Neonatal and Fetal Outcomes of Pregnant Mothers with Hypertensive Disorder of Pregnancy at Hospitals in Wolaita Zone, Southern Ethiopia

Document Type: Original Research Article

Authors

1 Assistant professor, Department of Anesthesia, Wolaita Sodo University, Wolaita Soddo, Ethiopia

2 MPH in public health, Department of Epidemology, Wolaita Sodo University, Wolaita Soddo, Ethiopia

3 MSc of Nursing, Department of Nursing, Wolaita Sodo University, Wolaita Soddo, Ethiopia

4 Assistant professor, Department of Gynecology and Obstetric, Wolaita Sodo University, Wolaita Soddo, Ethiopia

5 MSc in Anesthesia, Department of Anesthesia, Arsi University, Asella , Ethiopia

6 MSc in Anesthesia, Department of Anesthesia, Hawasa University, Hawassa, Ethiopia

7 MSc in Anesthesia, Department of Anesthesia, Addis Ababa University, Addis Ababa, Ethiopia

Abstract

Background & aim: Hypertensive disorders of pregnancy are among the severe medical disorders peculiar to pregnancy. It is one of the risk factors during pregnancy either for the mother or fetus or both. Therefore, this study aimed to assess fetal and neonatal outcomes of mothers with hypertensive disorders of Pregnancy.
Methods: This hospital-based cross-sectional study was conducted on neonates born from June 20 to November 20, 2014 at hospitals in Wolaita zone, Southern Ethiopia. The check lists of the study conducted on Prevalence of Hypertension and Complications of Hypertensive Disorders in Pregnancy in patients visiting in the Delivery Ward of Valiasr Hospital were used as base and then modified before being used in our study. Data were analysed using Epi Info (version 7) and SPSS (version 20). Bivariate and multivariate analyses were used to identify factors associated with perinatal outcomes. Analysis were used to identify factors associated with perinatal outcome.
Results: Preeclampsia and eclampsia can adversely affect the wellbeing of the fetuses and neonates. Nulliparous women were about five times more likely to develop unfavorable outcome in comparison with multiparous women (AOR 4.85; 95% CI: 0.064-12.442).
Conclusion: Hypertensive disorder of pregnancy is associated with the increased risk of adverse fetal and neonatal outcome. Therefore, it is of utmost importance to have timely diagnosis and appropriate care.

Keywords

Main Subjects


Introduction


Hypertensive disorder of pregnancy is a very severe medical disorder associated with high blood pressure (1). Normal blood pressure in pregnant women reduces at the beginning of pregnancy up to 20 weeks of gestation, and then slowly increases  until the time of delivery (2-3).

The study conducted in Geneva, in 2008, on high blood pressure in pregnancy showed that 5-8% of all pregnancies are complicated by hypertension. The most common risk of hypertension is preeclampsia. Hypertensive disorder in pregnancy is higher in primigravida mothers. However, hypertension is mostly associated with long standing essential hypertension or chronic renal failure in multipara. If all causes of hypertension are considered in pregnancies, preeclampsia accounts for 80%, essential hypertension 18%, renal disease 1.9%, and eclampsia 0.1% of them (4).

The prevalence of preeclampsia is usually after 20 weeks of gestation with hypertension and proteinuria (5). It is primarily a disorder of primigravida; however, multigravida pregnant women with a new partner have prominent risk of preeclampsia (6-7). Pregnancy-induced hypertension (PIH) is one of the risk factors during pregnancy either for the mother or fetus or both. The risk factors entail intrauterine fetal death, still birth, preterm baby, maternal death, and seizure (8-10). Additionally, the long-term sequel of women with a history of PIH includes greater risks of cerebrovascular disease, ischemic heart disease, and renal disease (11-13).

Therefore, it is very important to assess fetal and neonatal outcome of pregnant mothers in order to devise different strategies to reduce fetal and neonatal morbidity and mortality.

