Hypertensive disorders of pregnancy at Umtata General Hospital: perinatal and maternal outcomes.

BACKGROUND

Hypertensive disorders are a major cause of maternal and perinatal morbidity and mortality worldwide. The incidence and complications at Umtata General Hospital have not yet been documented, but clinical experience shows that hypertension is a common and serious problem.

OBJECTIVE

To determine the incidence, clinical features, complications, and perinatal outcome in patients with hypertensive disorders of pregnancy.

DESIGN

A cross-sectional analytical study.

SETTING

Umtata General Hospital (UGH), a referral and tertiary institution.

SUBJECTS: All patients with hypertension who delivered at Umtata General Hospital from January 1993 to December 1994.

MAIN OUTCOME MEASURES: The incidence, presentation, maternal complications, and perinatal outcome.

RESULTS

Of the 16,376 deliveries at UGH during this period, 760 (4.6%) were complicated by hypertension. The median age of the hypertensive women was 25 years. Teenagers comprised 27.3% of the cases and primigravidae accounted for 42.9% of all the cases. Proteinuric hypertension was present in 66% of the hypertensive women at admission and in 53.8% at delivery. Eclampsia occurred in 15% of the hypertensives, and the incidence of eclampsia in the general obstetric population at UGH was high at 7 per 1000 deliveries. Other maternal complications of hypertension included, pulmonary oedema (3.9%), abruptio placentae (1.7%), HELLP syndrome (1.2%), maternal death (1.0%), acute renal failure (0.9%), coma with cerebral pathology (0.5%), and DIC (0.5%). Hypertension accounted for 33% of all maternal deaths during this period, and almost all were eclamptic. The perinatal complications which occurred included preterm delivery (34%), low birthweight (19.9%), IUFD (11.2%), IUGR (6.6%), and neonatal deaths (3.8%). In general, eclamptic patients had significantly more maternal and foetal complications than non-eclamptic hypertensive women.

CONCLUSION

Hypertensive disorders of pregnancy are a major cause of maternal and perinatal morbidity and mortality at UGH, as in other parts of South Africa. Only quality obstetric care can reduce the adverse effects of hypertension.