Implementation of maternal guidelines for gravid teenagers with hypertensive disorders in KwaZulu-Natal

Background: The worldwide phenomenon of teenage pregnancy among 13­9-year-olds is complicated by obstetric conditions. Among the top three causes of maternal mortality, hypertension is the third in South Africa. Quality maternal care is assured by obstetric practitioners (OPs) implementing guidelines specific for management of hypertension in pregnancy. Objective: The objective of this study was to investigate implementation of maternal guidelines for hypertension in pregnancy among teenagers. Methods: As a retrospective quantitative research design was used, 173 maternal records of pregnant teenagers from 13 to 19 years were sampled from six district hospitals and Community Health Centres (CHCs) between 01 January 2017 and 31 December 2019 to undergo systematic random sampling. A pretested structured checklist was used to record data from sampled maternal records. Statistical Package for Social Sciences (SPSS) version 26 was used for data analysis, and results were presented using simple descriptive statistics. Results: Research results indicated that teenagers who suffered from hypertension intrapartum and postpartum did not receive maternal care according to the guidelines for maternity care in South Africa. Blood pressure was not measured of six (3.47%) intrapartum and five (2.9%) postpartum teenagers. Seventeen (9.8%) hypertensive postpartum teenagers received their antihypertensives. Conclusion: Public health institutions (PHIs) compromised provision of quality maternal care among teenagers, evidenced by incomplete intrapartum and postpartum assessment, diagnosis and management of hypertensive disorders in pregnancy (HDP).

Risk factors for preeclampsia and eclampsia in Sidama region, southern Ethiopia: a nested case-control study

Introduction: though Ethiopia has made a significant improvement in the reduction of maternal mortality, the high burden of preeclampsia remains a concern in the Sidama region of southern Ethiopia. This study aimed to determine the risk factors for preeclampsia and eclampsia in the Sidama region of southern Ethiopia. Methods: a nested case-control study was conducted from August 8, 2019, to October 1, 2020 in the Sidama region. Two-stage sampling techniques were used to recruit study participants. First, seven of the 13 public hospitals were selected using a random sampling technique. Second, cases and controls were selected from a cohort of pregnant women enrolled at ≥20 weeks of gestation up until the 37th week. Data were collected in a face-to-face interview using a locally translated and validated tool. Binary logistic regression analysis was used to identify risk factors for preeclampsia and eclampsia Results: of the planned sample size of 816 women, we enrolled 808 (404 cases and 404 controls). Of the 404 cases, (59.40%, 240/404) had preeclampsia without severity features, (30.94%, 125/404) had preeclampsia with severity features, and (9.65%, 39/404) had convulsions. After controlling for confounders, women having a low wealth status were 98% [AOR: 1.98, 95%CI: 1.34-2.92] at higher risk for preeclampsia and eclampsia compared to women having a high wealth status. Women who had early neonatal deaths were 5 times more likely to be developed preeclampsia and eclampsia than women who did not have early neonatal deaths [AOR: 5.09, 95%CI: 1.69-9.36]. Women who did not attend school were three times more likely to develop preeclampsia and eclampsia [AOR: 3.00, 95% CI: 1.10-8.19] compared to women who attended college/university. Conclusion: in this study, a higher risk for preeclampsia and eclampsia was observed among women with low wealth status, women who had early neonatal deaths and women who did not attend school. Some of these factors could be positively influenced by educational interventions. Maternal and child health providers should screen pregnant women at risk for preeclampsia and eclampsia using these factors. Findings of this study will provide epidemiological evidence for policy makers and implementers to reduce the occurrence of preeclampsia and eclampsia.

Magnitude of preeclampsia and associated factors among women attending delivery service in Debre Tabor Specialized Hospital

