Perinatal outcomes of hypertensive disorders in pregnancy at a referral hospital, Southern Ethiopia
Perinatal outcomes of hypertensive disorders in pregnancy at a referral hospital, Southern Ethiopia
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DOI：
10.1371/journal.pone.0213240
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发表时间：
2019-02-28
期刊：
影响因子：
3.7
通讯作者：
Demissie, Birhanu Wondimeneh
中科院分区：
文献类型：
--
作者：
Asseffa, Netsanet Abera;Demissie, Birhanu Wondimeneh
妊娠期高血压疾病(HDP)导致约10%的妊娠并发症。它占撒哈拉以南非洲孕产妇死亡的50%，先于全世界15%的围产儿死亡。在这项研究中，我们在埃塞俄比亚南部的Wolaita Sodo教学和转诊医院观察了妊娠期高血压疾病妇女的围产期结局和与不良围产期结局相关的因素。方法采用基于医院的回顾性横断面研究设计。从患者记录中检查社会人口学、产科、临床实验室、妊娠并发症和结局。描述性统计用于描述从患者记录中收集的参数。采用双因素和多因素Logistic回归分析来确定与不良围产儿结局相关的因素。P值小于0.05和95%可信区间不包括1被认为具有统计学意义。结果在2014年1月至2016年12月的研究期间，在7347例分娩中，有168例(2.3%)HDP。72.5%的产妇(72.5%)经阴道分娩，26.1%的产妇剖宫产。这项研究显示，围产期死亡率为每千名活产儿中有111.1人死亡。在双变量Logistic回归分析中，转诊状态、舒张压、ANC使用、HDP类型、出生时体重、母体并发症和母体结局等变量与不良围产儿结局相关。多因素Logistic回归分析发现，出生时胎儿体重和母体结局是围产儿预后不良的独立预测因素。结论本研究表明，在设有产科和新生儿急救服务并期望获得优质产科护理的三级医院，围产儿死亡率较高。然而，三级设施管理的疑难病例可以解释PMR高的原因。但这一比例很高，这意味着还有足够的提升空间。因此，转诊医院和邻近的卫生机构应对妇女HDP的早期发现和治疗给予应有的重视。
IntroductionHypertensive Disorders in Pregnancy (HDP) complicate about 10% of pregnancies. It accounts to 50% of maternal death in sub-Saharan Africa and precedes 15% of perinatal deaths worldwide. In this study, we looked at the perinatal outcomes and factors associated with unfavorable perinatal outcomes among women with hypertensive disorders in pregnancy at Wolaita Sodo teaching and referral hospital, southern Ethiopia.MethodsA hospital based retrospective cross-sectional study design was employed among women hospitalized for hypertensive disorders in pregnancy. Socio-demographic, obstetrics, clinical laboratory, pregnancy complications and outcome were checked from patient records. Descriptive statistics were used to describe parameters collected from patient records. Bivariate and multiple logistic regressions were done to determine factors associated with unfavorable perinatal outcome. A P-value of less than 0.05 and 95% confidence interval not including 1 were considered statically significant.ResultsThere were 168 (2.3%) cases of HDP of the total 7, 347 deliveries during the period of the study from January 2014-December 2016. 72.5% of mothers (72.5%) had vaginal delivery and 26.1% had Caesarean Section. This study revealed a perinatal mortality rate of 111.1 per 1000 live births. On bivariate logistic regression variables such as referral status, diastolic blood pressure, ANC use, types of HDP, fetal weight at birth, maternal complication and maternal outcome were found to be associated with unfavorable perinatal outcomes. On multiple logistic regression fetal weight at birth and maternal outcome were found to be an independent predictors of unfavorable perinatal outcome.ConclusionOur study shows higher perinatal mortality in a tertiary hospital where emergency obstetric and newborn care is set and quality obstetric care is expected. However, tertiary facilities manage difficult cases which can explain the high PMR. But it is high which means there is enough room for improvement. Hence, the referral hospital and neighboring health facilities should give due emphasis for early detection and management of women with HDP.