Hypertensive Disorders of Pregnancy Deaths: A Four-Year Review at a Tertiary/Quaternary Academic Hospital
Abstract
1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Context
2.3. Study Sample
2.4. Data Collection and Analysis
2.5. Ethics
3. Results
3.1. Maternal Demographics, Pregnancy Characteristics, and Initial Management
3.2. Management at Presentation at Referral Facilities and Study Site
4. Discussion
5. Conclusions
5.1. Strength and Limitations
5.2. Recommendations
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Description (n = 23) | n (%) or Median (IQR; Range) |
---|---|
Age in years | 27 (23–31; 18–39) |
Body mass index (BMI) | 33.5 (26.5–36.5; 19.5–49.9) |
Previous mode of delivery | |
Normal vaginal delivery (NVD) | 9 (50.0%) |
Caesarean section | 3 (16.7%) |
Median parity | 1 (0–2; 0–2) |
Booking status | |
Booked | 18 (78.2%) |
Unbooked | 5 (21.7%) |
EGA at booking | 15 (11.75–22.25; 6.0–30) |
Co-morbidities (n = 8) | |
Chronic hypertension (CHT) | 3(37.5%) |
Diabetes Mellitus (DM) | 1(12.5%) |
Previous gestational hypertensin (GHT) | 4 (50.0%) |
Prophylaxis | |
Low-dose aspirin (LDA) initiated in women with risk factors at first booking presentation (n = 8) | 1 (12.5%) |
Description | Referring Healthcare Centres (n = 18) | Study Site (n = 23) |
---|---|---|
n (%) or Median (IQR; Range) | n (%) or Median (IQR; Range) | |
Blood pressure | ||
SBP (mmHg) | 170(151–196; 130–241) | 149.5 (137–183.0;101–238) |
DBP | 110(96–122; 80–163) | 103.5 (89–123; 65–165) |
Proteinuria | ||
Proteinuria on urine dipstick | 18 (100) | 19 (10.5%) |
Spot urine protein-to-creatinine ratio (UCPCR) (mg/mmol) | 0 (0.0%) | 19 (90.5%) |
Signs and symptoms of severity | ||
BP 160/110 or more | 12 (66.7%) | 16 (69.6%) |
Eclamptic seizures | 3 (16.7%) | 6 (26.1%) |
Frontal headache | 5 (27.8%) | 9 (39.1%) |
Epigastric pain | 3 (16.7%) | 4(17.4%) |
Visual disturbances | 1 (5.6%) | 2 (8.7%) |
GCS less than 15 | 3 (16.7%) | 7 (30.4%) |
Management of acute elevated blood pressure (n = 12) | (n = 16) | |
Short-acting calcium channel blocker (Nifedipine®) | 5 (41.7%) | 7 (43.8%) |
Alpha-beta blocker (Labetalol®) † | 0 (0.0%) | 5 (31.3%) |
Magnesium sulphate | ||
Loading dose | 10 (83.3%) | 13 (81.2%) |
Maintenance dose | 7 (58.3%) | 9 (56.3%) |
Long-acting/maintenance antihypertensive treatment | (n = 23) | |
First line | 9 (75.0%) | 15 (65.2%) |
Second line | 0 (0.0%) | 4(17.4%) |
Third line | 0 (0.0%) | 2 (8.7%) |
Admission to obstetric high care (OHCU) and intensive care (ICU) units | ||
OHCU | 0 (0.0%) | 16 (73.9%) |
ICU | 0 (0.0%) | 7 (30.4%) |
Description (n = 23) | n (%) or Median (IQR; Range) |
---|---|
Delivery | |
Estimated gestational age at delivery (n = 20) | 32 (29–36, 20–39) weeks |
NVD | 4 (20.0%) |
Caesarean section | 16 (80.0%) |
Maternal Complications of HDP (n = 23) | |
Renal dysfunction | 17 (73.9%) |
HELLP syndrome | 15 (65.2%) |
Eclampsia | 9 (39.1%) |
Intracranial haemorrhage | 4 (17.4%) |
Pulmonary oedema | 3 (13.0%) |
Subcapsular liver haematoma | 2 (8.7%) |
Resuscitation | |
Performed | 16 (69.6%) |
Not performed | 7 (30.4%) |
Brain dead | 1 (14.3%) |
Poor prognosis | 1 (14.3%) |
Reason(s) not stated | 5 (71.4%) |
Timing of deaths | |
Postpartum | 20 (87.0%) |
Antepartum | 3 (13.0%) |
Place of Death | |
General ward/obstetric admission area | 4 (17.4%) |
Obstetrics high care unit (OHCU) | 7 (30.4%) |
Intensive care unit (ICU) | 12 (52.2%) |
Day of death post-delivery (n = 20) | 4 (1–8; 0–16) |
Postmortem | |
Performed | 21 (91.3%) |
Not performed | 2 (8.7%) |
Final cause of death | |
Eclampsia | 6 (26.1%) |
Renal failure | 6 (26.1%) |
HELLP syndrome and DIC | 5 (21.7%) |
Intracranial bleed | 4 (17.4%) |
Pulmonary embolism | 2 (8.7%) |
Avoidable Factor (23) | N (%) |
---|---|
Patient-related | 11 (47.5%) |
Lack of antenatal care | 5 (45.5%) |
Late booking/inadequate | 6 (54.5%) |
Administrative | |
Lack/delay in emergency transport | 17 (73.9%) |
Delay in finding an ICU bed/lack of ICU bed | 11 (21.7%) |
Healthcare-related | |
Inappropriate management or response to abnormal clinical findings or results | 12 (52.2%) |
Lack of resuscitation | 5 (21.7%) |
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Khan, Z.L.; Balie, G.M.; Chauke, L. Hypertensive Disorders of Pregnancy Deaths: A Four-Year Review at a Tertiary/Quaternary Academic Hospital. Int. J. Environ. Res. Public Health 2025, 22, 978. https://doi.org/10.3390/ijerph22070978
Khan ZL, Balie GM, Chauke L. Hypertensive Disorders of Pregnancy Deaths: A Four-Year Review at a Tertiary/Quaternary Academic Hospital. International Journal of Environmental Research and Public Health. 2025; 22(7):978. https://doi.org/10.3390/ijerph22070978
Chicago/Turabian StyleKhan, Zeenat L., Gaynor M. Balie, and Lawrence Chauke. 2025. "Hypertensive Disorders of Pregnancy Deaths: A Four-Year Review at a Tertiary/Quaternary Academic Hospital" International Journal of Environmental Research and Public Health 22, no. 7: 978. https://doi.org/10.3390/ijerph22070978
APA StyleKhan, Z. L., Balie, G. M., & Chauke, L. (2025). Hypertensive Disorders of Pregnancy Deaths: A Four-Year Review at a Tertiary/Quaternary Academic Hospital. International Journal of Environmental Research and Public Health, 22(7), 978. https://doi.org/10.3390/ijerph22070978