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1.
J Pregnancy ; 2020: 6029160, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32695514

RESUMO

Background: Maternal near miss refers to a very ill pregnant or delivered woman who nearly died but survived a complication during pregnancy, childbirth, or within 42 days of termination of pregnancy. Maternal death; the most catastrophic end is frequently described as just "tip of the iceberg," whereas maternal near-miss as the "base." Therefore, this study aimed at assessing the factors associated with maternal near-miss among women admitted in public hospitals of West Arsi zone, Ethiopia. Methods: A facility-based unmatched case-control study was conducted from Mar 1 to Apr 30, 2019. Three hundred twenty-one (80 cases and 241 controls) study participants were involved in the study. Cases were recruited consecutively as they present, whereas controls were selected by systematic sampling method. Cases were women admitted to hospitals during pregnancy, delivery, or within 42 days of termination of pregnancy and fulfilled at least one of the maternal near-miss disease-specific criteria, while controls were women admitted and gave birth by normal vaginal delivery. The interviewer-administered structured questionnaire and data abstraction tool was used to collect data. Data were entered Epi data 3.1 and then transferred into SPSS 20 for analysis. Multivariable logistic regression was used, and the significance level was declared at p value ≤ 0.05. Results: The major maternal near-miss morbidities were severe obstetric hemorrhage (32.5%), pregnancy-induced hypertensive disorders (31.3%), and obstructed labor (26.3%), followed by 6.3% and 3.8% of severe anemia and pregnancy-induced sepsis, respectively. The odds of maternal near miss were statistically significantly associated with women's lack of formal education [AOR = 2.24, 95% CI: (1.17, 4.31)]. Not attending antenatal care [AOR = 3.71, 95% CI: (1.10, 12.76)], having prior history of cesarean section [AOR = 3.53, 95% CI: (1.49, 8.36)], any preexisting chronic medical disorder [AOR = 2.04, 95% CI: (1.11, 3.78)], and having experienced first delay [AOR = 5.74, 95% CI: (2.93, 11.2)]. Conclusions: Maternal education, antenatal care, chronic medical disorders, previous cesarean section, and first delay of obstetric care-seeking were identified as factors associated with maternal near-miss morbidity. Therefore, this finding implies the need to get better with those factors, to preclude severe maternal complications and subsequent maternal mortality.


Assuntos
Hospitais Públicos/estatística & dados numéricos , Near Miss/estatística & dados numéricos , Complicações na Gravidez/epidemiologia , Anemia/epidemiologia , Anemia/mortalidade , Estudos de Casos e Controles , Etiópia/epidemiologia , Feminino , Educação em Saúde , Humanos , Hipertensão Induzida pela Gravidez/epidemiologia , Hipertensão Induzida pela Gravidez/mortalidade , Modelos Logísticos , Complicações do Trabalho de Parto/epidemiologia , Complicações do Trabalho de Parto/mortalidade , Hemorragia Pós-Parto/epidemiologia , Hemorragia Pós-Parto/mortalidade , Gravidez , Complicações na Gravidez/mortalidade , Cuidado Pré-Natal , Sepse/epidemiologia , Sepse/mortalidade , Inquéritos e Questionários
2.
Obstet Gynecol ; 136(1): 129-139, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32541286

RESUMO

OBJECTIVE: To investigate whether women with early pregnancy elevated blood pressure (BP) or stage 1 hypertension exhibit increased risk of preeclampsia and maternal or neonatal morbidity. METHODS: We conducted a clinical cohort study of 18,162 women who delivered a singleton neonate from 2015 to 2018 and attended at least two prenatal appointments before 20 weeks of gestation. Data were collected within the Magee Obstetric Maternal and Infant database, an aggregate of prenatal and delivery health records. Early pregnancy BP was defined as average BP before 20 weeks of gestation, and women were classified with normal, elevated BP, stage 1 or 2 hypertension according to current guidelines. The primary outcome was preeclampsia. Secondary outcomes were severe maternal morbidity, placental abruption, gestational diabetes, and composite neonatal morbidity. RESULTS: Overall, 75.2% of the women were categorized with normal BP, 13.9% with elevated BP, 5.4% with stage 1 hypertension, and 5.5% with stage 2 hypertension. Risk of preeclampsia increased in a stepwise fashion with increasing BP category, adjusted for covariates (normal BP, 4.7%, referent; elevated BP, 7.3%, adjusted odds ratio [aOR] 1.29, 95% CI 1.07-1.56; stage 1, 12.3%, aOR 2.35, 95% CI 1.86-2.96), and stage 2, 30.2%, aOR 6.49, 95% CI 5.34-7.89). Results were similar among black and white women. Gestational diabetes was more prevalent among women with stage 1 (11.4%; aOR 1.50, 95% CI 1.18-1.91] and stage 2 hypertension (14.2%; aOR 1.65, 95% CI 1.30-2.10). Severe maternal morbidity and neonatal morbidity were increased only among women with stage 2 hypertension (aOR 2.99, 95% CI 2.26-3.99, and aOR 2.67, 95% CI 2.28-3.12, respectively). CONCLUSION: Women with elevated BP, and stage 1 and 2 hypertension in early pregnancy are at increased risk for preeclampsia. These findings emphasize the importance of applying the 2017 BP guidelines to reproductive-aged women. Strategies to incorporate these guidelines into obstetric care may also be warranted.