BACKGROUND: Preeclampsia is among the leading causes of maternal and perinatal morbidity and mortality, and it continues as a global health concern. Therefore, this study was aimed to assess the magnitude of pre-eclampsia and its determinant factors among women attending delivery services in Debre Tabor Comprehensive Specialized Hospital Northwest Ethiopia. METHODS: Institutional-based cross-sectional study was conducted among 261 women from January 1- 30, 2021. A systematic sampling technique was applied. Data were collected using a structured and pre-tested questionnaire. The collected data were entered using Epi-data version 4.2 and analyzed by statistical package for social science (SPSS) version 23. A significant association was declared at a p-value of < 0.05 with a 95% Confidence interval. RESULTS: Overall 15,7% of women had preeclampsia. Age at menarche (10-15 years) (AOR=4.79; 95% CI: 2.07-15.27), unwanted pregnancy (AOR:1.29; 95% CI: 1.59-8.44), history of chronic hypertension (AOR:2.93; 95% CI: 1.00-6.20), BMI ≥ 30 Kg/m2 (AOR:1.79; 95% CI: 1.06-3.65), and alcohol consumption (AOR:2.12; 95% CI: 4.00-14.14) were significantly associated with preeclampsia. CONCLUSION: This study showed that the magnitude of preeclampsia was significantly high compared with previous national reports. Early menarche age, the status of current pregnancies, history of chronic hypertension, BMI, and alcohol consumption were significantly associated with preeclampsia. Therefore, the government and respective stakeholders should be strengthening antenatal care services to early identify and manage women with preeclampsia. Besides, health education and promotion should be strengthened regarding the maintenance of appropriate body weight and alcohol intake before pregnancy

Hypertensive disorders of pregnancy: A five-year review in Babcock University Teaching Hospital, Ilishan-Remo, Ogun State, Nigeria

Objective: To determine the prevalence and outcome of hypertensive disorder of pregnancy in Babcock University Teaching Hospital, Ilishan-Remo, Ogun State Nigeria Method: This was a retrospective descriptive study of all documented cases of hypertensive disorder of pregnancy between the 1st of June 2012 and 31st May, 2017. Information such as age, parity, booking status, level of education, blood pressure at presentation, urinalysis at presentation, gestational age at presentation, and delivery, mode of delivery, baby's birth weight was extracted from patients' case files. Result: There were 1,118 deliveries during the study period out of which 55 (4.9%) patients had hypertensive disorders in pregnancy. The mean age was 31.5years ±48.1 and mean parity, 1.2± 1.1. The mean systolic and diastolic blood pressures were 180.4 ± 1.88mmHg and 105.1± 1.5mmHg, respectively. Thirty-four (75.5%) of the women had preeclampsia/ eclampsia, while 7 (15.5%) had gestational hypertension. Most women were delivered preterm (22 patients, 48.7%). The majority of them (33, 73.3%) were delivered by cesarean section, out of which 2 (4.4%) were elective cesarean section and 31 patients (68.8%) were emergency cesarean section. The case fatality rate was 1.8%. Conclusion: Pre-eclampsia was the most prevalent t hypertensive disorder of pregnancy. It was more prevalent among primigravidae patients and the most common complication was preterm delivery. Strengthening antenatal care services will enable early identification of cases. Prompt referral of cases for specialist care will help in reducing the adverse outcomes associated with the condition.

Pregnancy induced hypertension and associated factors among women attending delivery service at Mizan-Tepi University Teaching Hospital, Tepi General Hospital and Gebretsadik Shawo Hospital, Southwest, Ethiopia

BACKGROUND: Disorders of pregnancy induced hypertensive are a major health problem in the obstetric population as they are one of the leading causes of maternal and perinatal morbidity and mortality. The World Health Organization estimates that at least one woman dies every seven minutes from complications of hypertensive disorders of pregnancy. The objective of this study is to assess pregnancy induced hypertension and its associated factors among women attending delivery service at Mizan-Tepi University Teaching Hospital, Gebretsadikshawo Hospital and Tepi General Hospital. METHODS: A health facility based cross-sectional study was carried out from October 01 to November 30/2016. The total sample size (422) was proportionally allocated to the three hospitals. Systematic sampling technique was used to select study participants. Variables with p-value of less than 0.25 in binary logistic regression were entered into the multivariable logistic regression to control cofounding. Odds ratio with 95% confidence interval was used. P-value less than 0.05 was considered as statistically significant. RESULTS: The prevalence of pregnancy induced hypertension was 33(7.9%); of which 5(15.2%) were gestational hypertension, 12 (36.4%) were mild preeclampsia, 15(45.5%) were severe preeclampsia and 1 (3%) eclampsia. Positive family history of pregnancy induced hypertension [AOR5.25 (1.39-19.86)], kidney diseases (AOR 3.32(1.04-10.58)), having asthma [AOR 37.95(1.41-1021)] and gestational age (AOR 0.096(0.04-.23)) were predictors of pregnancy induced hypertension. CONCLUSION: The prevalence of pregnancy induced hypertension among women attending delivery service was 7.9%. Having family history of pregnancy induced hypertension, chronic kidney diseases and gestational age were predictors of pregnancy induced hypertension

