Hypertensive disorders in pregnancy at Pietersburg Tertiary Hospital in Limpopo Province, South Africa

Abstract

Background: Rates of maternal hypertensive disorders during pregnancy are increasing among women in South Africa. However, overall prevalence of complications, demographic characteristics, and subtypes of hypertension in pregnancy are still unknown at Pietersburg Hospital. Objectives: To determine the prevalence of hypertensive disorders in pregnancy in the Department of Obstetrics and Gynaecology at Pietersburg Hospital, Limpopo Province. Method: A retrospective descriptive study was conducted to examine the medical files of patients who were admitted with hypertensive disorders in pregnancy and also singleton deliveries over a six-month period. The researcher also reviewed medical archives of mothers to find the perinatal outcome indicators of interest for the study. A pre-tested structured questionnaire was used to capture data. Data was then analysed using the Statistical Package for Social Sciences (v-28) through descriptive statistics (percentages, mean, and standard deviations [±SD]). A probability value (p) of ≤ 0.05 was a criterion for significance among variables. Results: The mean age for hypertensive pregnant women presenting with preeclampsia was 26.01 (±7.13) years, of whom 15.8% had singleton deliveries. Preeclampsia is the most common subtype of hypertensive disorder (63.4%), followed by gestational hypertension (15.0%), chronic hypertension (7.3%), and chronic hypertension with superimposed preeclampsia (11.2%). Maternal complications occurred in more than 80% of the hypertensive women. There were 4 (1.95%) maternal deaths. Adverse perinatal outcomes included 42 (20.5%) stillbirths, 1 (0.5%) early neonatal death, 18 (8.8%) cases of intrauterine growth restriction, and 101 (49.3%) low birth weight babies, with a 209 per 1000 births perinatal mortality rate. Comparisons between age, laboratory and clinical parameters were made. There was significant association when comparing age and AST (P value = 0.01); age and platelets (P value = 0.02); age at booking of pregnant mothers and diastolic blood pressure (P value = 0.00); age and systolic blood pressure (P value = 0.00); and age and birth weight (P value = 0.00). No comparisons were made (P value > 0.05) when age is compared to Hb, urea and creatinine. Age had a significant risk of developing preeclampsia (P value < 0.001) and younger age had a higher risk of having preeclampsia than with other maternal hypertensive disorders. Preeclampsia is also found more commonly in primigravidae and women with low parity (P value = 0.03). Pregnant mothers with previous complications of hypertensive disorders had less preeclampsia compared to those without such complications (P value = 0.09). Conclusion: There is a substantial burden of maternal and perinatal morbidity and mortality associated with maternal hypertensive disorders at Pietersburg Hospital, Limpopo Province, South Africa. Preeclampsia had more predominant adverse outcomes compared to other classes of maternal hypertensive disorders identified in the study.