Assuntos
Pressão Sanguínea , Hipertensão Induzida pela Gravidez/epidemiologia , Adulto , Determinação da Pressão Arterial , Estudos de Coortes , Feminino , Humanos , Hipertensão Induzida pela Gravidez/diagnóstico , Hipertensão Induzida pela Gravidez/mortalidade , Hipertensão Induzida pela Gravidez/prevenção & controle , Pennsylvania/epidemiologia , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/normas , Gravidez , Resultado da Gravidez , Diagnóstico Pré-Natal , Fatores de Risco
3.
BJOG ; 127(9): 1082-1089, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32383337

RESUMO

OBJECTIVE: The aim of this article is to describe the incidence and characteristics of pregnancy-related death in low- and middle-resource settings, in relation to the availability of key obstetric resources. DESIGN: This is a secondary analysis of a stepped-wedge cluster randomised controlled trial. SETTING: This trial was undertaken at ten sites across eight low- and middle-income countries in sub-Saharan Africa, India and Haiti. POPULATION: Institutional-level consent was obtained and all women presenting for maternity care were eligible for inclusion. METHODS: Pregnancy-related deaths were collected prospectively from routine data sources and active case searching. MAIN OUTCOME MEASURES: Pregnancy-related death, place, timing and age of maternal death, and neonatal outcomes in women with this outcome. RESULTS: Over 20 months, in 536 233 deliveries there were 998 maternal deaths (18.6/10 000, range 28/10 000-630/10 000). The leading causes of death were obstetric haemorrhage (36.0%, n = 359), hypertensive disorders of pregnancy (20.6%, n = 206), sepsis (14.1%, n = 141) and other (26.5%, n = 264). Approximately a quarter of deaths occurred prior to delivery (28.4%, n = 283), 35.7% (n = 356) occurred on the day of delivery and 35.9% (n = 359) occurred after delivery. Half of maternal deaths (50.6%; n = 505) occurred in women aged 20-29 years, 10.3% (n = 103) occurred in women aged under 20 years, 34.5% (n = 344) occurred in women aged 30-39 years and 4.6% (n = 46) occurred in women aged ≥40 years. There was no measured association between the availability of key obstetric resources and the rate of pregnancy-related death. CONCLUSIONS: The large variation in the rate of pregnancy-related death, irrespective of resource availability, emphasises that inequality and inequity in health care persists. TWEETABLE ABSTRACT: Inequality and inequity in pregnancy-related death persists globally, irrespective of resource availability.


Assuntos
Países em Desenvolvimento/estatística & dados numéricos , Hipertensão Induzida pela Gravidez/mortalidade , Sepse/mortalidade , Hemorragia Uterina/mortalidade , Adulto , África ao Sul do Saara/epidemiologia , Distribuição por Idade , Pressão Sanguínea , Transfusão de Sangue/estatística & dados numéricos , Feminino , Haiti/epidemiologia , Pessoal de Saúde/educação , Disparidades em Assistência à Saúde , Frequência Cardíaca , Humanos , Incidência , Índia/epidemiologia , Unidades de Terapia Intensiva/provisão & distribução , Mortalidade Materna , Período Pós-Parto , Fatores de Tempo , Adulto Jovem
4.
Pregnancy Hypertens ; 20: 96-101, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32224440

RESUMO

BACKGROUND: Hypertensive disorders of pregnancy (HDP) are responsible for high maternal mortality and morbidity worldwide. OBJECTIVE: Our primary objective was to report the epidemiological and clinical features of HDP in Cayenne General Hospital. Our secondary objectives were to search for factors associated to preeclampsia (PE) and to severe PE in patients with HDP. METHODS: Our study was observational and non-interventional. It was conducted over 4-month period (January to April 2019) in the Obstetrics and Gynaecology Unit of the Cayenne General Hospital. We included all pregnant women after 20 weeks of gestation (WG), who gave birth and who presented HDP and/or PE. RESULTS: During the study period 1243 patients gave birth in our unit. Among them, 156 were diagnosed with HDP (12.6%). The median age was 33 years (IQR 28 - 38 years). The most frequent medical histories were diabetes (27.5%) and chronic hypertension (23.5%). The socioeconomic status was low in 31% of patients. Ninety-four patients (61.4%) developed PE with a severe form in 80.9% of cases. HELLP syndrome was diagnosed in 6.5% and nephropathy in 3.3% of cases. Delivery was by cesarean in 49.7% of cases. The median gestational age at delivery was 37 WG (IQR: 35-39). Multivariate analysis showed no independent factors associated with the occurrence of PE or severe PE in patients with HDP. CONCLUSION: Our study shows a high prevalence of PE in patients with HDP. Hospitalization and repeated clinical evaluation are needed to screen for women exposed to develop PE or severe PE.


