Perinatal Outcomes of Pregnancies Complicated by Hypertensive Disorders of Pregnancy in Late Preterm in three Teaching Hospitals in Addis Ababa, Ethiopia
No Thumbnail Available
Date
2021-09
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Addis Abeba University
Abstract
Background: Hypertensive disorders of pregnancy (HDP) are multisystem diseases known to
increase the risk of perinatal mortality worldwide, with a significant proportion of these deaths
occurring in low income countries. However, little is known about the obstetric and treatment
predictors of perinatal mortality in women with HDP. Until now, only few studies focused on the
management of women with hypertensive disorders between 34 0/7 and 36 6/7 weeks of
gestational age in Ethiopia.
General objective: To investigate the perinatal outcomes of late preterm pregnancies
complicated by hypertensive disorders in low resource settings
Methods: Hospital based cross sectional descriptive study was conducted on 274 newborns
delivered from December 15, 2020 to June 15, 2021 at the three teaching hospitals. Structured
and pretested questionnaire were used to collect socio-demographic data and medical records
were reviewed. Neonatal status was checked every other day through phone call till 7 days after
delivery date. Descriptive statistics were used to describe parameters collected from the files.
Bivariate and multiple logistic regressions were done to determine factors associated with
unfavorable perinatal outcome. A P-value of less than 0.05 was considered statistically
significant.
Result: Among 10,129 deliveries during the study period, 952 (9.4%) were preterm. Of these
preterm deliveries 680 were late preterm and 274 neonates fulfill the inclusion criteria and
analyzed. About 83(30.3%) neonates were delivered 34+0-34+6 weeks, 45 (16.4%) at 35+035+6
weeks
and
the
majority
146 (53.3%) at 36+0-36+6 weeks. Cesarean section was the most
common mode of delivery 191 (69.7%) followed by SVD, 74 (27%) and 6 (2.2%) by AVD.
About 173 (63.1%) newborns were LBW (1500-2499 grams), 76 (27.8%) were NBW and the
remaining 25(9.1%) were VLBW. Fifty eight (21.5%) of neonates need resuscitations at
delivery. Hundred forty eight (55.2%) of these neonates were referred to NICU and 102 (68.9%)
of them required NICU admission. On day seven neonatal assessment the cumulative survival
was 93.7%. The survival rate of late preterm neonates is 87.7%, 90.9% and 97.9% at 34, 35, and
36 weeks respectively. The perinatal mortality rate in late preterm pregnancy in hypertensive
disorders of pregnancy in this study was 76.6/1000 live births. Over half, 9/17 (52.9%) of
neonatal deaths occurs within the first 48 hours while majority (76.5%) of neonatal deaths occurs
with in the first 3 days. In this study one fourth (25.9%) of women had at list one maternal
complication. Fetal weight at birth, gestational age during delivery and Apgar score at delivery
found to be independent predictors of perinatal survival.
Conclusion and Recommendation: During the study period the rate of late preterm birth was
71.4%. This study shows preeclampsia as the most common cause for late preterm birth (84.7%)
from hypertensive disorders of pregnancy. Late preterm neonates are at higher risk for neonatal
morbidities and mortality contrary to the belief that they are nearly mature. Neonatal birth weight
and Apgar score during delivery were the important predictors for the neonatal survival. Critical
attention should be paid on the first 72 hours of newborn life to reduce factors contributing to
high neonatal loss at this particular time.
Description
Keywords
Pregnancies,Complicated, Hypertensive disorders