Pre-eclampsia at Laquintinie hospital (Douala): survey of prevalence and morbidity from 2010 to 2015

Objective: to determine the prevalence of pre-eclampsia and describe its complications at Laquintinie Hospital in Douala. Methods: We conducted a descriptive study with retrospective data collection for 03 months (January 18, 2016 to April 18, 2016) from the records of pregnant women received at the gynecology-obstetrics department over a 6-year period from 1st January 2010 to 31st December 2015 at Laquintinie Hospital in Douala. We identified pregnant women with BP≥140 / 90 mmHg combined with proteinuria> 0.3g / 24h or significant albuminuria (2+) on urine strips after 20 weeks of amenorrhea. Results: Of the 17644 deliveries recorded during our study period, we found 1080 cases of PE, a frequency of 6.12%. PE was common among primi-parous women (46.7%) in the age group [20-29] years. Pregnant women under the age of 20 were the most affected by eclampsia. Preeclampsia was frequently found in pregnant women with twin pregnancies and those with macrosomic fetuses with 10.1% and 8.9% frequency, respectively. Multiparous women with preeclampsia often had a history of PE (43 cases or 4%), arterial hypertension (55 cases or 5.1%) and / or diabetes (5 cases or 0.5%). Eclampsia was the principal maternal complication (29.7%). The maternal case fatality rate was 0.5%. Fetal complications were dominated by induced prematurity (19.5%) and intra-uterine fetal death (9.4%). Conclusion: This study reveals that pre-eclampsia is frequent in Douala Laquintinie hospital with high maternal-fetal morbidity and mortality rate and therefore remains a major public health problem

Hypertension in pregnancy: a future risk for chronic kidney disease in South Africa

Background. Hypertension in pregnancy is a risk factor for end-stage chronic kidney disease (ESKD) and is particularly common in South Africa (SA). There are no data for the risk of developing chronic kidney disease (CKD).Objectives. To conduct a study of all female patients who presented to the renal replacement programme at Groote Schuur Hospital, Cape Town, SA.Methods. This was a retrospective study of female patients with ESKD who were presented to renal replacement meetings between 2007 and 2017. For each patient who was assessed, there was a comprehensive letter detailing patient demographics, as well as psychosocial and medical history, which served as the source data. Patients with a history of hypertension in pregnancy were identified as the case group and those without the condition were the control group. Patient demographics, causes of CKD, kidney function and outcome of the meeting were documented.Results. Of the 415 female patients with ESKD, 70 (16.9%) had a history of hypertension in pregnancy. The ethnic breakdown was as follows: 132 (42.44%) black, 172 (55.3%) mixed ancestry and 7 (2.25%) white. Compared with the control group, the patients were younger, with a median age of 33 v. 41 years (p<0.001), higher serum creatinine 1 045 v. 751 µmol/L (p=0.017) and lower estimated glomerular filtration rate (eGFR) 4.0 v. 5.1 mL/min (p=0.029). Patients were more likely to abuse methamphetamine (5.7 v. 1.7%; p=0.049), and less likely to be diabetic (1.4 v. 20.9%; p<0.001) or HIV-positive (2.9 v. 12.5%; p=0.019). There were no ethnic differences between patients and controls. Underlying causes of renal disease showed significant differences, as patients were more likely to have hypertensive nephropathy (57.1 v. 22.9%; p<0.0001), and less likely to have diabetic kidney disease (1.4 v. 20.4%; p<0.001), HIV-associated nephropathy (HIVAN) (1.4 v. 6.4%) or polycystic kidney disease (1.4 v. 7.0%). There was no difference in acceptance to the dialysis and transplant programme (53 v. 47%).Conclusions. This study suggests an important link between hypertension in pregnancy and ESKD. The patients were significantly younger, presented later and were more likely to have hypertensive nephropathy. Methamphetamine abuse appears to be a risk factor. The study suggests that all women with hypertensive disorders during pregnancy need further evaluation and follow-up postpartum