Assuntos
Hipertensão Induzida pela Gravidez/epidemiologia , Saúde Materna , Adulto , Cesárea , Feminino , Guiana Francesa/epidemiologia , Síndrome HELLP/epidemiologia , Hospitalização , Humanos , Hipertensão Induzida pela Gravidez/diagnóstico , Hipertensão Induzida pela Gravidez/mortalidade , Hipertensão Induzida pela Gravidez/terapia , Mortalidade Materna , Pré-Eclâmpsia/epidemiologia , Gravidez , Prevalência , Prognóstico , Proteinúria/epidemiologia , Fatores de Risco , Índice de Gravidade de Doença , Adulto Jovem
5.
Prev Chronic Dis ; 16: E162, 2019 12 12.
Artigo em Inglês | MEDLINE | ID: mdl-31831105

RESUMO

INTRODUCTION: Maternal and child health (MCH) and chronic disease programs at state health agencies may not routinely collaborate. The objective of this study was to describe a project that enhanced relationships between MCH and chronic disease epidemiologists at the Florida Department of Health, increased epidemiologic capacity, and informed both programs. METHODS: We collaborated to assess hypertension-related severe maternal morbidity (H-SMM) and hypertensive disorders (preexisting hypertension, gestational hypertension, and preeclampsia) among women at delivery of their live birth to help determine the burden on health care systems in Florida. We identified ways to improve the health of women before they conceive and to help them manage any chronic diseases during the perinatal period. RESULTS: We found differences by maternal characteristics in H-SMM rates among 979,660 women who delivered live births. We proposed strategies to support collaboration between state MCH and chronic disease staff. First, increase the screening, monitoring, and management of hypertension before, during, and after pregnancy. Second, examine H-SMM concurrently with maternal mortality to help find prevention strategies. Third, include reproductive-aged women in ongoing hypertension prevention and intervention efforts. Fourth, expand team-based care to include obstetricians, midwives, and doulas who can work together with primary care providers for hypertension management. And fifth, create and share data products that guide various groups about hypertension and related risk factors among reproductive-aged women. CONCLUSION: The collaboration between the Florida Department of Health MCH and chronic disease epidemiologists produced 1) a program-relevant indicator, H-SMM and 2) strategies for enhancing program and clinical activities, communication, and surveillance to reduce H-SMM rates.


Assuntos
Saúde da Criança , Doença Crônica , Hipertensão Induzida pela Gravidez/mortalidade , Hipertensão/epidemiologia , Hipertensão/mortalidade , Saúde Materna , Adulto , Criança , Feminino , Florida/epidemiologia , Humanos , Mortalidade Materna , Fatores de Risco
6.
S Afr Med J ; 109(9): 12723, 2019 09 13.
Artigo em Inglês | MEDLINE | ID: mdl-31635598

RESUMO

BACKGROUND: Hypertensive disorders of pregnancy (HDP), including pre-eclampsia/eclampsia, account for significant maternal and fetal mortality globally and especially in South Africa. Objective. To formulate clinical guidelines for the management of HDP in order to substantially reduce the number of maternal deaths from HDP. Methods. The Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument was used to formulate the guidelines and included six domains: scope and purpose; stakeholder involvement; rigour and development; clarity of presentation; applicability; and editorial independence. Recommendations. The guideline stipulates management strategies for all levels of care where women with hypertensive disorders in pregnancy are seen. It also has a detailed implementation plan. Conclusion. A clinical guideline that is of practical value has been formulated by a wide group of stakeholders. It is hoped that its dissemination and implementation by all doctors and nurses will reduce mortality and morbidity associated with HDP.


Assuntos
Morte Fetal/prevenção & controle , Hipertensão Induzida pela Gravidez/terapia , Morte Materna/prevenção & controle , Feminino , Mortalidade Fetal , Humanos , Hipertensão Induzida pela Gravidez/mortalidade , Mortalidade Materna , Gravidez , África do Sul
7.
Rev Med Suisse ; 15(662): 1603-1606, 2019 Sep 11.
Artigo em Francês | MEDLINE | ID: mdl-31508911

RESUMO

Hypertensive disorders of the pregnancy represent a major cause of maternal and fetal morbidity and mortality worldwide. Immediate and future complications are already well known, but recently gestational hypertension emerged as an equally serious risk factor for future maternal health. This article so offers a review of knowledge and recent changes about the diagnosis, treatment and long-term follow-up of hypertensive troubles of the pregnancy which are useful to know for the general practitioner. It also describes the ambulatory follow-up that has been implemented in the University hospitals of Geneva.


Assuntos
Hipertensão Induzida pela Gravidez , Feminino , Humanos , Hipertensão Induzida pela Gravidez/diagnóstico , Hipertensão Induzida pela Gravidez/mortalidade , Hipertensão Induzida pela Gravidez/terapia , Gravidez , Cuidado Pré-Natal , Fatores de Risco
8.
S Afr Med J ; 109(6): 412-414, 2019 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-31266559

RESUMO

BACKGROUND: Despite increased resources to reduce maternal deaths, South Africa (SA) has an unacceptably high maternal mortality rate (MMR). OBJECTIVES: To determine the causes of maternal deaths at Natalspruit Hospital, Johannesburg, SA. METHODS: A 2-year retrospective audit of case records was done All maternal deaths from January 2013 to December 2014 were included. RESULTS: There were 20 676 live births and 79 deaths, with a MMR of 382.08/100 000. Forty-four women (56%) were HIV-positive, 14 (21%) died of obstetric haemorrhage and 12 (15%) had hypertensive disorders of pregnancy. Thirty women (38%) had not attended an antenatal clinic. More women died between 16h00 and 08h00 than between 08h00 and 16h00. Most women (88%) had at least one avoidable factor. CONCLUSIONS: Natalspruit Hospital has a high MMR. The majority of deaths were HIV-related. There was a high number of women who were unbooked. Most deaths occurred after normal working hours.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/mortalidade , Hipertensão Induzida pela Gravidez/mortalidade , Hemorragia Pós-Parto/mortalidade , Cuidado Pré-Natal/estatística & dados numéricos , Aborto Incompleto/mortalidade , Adolescente , Adulto , Plantão Médico/estatística & dados numéricos , Causas de Morte , Cesárea/estatística & dados numéricos , Parto Obstétrico/estatística & dados numéricos , Feminino , Infecções por HIV/epidemiologia , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Mortalidade Materna , Gravidez , Gravidez Ectópica/mortalidade , Estudos Retrospectivos , Fatores de Risco , Sepse/mortalidade , África do Sul/epidemiologia , Hemorragia Uterina/mortalidade , Adulto Jovem
9.
BMC Pregnancy Childbirth ; 19(1): 208, 2019 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-31221123

