Severe maternal outcome among patients with severe pre eclampsia and eclampsia at Muhimbili National Hospital

Abstract

ABSTRACT Background: Hypertensive disorders in pregnancy (HDP) is the second most common direct cause of maternal deaths accounting for 14% of maternal deaths worldwide.Severe pre eclampsia and eclampsia are among the HDP which cause significant morbidity and mortality,hence categorized as Maternal Near Miss (MNM).At Muhimbili National Hospital these are the leading causesof maternal deaths (MD) accounting for 19.9% of MD.

Objective: The aim of this study was to determine the proportion of severe maternal outcome among patients with severe pre eclampsia and eclampsia and to determine MNM indices at Muhimbili National Hospital in Tanzania.

Methods: A descriptive cross sectional study was conducted at Muhimbili National Hospital. Women with severe pre eclampsia and eclampsia were recruited for the study. Data was extracted from patient files after admission,and followed up until discharge or death; after discharge was categorized as MNM or death as MD . Such data included: age,parity,gravidity, gestation age,hypertensive disorder, admission to ICU, organ dsyfunction, matenal death, mode of delivery and referral status then filled in a structured check list form.The information extracted was coded,entered cleaned and analysed using Statistical Package for the Social Sciences(SPSS), Version 22. Continous variables was summarized into mean and standard deviation.Categorical were summaized as frequencies and percentage.Outcome indicators were calculated.

Results: During the study period there were 3853 deliveries, whereby 3661were live births.A total of 320 women were recruited in this study, nearly two thirds of women, 199 (62.2%) had severe pre eclampsia while 121 (37.8%) had eclampsia, 310 (96.5%) women had been referred from other health facilities.Seventy one women (22.1%) were found to have severe maternal outcome whereby 63 had MNM with organ dsyfunction and 8 maternal deaths. Overall MNMR was 87.4 per1000 live births,54 per 1000 live birth for severe pre eclampsia and 33 per 1000 live births for eclampsia. Overall SMOR was 19.4 while that for severe pre eclampsia was 12 per 1000 live births and that foreclampsiawas 9.5 per 1000 live births.Mortality index was11%; 9% for severe pre eclampsia and 11.4% for eclampsia. Case fatality rate was 2.5%; 2.1 for severe pre eclampsia and 3.3% for eclampsia.

CONCLUSION There is high proportion of women with severe maternal outcome attributable to severe pre eclampsia and eclampsia, with reduced proportion of maternal deaths as compared to previous studies.This signifiesimprovement of performance in our health facility in dealing with patients with severe morbidities due to severe pre eclampsia and eclampsia, however more effort has to be put to reduce maternal mortality to the acceptable standards.