Maternal and perinatal outcomes among primigravid and multigravid patients with severe pre-eclampsia/eclampsia delivering at Muhimbili National Hospital: a comparative study

Abstract

Introduction: Severe pre-eclampsia/eclampsia is one of the top ten causes of maternal and fetal morbidity and mortality worldwide. These conditions are seen to have more impact on the low income countries. Parity is also another health issue seen in low income countries where high parity is observed for most women. Understanding the relationship between parity and what impact it has on the outcome on the mother and fetus is very important. Objective: The aim of the study was to compare the maternal and perinatal outcomes among primigravid and multigravid patients with severe pre-eclampsia/eclampsia delivering at Muhimbili National Hospital in Dar es salaam, Tanzania. Methodology: This was a hospital based cross-sectional study which took six months from 1st August 2017 to 30th January 2018. The study included all pregnant women with singleton pregnancy delivering at MNH admitted with the diagnosis of severe pre-eclampsia/eclampsia. Data were collected using a check list that included clinical parameters such as presence of headache, visual disturbance, epigastric pain, proteinuria, oliguria, blood pressure and laboratory parameters such as hemoglobin level, platelets count, hematocrit, creatinine, urea, uric acid, aspartate aminotransferase and alanine transferase which were analyzed using Statistic Package for the Social Science (SPSS) version 23. Descriptive statistics were done and the results were presented as frequencies, means, and standard deviations. Pearson’s Chi-square and Fischers exact test was used to compare categorical variables. P-value <0.05 was considered statistically significant. The results of the analysis were presented in odds ratio and 95% confidence interval. Crude odds ratio was calculated to understand the effect of the gravidity as an independent factor on the outcomes seen. Results: Multigravid women showed to have a higher of proportion (73.2%) of delivering preterm babies compared to the primigravid women (61.1%). There was evidence of statistical significance with the p value = 0.002 (COR=1.7; 95% CI, 1.2, 2.5). Higher proportion was seen in most outcomes among the multigravid women with AKI (10.4%), HELLP syndrome (16.4%), DIC (3.0%), abruption placenta (3.0%), and NICU admission (52.3%) compared to the primigravid women who had occurrence of the outcomes at a lower proportion AKI (9.7%), HELLP syndrome (11.4%), DIC (1.3%), abruption placenta (2.0%), and NICU admission 45.0%). Conclusion: Mutigravid women had a higher proportion of preterm labour as compared to primigravid women. There is no difference in other poor maternal and perinatal outcomes among the two groups. The lack of statistical significant differences in the other outcomes of interest in the study suggests that the outcomes of the disease are not affected by gravidity and that both primigravid and multigravid women should be screened and managed under similar protocols.