RESUMO

BACKGROUND: This study aims to determine reported prevalence of hypertensive disorders in pregnancy (HDP) and maternal and neonatal outcomes associated with these disorders among women delivering at selected hospitals across Haiti. METHODS: A retrospective review of 8822 singleton deliveries between January 2012 and December 2014 was conducted at four hospitals in separate Departments across Haiti. Researchers examined the proportion of women with reported HDP (hypertension, preeclampsia, eclampsia) and the association between women with HDP and three neonatal outcomes: low birth weight, preterm birth, and stillbirths; and two maternal outcomes: placental abruption and maternal death in Hôpital Albert Schweitzer (HAS). Odds ratios for associations between HDP and perinatal outcomes at HAS were assessed using logistic regression, adjusting for potential confounders. RESULTS: Of the 8822 singleton births included in the study, 510 (5.8%) had a reported HDP (including 285 (55.9%) preeclampsia, 119 (23.3%) eclampsia, and 106 (20.8%) hypertension). Prevalence of HDP among each hospital was: HAS (13.5%), Hôpital Immaculée Conception des Cayes (HIC) (3.2%), Fort Liberté (4.3%), and Hôpital Sacré Coeur de Milot (HSC) (3.0%). Among women at HAS with HDP, the adjusted odds of having a low birth weight baby was four times that of women without HDP (aOR 4.17, 95% CI 3.19-5.45), more than three times that for stillbirths (aOR 3.51, 95% CI 2.43-5.06), and five times as likely to result in maternal death (aOR 5.13, 95% CI 1.53-17.25). Among the three types of HDP, eclampsia was associated with the greatest odds of adverse events with five times the odds of having a low birth weight baby (aOR 5.00, 95% CI 2.84-8.79), six times the odds for stillbirths (aOR 6.34, 95% CI 3.40-11.82), and more than twelve times as likely to result in maternal death (aOR 12.70, 95% CI 2.33-69.31). CONCLUSIONS: A high prevalence of HDP was found among a cohort of Haitian mothers. HDP was associated with higher rates of adverse maternal and neonatal outcomes in HAS, which is comparable to studies of HDP conducted in high-income countries.


Assuntos
Descolamento Prematuro da Placenta/epidemiologia , Hipertensão Induzida pela Gravidez/epidemiologia , Recém-Nascido de Baixo Peso , Nascimento Prematuro/epidemiologia , Natimorto/epidemiologia , Adulto , Estudos de Casos e Controles , Coleta de Dados , Feminino , Haiti/epidemiologia , Hospitais/estatística & dados numéricos , Humanos , Hipertensão Induzida pela Gravidez/mortalidade , Mortalidade Materna , Vigilância da População , Gravidez , Prevalência , Estudos Retrospectivos , Adulto Jovem
10.
Obstet Gynecol Clin North Am ; 46(2): 353-365, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31056136

RESUMO

Maternal morbidity and mortality is on the rise in the United States. Several local, state, and nationwide organizations have worked toward reducing maternal mortality by improving patient safety. Early warning systems unique to the obstetric population have been developed to provide early intervention and to prevent patients from decompensating. Patient care bundles, supported by the American College of Obstetricians and Gynecologists, as well as The Council on Patient Safety, provide a standardized approach to obstetric care. Monitoring outcomes through root cause analysis is key to improving patient safety and outcomes.


Assuntos
Mortalidade Materna , Segurança do Paciente , Complicações na Gravidez/mortalidade , Complicações na Gravidez/prevenção & controle , Diagnóstico Precoce , Medicina Baseada em Evidências , Feminino , Ginecologia , Humanos , Hipertensão Induzida pela Gravidez/mortalidade , Hipertensão Induzida pela Gravidez/prevenção & controle , Hipertensão Induzida pela Gravidez/terapia , Mortalidade Materna/etnologia , Obstetrícia , Segurança do Paciente/normas , Gravidez , Complicações na Gravidez/terapia , Resultado do Tratamento , Estados Unidos/epidemiologia , Hemorragia Uterina/mortalidade , Hemorragia Uterina/prevenção & controle , Hemorragia Uterina/terapia
11.
J Perinat Neonatal Nurs ; 33(2): 136-148, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31021939

