Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, Mbarara, Uganda.
Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
PLoS One. 2020 Oct 28;15(10):e0241207. doi: 10.1371/journal.pone.0241207. eCollection 2020.
Hypertensive disorders of pregnancy (HDP) are a leading cause of global perinatal (fetal and neonatal) and maternal morbidity and mortality. We sought to describe HDP and determine the magnitude and risk factors for adverse perinatal and maternal outcomes among women with HDP in southwestern Uganda.
We prospectively enrolled pregnant women admitted for delivery and diagnosed with HDP at a tertiary referral hospital in southwestern Uganda from January 2019 to November 2019, excluding women with pre-existing hypertension. The participants were observed and adverse perinatal and maternal outcomes were documented. We used multivariable logistic regression models to determine independent risk factors associated with adverse perinatal and maternal outcomes.
A total of 103 pregnant women with a new-onset HDP were enrolled. Almost all women, 93.2% (n = 96) had either pre-eclampsia with severe features or eclampsia. The majority, 58% (n = 60) of the participants had an adverse perinatal outcome (36.9% admitted to the neonatal intensive care unit (ICU), 20.3% stillbirths, and 1.1% neonatal deaths). Fewer participants, 19.4% (n = 20) had an adverse maternal outcome HELLP syndrome (7.8%), ICU admission (3%), and postpartum hemorrhage (3%). In adjusted analyses, gestational age of < 34 weeks at delivery and birth weight <2.5kg were independent risk factors for adverse perinatal outcomes while referral from another health facility and eclampsia were independent risk factors for adverse maternal outcomes.
Among women with HDP at our institution, majority had preeclampsia with severe symptoms or eclampsia and an unacceptably high rate of adverse perinatal and maternal outcomes; over a fifth of the mothers experiencing stillbirth. This calls for improved antenatal surveillance of women with HDP and in particular improved neonatal and maternal critical care expertise at delivering facilities. Earlier detection and referral, as well as improvement in initial management at lower level health units and on arrival at the referral site is imperative.
妊娠高血压疾病（HDP）是全球围产期（胎儿和新生儿）和孕产妇发病率和死亡率的主要原因。我们旨在描述 HDP，并确定在乌干达西南部患有 HDP 的妇女中不良围产儿和孕产妇结局的程度和危险因素。
我们前瞻性纳入了 2019 年 1 月至 2019 年 11 月在乌干达西南部一家三级转诊医院分娩并诊断为 HDP 的孕妇，不包括患有既往高血压的孕妇。观察参与者并记录不良围产儿和孕产妇结局。我们使用多变量逻辑回归模型来确定与不良围产儿和孕产妇结局相关的独立危险因素。
共纳入 103 例新发 HDP 孕妇。几乎所有女性（93.2%，n=96）均患有重度子痫前期或子痫。大多数（58%，n=60）参与者存在不良围产儿结局（36.9%入住新生儿重症监护病房（NICU），20.3%死胎，1.1%新生儿死亡）。较少的参与者（19.4%，n=20）出现不良孕产妇结局（HELLP 综合征 7.8%，入住 ICU 3%，产后出血 3%）。在调整分析中，分娩时<34 周的孕龄和<2.5kg 的出生体重是不良围产儿结局的独立危险因素，而来自另一家医疗机构的转诊和子痫是不良孕产妇结局的独立危险因素。
在我们的机构中，患有 HDP 的女性中，大多数患有重度子痫前期或子痫，且不良围产儿和孕产妇结局发生率高；超过五分之一的母亲经历死胎。这需要加强对 HDP 妇女的产前监测，特别是在分娩机构提高新生儿和孕产妇重症护理专业知识。早期发现和转诊，以及改善基层卫生单位的初始管理并在转诊时加强管理至关重要。
