Intensive Care Management and Outcome of Women with Hypertensive Diseases of Pregnancy at a tertiary Care Hospital in Mogadishu, Somalia.

Abstract

Hypertensive diseases of pregnancy remains severe disease burden in developing countries and is associated with increased morbidity and mortality for both mother and the baby. This study highlights the level of morbidity and mortality associated with hypertensive pregnant mothers admitted to intensive care unit. Methods: - This retrospective study was conducted in Mogadishu Somali Turkish Training and Research Hospital from February 2019 to July 2022. The study focused on the different complications, managements and final outcomes of hypertensive pregnant mothers admitted to the Intensive care unit. Results: The mean age of studied patients was 25 ± 8years. Considering the comorbidities, 38 out of 71 patients had comorbid conditions, including a previous history of gestational hypertension 26(36.6%), a history of previous pre-eclampsia 8 (11.2%) and history of diabetics 4(5.6%). The most common reason for being taken to the intensive care unit (ICU) was having a seizure (n = 33, 46.5%), followed by having very high blood pressure (n = 20, 28.2%), and being confused (n = 18, 25.3%). Regarding the clinical characteristics of these patients, those in their 3rd trimester were the most common among them. The majority of patients, on the other hand, were primigravida (n = 53, 74.6%), and nulliparous (n = 50, 70%). Infection was the most common maternal complication during ICU admission (66.7%), followed by cardiac-related arrhythmia (66.7%), bleeding (48%), acute renal failure (18.4%), HEELP syndrome (16.4%), severe anemia (9.6%), and stroke (8.7%). Despite the fact that less than 10% of patients had severe anemia necessitating transfusion during admission, 51 (71.8%) received a transfusion for other reasons, such as severe bleeding or dialysis. 10 (14.1%) needed hemodialysis due to acute renal failure. On the other hand, 65 (91.5%) needed mechanical ventilation. For the delivery, 70 (99%) had a cesarean section, while 1 (1%) had a vaginal delivery. Out of those who had a cesarean section, 75.7% had it under general anesthesia, while the remainder (24.3%) had it under spinal anesthesia. Unfortunately, 11.1% of these patients died, and 88.9% were discharged. There were associations between mortality and some complications, especially acute renal failure (p-value less than 0.02) and infection (p-value less than 0.003). Conclusion: A hypertensive women hospitalized to an intensive care unit (ICU) have high morbidity and mortality rates. For a subsequent sizable multi-central investigation, these data serve as the foundational research.