RESUMO

The postpartum period represents a critical window to initiate targeted interventions to improve cardiometabolic health following pregnancies complicated by gestational diabetes mellitus and/or a hypertensive disorder of pregnancy. The purpose of this systematic review was to examine studies published since 2011 that report rates of postpartum follow-up and risk screening for women who had gestational diabetes and/or a hypertensive disorder of pregnancy and to identify disparities in care. Nine observational studies in which postpartum follow-up visits and/or screening rates were measured among US women following pregnancies complicated by gestational diabetes and/or a hypertensive disorder of pregnancy were reviewed. Rates of postpartum follow-up ranged from 5.7% to 95.4% with disparities linked to black race and Hispanic ethnicity, low level of education, and coexisting morbidities such as mental health disorders. Follow-up rates were increased if the provider was an obstetrician/endocrinologist versus primary care. Payer source was not associated with follow-up rates. The screening rate for diabetes in women who had gestational diabetes did not exceed 58% by 4 months across the studies analyzed, suggesting little improvement in the last 10 years. While women who had a hypertensive disorder appear to have had a postpartum blood pressure measured, it is unclear whether follow-up intervention occurred. Overall, postpartum screening rates for at-risk women remain suboptimal and vary substantially. Further research is warranted including reliable population-level data to inform equitable progress to meeting the evidence-informed guidelines.


Assuntos
Diabetes Gestacional/diagnóstico , Disparidades em Assistência à Saúde/economia , Hipertensão Induzida pela Gravidez/diagnóstico , Programas de Rastreamento/normas , Morte Materna/prevenção & controle , Cuidado Pós-Natal/métodos , Diabetes Gestacional/mortalidade , Diabetes Gestacional/terapia , Feminino , Seguimentos , Disparidades em Assistência à Saúde/etnologia , Humanos , Hipertensão Induzida pela Gravidez/mortalidade , Hipertensão Induzida pela Gravidez/terapia , Programas de Rastreamento/tendências , Período Pós-Parto , Gravidez , Resultado da Gravidez , Gravidez de Alto Risco , Medição de Risco
12.
PLoS One ; 14(2): e0213240, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30817780

RESUMO

INTRODUCTION: Hypertensive Disorders in Pregnancy (HDP) complicate about 10% of pregnancies. It accounts to 50% of maternal death in sub-Saharan Africa and precedes 15% of perinatal deaths worldwide. In this study, we looked at the perinatal outcomes and factors associated with unfavorable perinatal outcomes among women with hypertensive disorders in pregnancy at Wolaita Sodo teaching and referral hospital, southern Ethiopia. METHODS: A hospital based retrospective cross-sectional study design was employed among women hospitalized for hypertensive disorders in pregnancy. Socio-demographic, obstetrics, clinical laboratory, pregnancy complications and outcome were checked from patient records. Descriptive statistics were used to describe parameters collected from patient records. Bivariate and multiple logistic regressions were done to determine factors associated with unfavorable perinatal outcome. A P-value of less than 0.05 and 95% confidence interval not including 1 were considered statically significant. RESULTS: There were 168 (2.3%) cases of HDP of the total 7, 347 deliveries during the period of the study from January 2014-December 2016. 72.5% of mothers (72.5%) had vaginal delivery and 26.1% had Caesarean Section. This study revealed a perinatal mortality rate of 111.1 per 1000 live births. On bivariate logistic regression variables such as referral status, diastolic blood pressure, ANC use, types of HDP, fetal weight at birth, maternal complication and maternal outcome were found to be associated with unfavorable perinatal outcomes. On multiple logistic regression fetal weight at birth and maternal outcome were found to be an independent predictors of unfavorable perinatal outcome. CONCLUSION: Our study shows higher perinatal mortality in a tertiary hospital where emergency obstetric and newborn care is set and quality obstetric care is expected. However, tertiary facilities manage difficult cases which can explain the high PMR. But it is high which means there is enough room for improvement. Hence, the referral hospital and neighboring health facilities should give due emphasis for early detection and management of women with HDP.


Assuntos
Hipertensão Induzida pela Gravidez/mortalidade , Adulto , Peso ao Nascer , Estudos Transversais , Eclampsia/mortalidade , Etiópia/epidemiologia , Feminino , Humanos , Recém-Nascido , Masculino , Mortalidade Materna , Mortalidade Perinatal , Pré-Eclâmpsia/mortalidade , Gravidez , Resultado da Gravidez , Estudos Retrospectivos , Fatores de Risco , Centros de Atenção Terciária , Adulto Jovem
13.
J Clin Hypertens (Greenwich) ; 21(4): 479-488, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30848083

RESUMO

Hypertensive disorders of pregnancy (HDP) are a major contributor to maternal and perinatal morbidity and mortality, especially in resource-limited settings. Little is known about the magnitude of HDP in Africa. We conducted the first systematic review and meta-analysis to summarize available data on the prevalence of HDP in Africa. We did a comprehensive literature search to identify review paper published from January 1, 1996, to September 30, 2017, and searched the reference list of retrieved review paper. We used a random-effects model to estimate the overall and type-specific prevalence of HDP in Africa. We included 82 studies published between 1997 and 2017 reporting data on a pooled sample of 854 304 women during pregnancy or puerperium. Most studies were hospital-based, conducted in urban settings across 24 countries. In this population, the overall prevalence of HDP was 100.4‰ (95% CI: 81.4-121.2). The prevalence was 49.8‰ (95% CI: 32.3-70.7) for gestational hypertension, 14.7‰ (95% CI: 11.6-18.2) for chronic hypertension, 9.2‰ (95% CI: 4.2-16.0) for superimposed preeclampsia, 44.0‰ (95% CI: 36.7-52.0) for preeclampsia, 22.1‰ (95% CI: 14.8-30.8) for severe preeclampsia, 14.7‰ (95% CI: 8.1-23.2) for eclampsia and 2.2‰ (95% CI: 1.2-3.4) for HELLP syndrome. Prevalence of HDP was significantly higher in Central and Western Africa; there was a consistent tendency of increasing HDP prevalence with income at the country level. In conclusion, the burden of HDP in Africa is high, with about one in 10 pregnancies affected. The higher rate of severe forms of HDP that are associated with significant maternal and perinatal mortality is a major concern in the region.


