Maternal mortality predictors in women with hypertensive disorders of pregnancy: a retrospective cohort study.
BACKGROUND
Hypertensive disorders of pregnancy (HDP) are multisystem disorders unique to human pregnancy. They are becoming the leading causes of maternal mortality worldwide, with the majority of deaths occurring in low income countries. However, little is known about the predictors of maternal mortality in women with HDP.


METHODS
A retrospective cohort study was conducted between 2008 and 2013 in three university teaching hospitals among 1015 women admitted with a diagnosis of HDP. Statistically significant associations were assessed by the hazard ratio (HR) with 95% confidence using the Cox proportional hazards 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 survival analyses showed an increased risk of maternal mortality among women with eclampsia (HR=8.4), no antenatal 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 untreated with antihypertensive drug (HR=4.2).


CONCLUSIONS
The case fatality rate of HDP was among the highest in the world and a delay in initiation of treatment because of delay in health care-seeking contributed to the majority of maternal deaths.
Hawassa University College of Medicine and Health Sciences, Ethiopia.
Yifru
Y
Berhan
Hawassa University College of Medicine and Health Sciences, Ethiopia.
Gezahegn
G
Endeshaw
D000293:Adolescent; D000328:Adult; D000927:Anticonvulsants / Q000009:adverse effects / Q000627:therapeutic use; D001794:Blood Pressure; D002423:Cause of Death; D003404:Creatinine / Q000097:blood; D003975:Diazepam / Q000009:adverse effects / Q000627:therapeutic use; D004461:Eclampsia / Q000401:mortality*; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000401:mortality; D063130:Maternal Death / Q000209:etiology*; D008428:Maternal Mortality; D008875:Middle Aged; D010298:Parity; D010342:Patient Acceptance of Health Care; D011247:Pregnancy; D011295:Prenatal Care; D012189:Retrospective Studies; D061665:Time-to-Treatment; D055815:Young Adult
D000927:Anticonvulsants; D003404:Creatinine; D003975:Diazepam
Ethiopia; hypertensive disorders; maternal mortality; predictors; retrospective cohort