pressures and urinary protein. Results Majority (86%) of women were 18-34 years. More than half started attending Antenatal Care (ANC) clinics ≤ 20 weeks of gestation and 49 % attended ≥ 4 times. Twenty seven (25%) had hypertension alone (chronic & gestational), 67 (61%) pre-eclampsia, 7 (6.4%) pre-eclampsia superimposed on chronic hypertension (CHT), 2 (2%) pre-eclampsia with HELLP syndrome and 7 (6.4%) developed eclampsia. Good and adverse maternal outcomes were registered in this study. Higher proportions (78%) of vaginal deliveries occurred to women with hypertension alone. Higher rates of (C/S) (57%) and PPH (29%) were both registered in women with pre-eclampsia superimposed on CHT. Majority (57%) of women with eclampsia had major complaints of severe headache, blurring of vision and dizziness. When outcomes of women with and without pre-eclampsia/eclampsia were compared, 43% of women with pre-eclampsia/ eclampsia were more likely to deliver by C/S compared to 30% without (OR, 3.35; 95% CI, 1.39-8.04: p= 0.01) and 19% had major complaints compared to 15% without (OR, 6.70; 95% CI, 1.61-27.78) p=0.01. About the perinatal outcomes, women with pre/eclampsia/eclampsia had higher rates of low birth weight and preterm delivery compared to those with hypertension alone. However the difference was not statistically significant. Conclusion Both good and adverse pregnancy outcomes occur with all categories of HDP. Women with pre-eclampsia /eclampsia were more likely to deliver by C/S and to have major complaints. Although pre-eclampsia and eclampsia are associated with adverse pregnancy outcomes, the difference between perinatal outcomes of hypertension with and without pre-eclampsia/eclampsia was not statistically significant. This probably suggests that adverse outcomes may be determined by hypertension other than pre-eclampsia/eclampsia.