Assuntos
Síndrome HELLP/epidemiologia , Hipertensão Induzida pela Gravidez/epidemiologia , Pré-Eclâmpsia/epidemiologia , Adulto , África/epidemiologia , Efeitos Psicossociais da Doença , Feminino , Humanos , Hipertensão Induzida pela Gravidez/economia , Hipertensão Induzida pela Gravidez/mortalidade , Recém-Nascido , Mortalidade Materna/tendências , Mortalidade Perinatal/tendências , Gravidez , Prevalência , Fatores de Risco , Índice de Gravidade de Doença , Classe Social
15.
BJOG ; 126 Suppl 3: 12-18, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30270518

RESUMO

OBJECTIVE: To investigate life-threatening maternal complications related to hypertensive disorders of pregnancy (HDP) in Nigerian public tertiary hospitals. DESIGN: Secondary analysis of a nationwide cross-sectional study. SETTING: Forty-two tertiary hospitals. POPULATION: Women admitted for pregnancy, childbirth or puerperal complications. METHOD: All cases of severe maternal outcome (SMO: maternal near-miss or maternal death) due to HDP were prospectively identified using the WHO criteria over a 1-year period. MAIN OUTCOME MEASURES: Incidence of SMO, health service events, case fatality rate, and mortality index (% of maternal death/SMO). RESULTS: Out of 100 107 admissions for maternal complications, 6753 (6.8%) women had HDP. Pre-eclampsia (PE) (54.5%) and eclampsia (E) (30.4%) were the most common HDP recorded. SMO occurred in 587 women with HDP: 298 maternal near-misses and 289 maternal deaths. The majority (93%) of the women with SMO due to HDP were admitted in a critical condition. The median diagnosis-definitive intervention interval was over 4 hours in a quarter of women who died from HDP. For PE and E, case fatality rates were 1.9 and 10.4%, respectively, although both conditions had a similar mortality index of 49.3%. Lack of antenatal care and place of residence further than 5 km from the hospital were associated with maternal death. CONCLUSIONS: Severe maternal outcomes from HDP were due to late presentations and health system challenges. To reduce maternal deaths from HDP, health system strengthening that would engender early hospital presentation and prompt treatment is recommended. FUNDING: The original research that generated the data for this secondary analysis was funded by the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), a co-sponsored programme executed by the World Health Organization (WHO). We have no other funding issue to declare for our study. TWEETABLE ABSTRACT: Eclampsia is the leading cause of maternal death in Nigerian hospitals.


Assuntos
Hipertensão Induzida pela Gravidez/mortalidade , Morte Materna/estatística & dados numéricos , Near Miss/estatística & dados numéricos , Adulto , Estudos Transversais , Eclampsia/mortalidade , Feminino , Inquéritos Epidemiológicos , Humanos , Incidência , Morte Materna/etiologia , Mortalidade Materna , Nigéria/epidemiologia , Pré-Eclâmpsia/mortalidade , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , Estudos Prospectivos , Centros de Atenção Terciária
16.
Pregnancy Hypertens ; 14: 55-58, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30527119

RESUMO

OBJECTIVE: To determine if timely treatment within 60 min of confirmed diagnosis of severe maternal hypertension with antihypertensive medications was associated with reduction in severe maternal morbidity. STUDY DESIGN: Medical records of women with severe hypertension (at least two severe blood pressures, systolic ≥160 mmHg and/or diastolic ≥110 mmHg, within 60 min) were accessed for timing of severe blood pressures, timing of treatment, and blood pressure response to treatment. Severe maternal morbidity was confirmed by multidisciplinary case review. We compared the incidence of severe maternal morbidity between women who received timely (within 60 min of diagnosis) vs. not-timely treatment. RESULTS: Of 465 women with severe hypertension, 29 (6.2%) experienced severe maternal morbidity. Fifty-six percent of women received timely treatment, of whom 1.9% had severe maternal morbidity, compared with 6.4% of women who did not receive timely treatment (p = 0.02). Timely treatment was associated with a 72% reduction in relative risk of severe maternal morbidity (p = 0.02). No significant difference was seen in median pre-treatment systolic pressures (p = 0.20) between the groups. CONCLUSION: Antihypertensive treatment within 60 min of confirmed diagnosis of severe hypertension was associated with reduction in severe maternal morbidity. Our findings support current recommendations to treat all women with severe hypertension with antihypertensive medications in a timely fashion.