 

Materials and Methods

This hospital-based cross-sectional study was conducted on all fetuses and newborns of pregnant mothers with hypertensive disorder of Pregnancy referring to hospitals in Wolaita Zone, Southern Ethiopia, from June 20 to November 20, 2014.The administrative center of Wolaita Zone is Wolaita Soddo situated at 334 Km far from Addis Ababa along the main highway passes through Arbaminch to Hosanna. There are three functional hospital zones, including one governmental hospital and the two private ones.

Wolaita Soddo Hospital (WSTRH) is the governmental hospital located in the eastern part of municipality, approximately 2km from the centre of the town. It was established in 1920 E.C. The hospital serves about three million people with a very wide catchments area of about 250km radius. This hospital has 150 beds and2 operational theatres There are four major departments, including obstetrics and genecology, pediatrics, internal medicine, and surgery, as well as four minor department, including psychiatry, ophthalmology, dentistry. Moreover, there are follow–up clinics for chronic illness, such as tuberculosis, HIV, diabetes mellitus. The main diagnostic modalities in the hospital are routine laboratory investigation, radiological service, genecology and obstetrics clinic, where pregnant women are having follow-up.

The study was performed after obtaining research the consent of all mothers. The check lists of the study conducted on Prevalence
of Hypertension and Complications of Hypertensive Disorders in Pregnancy in patients visiting in the Delivery Ward of Valiasr Hospital were used as base and then modified before being used in our study. Data collectors and supervisors were seven diploma holder and three bachelor holders in nursing, respectively. The data was analyzed through Epi Info (version 7) and statistical SPSS software (version 20). Binary Logistic regression was used to see the impact of pregnancy induced hypertension on fetal and neonatal outcome. P

The inclusion criteria of study for mother were very critically ill status, refusal to give consents, admission to receive care.  

After the approval of proposal, a letter of support and permission was obtained from Research Ethical Review Committee of Wolaita Soddo University. The permission was obtained from the hospitals. The purpose of study was described to the participants. The obtained information was kept confidential.

 

Results

Demographic information of the neonates

Out of 225 fetuses, 62.7% (n=141) of the cases were male. The 72% of neonates were born within 37-42 weeks of gestation. There was also no case of post-term neonates. Concerning Apgar score of the newborn babies, the Apgar score of 30.7% and 43.5 % of the newborns were lower than 3andgreater than 6, respectively. Moreover, 25.8% of the neonates had the Apgar score of 3-6 at birth (Table 1).

 

Neonatal and fetal outcome

According to Table 2, 42.2% (n=95) of fetuses were without any complication. However, 25.8% (n=58) of them had in trauterine growth restriction. In addition, intrauterine fetal death occurred in 8.89% (n=20) of the cases.

 

Determinants of fetal and neonatal outcome

The obtained data of multivariate analysis revealed that the age range of 20-24 years, parity, type of HDP, and high blood pressure were strongly associated with unfavorable fetal and neonatal outcome (P<0.05).In addition ANC follow up was not associated (P>0.05) As can be seen in Table 3, nulliparous women were about 5 times more likely to develop unfavorable outcome in comparison with multiparous women (AOR 4.85; 95% CI: 0.064-12.442). The odd of having unfavorable outcome in preterm was 5.126 (0.033-16.94), the odd of having unfavorable outcome in eclampsia was 6.129 (0.024-22.147) and the odd of
having unfavorable outcome among blood hypertension of greater than was 160/110 mm Hg was 5.266 (0.134-25.45)

 

                

                 Table 1. Demographic characteristics of pregnant mothers with hypertensive disorder of pregnancy

Personal characteristics

Category

Frequency

Percentage (%)

Sex

Male

141

62.70

Female

84

37.30

Gestational age

Term

162

72.00

Preterm

63

28.00

Birth weight

Macrocosmic

4

1.80

Normal

156

69.3

Low birth weight

61

27.10

Very low birth weight

4

1.80

Apgar score

Seven to ten

69

30.70

Three to six

98

43.55

Less than three

58

25.75

 

                Table 2. Fetal and neonatal outcome of pregnant mothers with hypertensive disorder of pregnancy

Neonatal and fetal outcome

Category

Frequency

Percentage

Normal

95

42.22

IUFD

20

8.89

IUGR

58

25.78

Still birth

18

8.00

Fetal asphyxia

12

5.33

Meconium aspiration

14

6.22

ENND

8

3.56

                IUFD: intrauterine fetal death; IUGR: intrauterine growth restriction; ENND: early neonatal death

 

                Table 3. Determinants of fetal outcome of pregnant mothers with hypertensive disorder of pregnancy

Variable

Category

P-value

AOR (95% C.I.)