Prévalence et facteurs de risque des syndromes vasculo-rénaux en milieu hospitalier à Parakou (Bénin) en 2015

Introduction : L'hypertension artérielle (HTA) au cours de la grossesse est une pression artérielle systolique ≥ 140 mmHg (millimètre de mercure) et/ou une pression artérielle diastolique ≥ 90 mmHg confirmée par deux reprises, chez une patiente assise ou couchée.Objectif : Déterminer la prévalence des syndromes vasculo-rénaux en milieu hospitalier. Méthode : Il s'est agi d'une étude prospective, transversale, descriptive à visée analytique qui s'est déroulée du 1er mars au 31 juillet 2015 en milieu hospitalier à Parakou. Résultats : Deux-mille cinq cent trois (2503) patientes avaient été enregistrées avec 180 cas de pathologies cardiovasculaires dont 155 cas d'HTA (86,11%) soit une prévalence hospitalière de 6,19%. L'HTA gestationnelle (36,13%) et la prééclampsie (39,35%) étaient les plus représentées suivi de l'HTA chronique (11 ; 07,10%) de l'éclampsie (23 ; 14,84%) et de la prééclampsie surajoutée (4 ; 02,58%). Les femmes étaient enceintes (92,90%) et dans les suites de couche (7,10%). L'âge moyen de la grossesse était de 34,8 ± 4,7 avec des extrêmes de 19 et 41 semaines d'aménorrhée. Les facteurs associés à l'HTA étaient le jeune âge ≤ 30 ans (p = 0,007), le bas niveau socioéconomique (p = 0,02), la faible gestité (p = 0,0007) et la faible parité (p = 0,000002)

Les caracteristiques de l'hypertension arteriellle severe au cours de la gravido-puerperalite : a propos de 389 cas colliges a la maternite du CHU de Treichville; Abidjan

INTRODUCTION : L'HTA severe se definit comme une TAS160mmHg et ou TAD110mmHg. L' HTA au cours de la gravido-puerperalite est un probleme de sante d'ampleur mondiale qui pose un probleme singulier en Afrique du fait qu'elle fait partie des 3 premieres causes de la mortalite maternelle. A Abidjan; ABHE [6] et COULIBALY [7] ont deja cible les complications. OBJECTIFS: -Principal: Identifier les caracteristiques des complications materno- foetales de 1'HTA severe au cours de la gravido-puerperalite ; -Specifiques: Determiner la frequence de I' FITA severe de la gravido-puerperalite; en preciser les types de complications et evaluer le pronostic matemo-foetal immediat. MATERIEL ET METHODOLOGIE : Cette etude; prospective; transversale et descriptive; a eu lieu dans le service de gynecologie- obstetrique du CHU; Treichville; sur douze mois. Elle a concerne les gestantes; les parturientes et les femmes en suites de couches; admises dans le service pour HTA severe. Nous avons exclu les femmes normotendues ou atteintes d'HTA legere ou moderee (TASl60minHg et TAD ll0mmHg) ainsi que celles admises pour des causes autres que HTA severe. Nos patientes ont ete recrutees des l'admission et chacune a beneficie d'evaluation journaliere selon des criteres definis. Les donnees ont ete collectees a partir des registres du service (Reanimation et Salle d'accouchement); des dossiers des patientes et de l'interrogatoire des patientes ou de l'entourage. Les logiciels EPI INFO 6 et EXCEL ont servi pour l'informatique et nous nous sommes servi des calculs de frequence et de la moyenne pour les statistiques. RESULTATS : Nos resultats etaient de 3 ordres: les caracteristiques epidemiologiques marques par une frequence elevee de 6;7pour cent; et les complications dominees par l'eclampsie et l'HRP; le pronostic maternel qui a montre des taux de letalite maternelle et de cesarienne elevees ; et quant au pronostic foetal; on remarque des taux eleves de la prematurite; de l'hypotrophie fotale; de la souffrance cerebrale et de la mortalite perinatale. COMMENTAIRES : Ces resultats ont; en general; reflete ceux de la litterature. CONCLUSION ET RECOMMANDATIONS : L'inefficacite du traitement anti-hypertenseur sur les complications et le pronostic; due au fait qu'il agit en aval des phenomenes en causes; fait concevoir la necessite du traitement preventif; afin de reduire ces complications et ameliorer le pronostic maternel et foetal