Assuntos
Hipertensão Induzida pela Gravidez/mortalidade , Padrões de Prática Médica , Diagnóstico Pré-Natal , Adulto , Anti-Hipertensivos/administração & dosagem , Anti-Hipertensivos/uso terapêutico , California , Estudos de Coortes , Esquema de Medicação , Feminino , Humanos , Hipertensão Induzida pela Gravidez/diagnóstico , Hipertensão Induzida pela Gravidez/tratamento farmacológico , Hipertensão Induzida pela Gravidez/patologia , Gravidez , Estudos Retrospectivos , Risco , Índice de Gravidade de Doença , Fatores de Tempo
17.
Pregnancy Hypertens ; 12: 16-22, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29674193

RESUMO

BACKGROUND: Induction of labour (IOL) is a common procedure yet we have little information on the efficacy of the process for women with a hypertensive disorder of pregnancy (HDP). OBJECTIVE: To describe the birth type and associated factors in nulliparous HDP women undergoing an induction of labour. STUDY DESIGN: Statutorily collected datasets on every birth and hospital admission which occurred in the state of NSW Australia between the years 2000-2011 were analysed. Hypertensive women were compared to normotensive women. RESULTS: Of the nulliparous women, 9.9% had a HDP. IOL for HDP women were 56.2% in a cohort of 447 558 women. The AOR for a woman with a HDP undergoing an IOL resulting in a vaginal delivery when compared to a normotensive woman is 0.86 (95% CI 0.83-0.88). Prior to 33 weeks, the lowest perinatal mortality rates (PMR) are seen in women who undergo elective caesarean section (C/S). For women with preeclampsia (PE), lower PMR are seen in women who undergo IOL. CONCLUSION: For women with PE and SPE, IOL resulted in lower rates of vaginal delivery than spontaneous labour when compared to normotensive women who also underwent IOL. Women with PE at ≥33 weeks who underwent IOL had the lowest PMR.


Assuntos
Pressão Sanguínea , Hipertensão Induzida pela Gravidez/fisiopatologia , Trabalho de Parto Induzido , Trabalho de Parto , Paridade , Adulto , Estudos de Casos e Controles , Cesárea , Feminino , Humanos , Hipertensão Induzida pela Gravidez/diagnóstico , Hipertensão Induzida pela Gravidez/mortalidade , Recém-Nascido , Trabalho de Parto Induzido/efeitos adversos , Trabalho de Parto Induzido/mortalidade , Mortalidade Materna , New South Wales/epidemiologia , Mortalidade Perinatal , Gravidez , Sistema de Registros , Fatores de Risco , Resultado do Tratamento , Adulto Jovem
18.
Trials ; 19(1): 206, 2018 Mar 27.
Artigo em Inglês | MEDLINE | ID: mdl-29587875

RESUMO

BACKGROUND: Obstetric haemorrhage, sepsis and pregnancy hypertension account for more than 50% of maternal deaths worldwide. Early detection and effective management of these conditions relies on vital signs. The Microlife® CRADLE Vital Sign Alert (VSA) is an easy-to-use, accurate device that measures blood pressure and pulse. It incorporates a traffic-light early warning system that alerts all levels of healthcare provider to the need for escalation of care in women with obstetric haemorrhage, sepsis or pregnancy hypertension, thereby aiding early recognition of haemodynamic instability and preventing maternal mortality and morbidity. The aim of the trial was to determine whether implementation of the CRADLE intervention (the Microlife® CRADLE VSA device and CRADLE training package) into routine maternity care in place of existing equipment will reduce a composite outcome of maternal mortality and morbidity in low- and middle-income country populations. METHODS: The CRADLE-3 trial was a stepped-wedge cluster-randomised controlled trial of the CRADLE intervention compared to routine maternity care. Each cluster crossed from routine maternity care to the intervention at 2-monthly intervals over the course of 20 months (April 2016 to November 2017). All women identified as pregnant or within 6 weeks postpartum, presenting for maternity care in cluster catchment areas were eligible to participate. Primary outcome data (composite of maternal death, eclampsia and emergency hysterectomy per 10,000 deliveries) were collected at 10 clusters (Gokak, Belgaum, India; Harare, Zimbabwe; Ndola, Zambia; Lusaka, Zambia; Free Town, Sierra Leone; Mbale, Uganda; Kampala, Uganda; Cap Haitien, Haiti; South West, Malawi; Addis Ababa, Ethiopia). This trial was informed by the Medical Research Council guidance for complex interventions. A process evaluation was undertaken to evaluate implementation in each site and a cost-effectiveness evaluation will be undertaken. DISCUSSION: All aspects of this protocol have been evaluated in a feasibility study, with subsequent optimisation of the intervention. This trial will demonstrate the potential impact of the CRADLE intervention on reducing maternal mortality and morbidity in low-resource settings. It is anticipated that the relatively low cost of the intervention and ease of integration into existing health systems will be of significant interest to local, national and international health policy-makers. TRIAL REGISTRATION: ISCRTN41244132. Registered on 2 February 2016. Prospective protocol modifications have been recorded and were communicated to the Ethics Committees and Trials Committees. The adapted Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) Checklist and the SPIRIT Checklist are attached as Additional file 1.