Unfavorable

favorable

Age of mother in year

   20-24

18

10

0.04

3.478 (0.034-18.72)

   25-29

34

78

0.86

1.243 (0.026-37.62)

   30-34

31

34

0.001

1.142 (0.034-18.72)

   35-39

12

8

*

*

Gestational age

   Term

75

87

*

*

   Preterm

20

43

0.047

5.126 (0.033-16.94)

Parity

   Nulliparous

67

28

0.02

4.85 (0.064-12.442)

   Multiparous

28

102

*

*

Blood pressure

   140/90-159/109 mm Hg

50

82

*

*

   >160/110 mm Hg

45

48

0.03

5.266 (0.134-25.45)

Type of HDP

   PIH

4

1

*

*

   Preeclampsia

43

121

0.014

3.784 (0.014-12.182)

   Eclampsia

48

8

0.06

6.129 (0.024-22.147)

ANC follow Up

   Yes

75

116

*

*

   No

20

14

0.679

5.6570 (0.032-11.286)

 

Discussion

 

The prevalence of PIH can cause multiple complications in the mother and baby. It is associated with increased risks of serious outcomes, such as premature delivery, intrauterine growth restriction, perinatal mortality and morbidity, acute renal failure, acute hepatic failure, bleeding at the time of delivery and postpartum bleeding, maternal mortality, and morbidity (14-17). The hazards of these outcomes depend on the severity of hypertension, gestational age at the onset of hypertension, and gestational age at the time of delivery (18-19).

Likewise other studies, it was found that hypertensive disorder in pregnancy was related to significant perinatal morbidity and mortality (20-21). Moreover, it was revealed in the current study that the most common manifestation of hypertensive disorder in pregnancy was preeclampsia, followed by eclampsia, which was consistent with the findings of other similar studies (18-19, 22).

In this study, it was also found that poor fetal and neonatal outcomes were respectively six and four times higher in severe preeclampsia and eclampsia than in gestational hypertension. Likewise, the findings of another study(22) indicated that pregnant mothers who had preeclampsia and eclampsia were more likely to develop unfavorable outcome, compared to mothers without preeclampsia and eclampsia, which can be due to very high blood pressure. This means that high blood pressure reduces low normal uteroplacental blood flow, which can affect the well-being of fetuses.

According to the findings of the current study, preterm delivery had unfavorable outcomes, compared to term delivery. Consistently, another study suggested that  preterm delivery was the most important determinant of neonatal morbidity and mortality in developed countries (23-24). This might be due to the significant immaturity of fetal system, which causes failure to adaptation of intrauterine or extra uterine life. In addition, this may be a result
of pregnancy complications or pre-existing maternal medical conditions that can cause an increased risk of morbidity and mortality in neonates (25-27).

The main limitation of this study was that arterial blood gas analysis was not included in the study to determine fetal acidosis. Therefore, we use Apgar score as a best indicator of fetal asphyxia. Apgar score can indicate the degree of birth asphyxia even in the presence of arterial blood gas analysis.

 

Conclusion

Hypertensive disorder of pregnancy is associated with the increased risk of perinatal adverse effects. As a result, early diagnosis and appropriate supervisions are very important.

 

Acknowledgements

This study was conducted under the financial support of Wolaita Soddo University.

We would like to thank Wolaita Soddo University for material support. We also appreciate the help of all research participants for providing a high response rate.

 

Conflicts of interest

Authors declare no conflicts of interest.

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