Severe preeclampsia and eclampsia: incidence, complications, and perinatal outcomes at a low-resource setting, Mpilo Central Hospital, Bulawayo, Zimbabwe

Abstract

BackgroundSevere preeclampsia is a disorder of pregnancy characterized by high blood pressure and significant proteinuria after 20 weeks gestation. Severe preeclampsia and eclampsia have considerable adverse impacts on maternal, fetal, and neonatal health especially in low-resource countries. Hypertensive disorders of pregnancy are the third leading cause of maternal deaths in Sub-Saharan Africa. Significant avoidable maternal and neonatal morbidity and mortality may result.ObjectivesThis study aimed 1) to determine the incidence of severe preeclampsia/eclampsia in a low-resource setting; 2) to determine the maternal complications of severe preeclampsia/eclampsia in a low-resource setting; 3) to determine the perinatal outcomes of severe preeclampsia/eclampsia in a low-resource setting.MethodsThis was a retrospective descriptive cohort study carried out at Mpilo Central Hospital, a tertiary teaching referral government hospital in a low-resource setting in Bulawayo, Zimbabwe. Data were obtained from the birth registers in labor ward, intensive care unit, and neonatal intensive care unit of patients who had a diagnosis of severe preeclampsia or eclampsia for the period January 1, 2016, to December 31, 2016. The case notes were retrieved and the demographic, clinical, and outcome data were gathered.ResultsThere were 9,086 deliveries at the institution during the period January 1, 2016, to December 31, 2016. There were 121 cases of severe preeclampsia/eclampsia. The incidence of severe preeclampsia/eclampsia was 1.3% at Mpilo Central Hospital. The most common major complication was HELLP syndrome (9.1%). Maternal mortality was 1.7%. There were 127 babies born with six sets of twins, 49.6% of the babies were lost through stillbirths and early neonatal deaths.ConclusionThe incidence of severe preeclampsia/eclampsia at Mpilo Central Hospital was 1.3%. The most common maternal complication was hemolysis elevated liver enzymes low platelet syndrome. Maternal mortality was 1.7% due to acute renal failure. Nearly half (49.6%) of the babies born were lost to stillbirths and early neonatal deaths.

A Prospective Study of Maternal and Neonatal Outcome in Women with Preeclampsia

“…The rate of still births and neonatal mortality was also found to be more in preeclampsia group than in healthy women. Similar findings were reported by the authors like HC Backes et al and S Ngwenya et al 19,20 .…”

Maternal and Perinatal Complications of Severe Preeclampsia

“…[9] 72.9% belonged to rural area as in Mohammad Ahadi et al (2015). [10] Most of them were booked case (70.6%) as in Ngwenya et al(2017). [11] Among clinical characteristics most were term pregnancies (57.9%), which is in accordance with Ngowa et al (2015) [9] and 41.9% were nullipara as in Mohammad Ahadi et al (2015).…”

“…Eclampsia was seen in 6% and abruptio placentae in 6.8%, as in Nankali et al (2013). [12] Caesarean section was the most common mode of termination of pregnancy, which correlates with Ngwenya et al (2017). [11] Still birth was seen in 26.7%, IUGR in 9.0% and low APGAR score in 26.7% which was in concordance with Ngowa et al(2015).…”

“…[12] Caesarean section was the most common mode of termination of pregnancy, which correlates with Ngwenya et al (2017). [11] Still birth was seen in 26.7%, IUGR in 9.0% and low APGAR score in 26.7% which was in concordance with Ngowa et al(2015). [9] Prematurity was seen in 65.5% and NICU referral in 54.7% cases, as in Ngwenya et al (2017).…”

Assessing multidimensional care coverage for pre‐eclampsia in the era of universal health coverage: A pre–post evaluation of the Salud Mesoamérica Initiative

“…To our knowledge, this is the first multinational study in Central America that assesses multidimensional care coverage of pre‐eclampsia/eclampsia management in health facilities. A few studies exist that examine quality‐improvement bundles for pre‐eclampsia/eclampsia patients in sub‐Saharan Africa, and indirectly monitor multidimensional care for pre‐eclampsia within a single country in Central America On a broader level, literature also exists for low‐income countries on the practice of magnesium sulfate use alone and adverse outcomes of hypertensive disorders . Thus, this study adds value in characterizing current coverage and performance of multidimensional care for pre‐eclampsia/eclampsia treatment specific to Central American health facilities.…”