Assuntos
Determinação da Pressão Arterial/instrumentação , Pressão Sanguínea , Alarmes Clínicos , Países em Desenvolvimento , Hipertensão Induzida pela Gravidez/diagnóstico , Choque Cardiogênico/diagnóstico , África , Determinação da Pressão Arterial/economia , Alarmes Clínicos/economia , Análise Custo-Benefício , Países em Desenvolvimento/economia , Desenho de Equipamento , Feminino , Haiti , Custos de Cuidados de Saúde , Humanos , Hipertensão Induzida pela Gravidez/mortalidade , Hipertensão Induzida pela Gravidez/fisiopatologia , Hipertensão Induzida pela Gravidez/terapia , Índia , Mortalidade Materna , Estudos Multicêntricos como Assunto , Ensaios Clínicos Pragmáticos como Assunto , Valor Preditivo dos Testes , Gravidez , Fatores de Risco , Choque Cardiogênico/mortalidade , Choque Cardiogênico/fisiopatologia , Choque Cardiogênico/terapia , Resultado do Tratamento
19.
Pregnancy Hypertens ; 11: 115-123, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29198742

RESUMO

BACKGROUND: The hypertensive disorders of pregnancy are a leading cause of maternal and perinatal mortality and morbidity. The ability to predict these complications using simple tests could aid in management and improve outcomes. We aimed to systematically review studies that reported on potential predictors of adverse maternal outcomes among women with a hypertensive disorder of pregnancy. METHODS: We searched MEDLINE, Embase and CINAHL (inception - December 2016) for studies of predictors of severe maternal complications among women with a hypertensive disorder of pregnancy. Studies were selected in a two-stage process by two independent reviewers, excluding those reporting only on adverse fetal outcomes. We extracted data on study and test(s) characteristics and outcomes. Accuracy of prediction was assessed using sensitivity, specificity, likelihood ratios and area under the receiver operating curve (AUROC). Strong evidence of prediction was taken to be a positive likelihood ratio >10 or a negative likelihood ratio <0.1, and for multivariable models, an AUROC ≥0.70. Bivariate random effects models were used to summarise performance when possible. RESULTS: Of 32 studies included, 28 presented only model development and four examined external validation. Tests included symptoms and signs, laboratory tests and biomarkers. No single test was a strong independent predictor of outcome. The most promising prediction was with multivariable models, especially when oxygen saturation, or chest pain/dyspnea were included. CONCLUSION: Future studies should investigate combinations of tests in multivariable models (rather than single predictors) to improve identification of women at high risk of adverse outcomes in the setting of the hypertensive disorders of pregnancy.


Assuntos
Hipertensão Induzida pela Gravidez/diagnóstico , Pré-Eclâmpsia/diagnóstico , Adulto , Área Sob a Curva , Feminino , Humanos , Hipertensão Induzida pela Gravidez/etiologia , Hipertensão Induzida pela Gravidez/mortalidade , Mortalidade Materna , Análise Multivariada , Pré-Eclâmpsia/etiologia , Pré-Eclâmpsia/mortalidade , Valor Preditivo dos Testes , Gravidez , Prognóstico , Curva ROC , Medição de Risco , Fatores de Risco , Adulto Jovem
20.
BMC Pregnancy Childbirth ; 17(1): 388, 2017 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-29157196

RESUMO

BACKGROUND: Hypertensive disorders in pregnancy remain a major global health issue not only because of the associated high adverse maternal outcomes but there is a close accompaniment of significant perinatal morbidity and mortality especially in Sub-Saharan Africa (SSA). However, the perinatal burden of HDP in Ghana has not been explored. We conducted this study to determine the perinatal outcomes of HDP at a tertiary hospital in Ghana. METHODS: A cross-sectional study conducted between January to February 2013 at Korle Bu Teaching Hospital (KBTH) in Accra, Ghana. Data collection involved baseline review of all the obstetric population who had just delivered to identify those with HDP. An informed consent was obtained after which a structured questionnaire was adminstered to the hypertensive mothers. The medical records of the mothers and their babies were also reviewed to determine the perinatal outcome indicators of relevance to the study. Data obtained were analyzed using SPSS version 20. RESULTS: We included 368 women with HDP and singleton births with a mean gestational age at delivery of 37.4 ± 3.3 weeks. Adverse perinatal outcomes determined include the following: 91 (24.7%) neonates were admitted to the Neonatal Intensive Care Unit, 56 (15.2%) had neonatal respiratory distress/asphyxia with 14 (3.8%) requiring ventilatory support and 80 (21.7%) were delivered preterm. Also, stillbirth, early neonatal death, intrauterine growth restriction and low birth weight occurred in 25 (6.8%), 14 (3.8%), 23 (6.1%) and 91 (24.7%) respectively with a perinatal mortality rate of 106 per 1000 births. One and 5 minute APGAR scores <7 occurred in 125 (34.0%) and 55 (14.7%) neonates respectively. Most of the adverse perinatal outcomes were significantly more common in those with preeclampsia compared to the other hypertensive disorders. CONCLUSION: There is a significant burden of perinatal morbidity and mortality associated with HDP in the Ghanaian obstetric population and these adverse outcomes were more prevalent in preeclampsia compared to the other hypertensive disorders. Regular goal-oriented clinical audit into perinatal morbidity and mortality associated with HDP and an active multidisciplinary approach to the management of these disorders in the hospital might improve the clinical outcomes of women with maternal hypertension.


Assuntos
Hipertensão Induzida pela Gravidez/mortalidade , Doenças do Recém-Nascido/mortalidade , Mortalidade Perinatal , Adulto , Estudos Transversais , Feminino , Idade Gestacional , Gana/epidemiologia , Humanos , Recém-Nascido , Doenças do Recém-Nascido/etiologia , Gravidez , Resultado da Gravidez , Centros de Atenção Terciária , Adulto Jovem
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