Perinatal Outcome in Women with Hypertensive Disorders of Pregnancy: A Retrospective Cohort Study

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. Methods. A retrospective cohort study design was used to include 1015 hypertensive pregnant women who gave birth to 1110 babies between 2008 and 2013 in three university teaching hospitals. Bivariate and multivariate regression models were used to estimate the associations between selected predictor variables and perinatal mortality taking the onset of HDP illness to death or discharge from the hospital as the time period. Results. There were 322 perinatal deaths resulting in a perinatal mortality rate (PMR) of 290/1000 total births. The proportion of stillbirths was more than 4-fold higher than early neonatal deaths (81% versus 19%). The multivariate analysis demonstrated that multiparity (OR, 1.6; 95% CI, 1.12-228), grand multiparity (OR, 2.8; 95% CI, 1.55-4.92), preterm (OR, 1.5; 95% CI, 1.02-2.35) and very preterm gestational age (OR, 7.7; 95% CI, 5.26-11.20), lack of antenatal care (OR, 2.0; 95% CI, 1.43-2.67), having eclampsia (OR, 4.1; 95% CI, 2.85-6.04), antepartum or before (OR, 6.6; 95% CI, 3.40-12.75) and intrapartum onset of HDP (OR, 4.0; 95% CI, 1.99-8.04), raised SGOT level (OR, 2.3; 95% CI, 1.30-3.91), vaginal delivery (OR, 5.3; 95% CI, 2.93-9.54), low fetal birth weight (OR, 4.3; 95% CI, 2.56-7.23), and maternal death (OR, 12.8; 95% CI, 2.99-54.49) were independent predictors of perinatal mortality. Conclusion. This study showed that the PMR of HDP was among the highest in the world. Parity, gestational age, type and onset of HDP, mode of delivery, birthweight, and maternal outcome were strong predictors of perinatal mortality.