MATERNAL MORTALITY PREDICTORS IN WOMEN WITH HYPERTENSIVE DISORDERS OF PREGNANCY A RETROSPECTIVE COHORT STUDY

Abstract

BACKGROUND: Hypertensive disorders of pregnancy (HDP) are multisystem disorders unique tohuman pregnancy. They are becoming the leading causes of maternal mortality worldwide, with themajority of deaths occurring in low income countries. However, little is known about the predictors ofmaternal mortality in women with HDP.METHODS: A retrospective cohort study was conducted between 2008 and 2013 in three universityteaching hospitals among 1015 women admitted with a diagnosis of HDP. Statistically significantassociations were assessed by the hazard ratio (HR) with 95% confidence using the Cox proportionalhazards model and by the Log Rank test using the Kaplan-Meier survival analyses.RESULTS: There were 51(5%) maternal deaths and the majority died after they developed eclampsia.The median delay in arrival among the deaths was longer than the survivors. The multivariate survivalanalyses showed an increased risk of maternal mortality among women with eclampsia (HR=8.4), noantenatal care (HR=2.3), being grand multiparous (HR=2.8), having low diastolic blood pressure(HR=4.5), high creatinine level (HR=9.9), use of diazepam as anticonvulsant (HR=2.7) and untreatedwith antihypertensive drug (HR=4.2).CONCLUSIONS: The case fatality rate of HDP was among the highest in the world and a delay ininitiation of treatment because of delay in health care-seeking contributed to the majority of maternaldeaths.