Severe Hypertensive Disorders of Pregnancy in Eastern Ethiopia: Comparing the Original WHO and Adapted sub-Saharan African Maternal Near-Miss Criteria

Abstract

Abera Kenay Tura,1,2 Sicco Scherjon,2 Jelle Stekelenburg,3,4 Jos van Roosmalen,5,6 Thomas van den Akker,5,6 Joost Zwart7 1School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia; 2Department of Obstetrics and Gynecology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands; 3Department of Health Sciences, Global Health, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands; 4Department of Obstetrics and Gynecology, Leeuwarden Medical Centre, Leeuwarden, The Netherlands; 5Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; 6Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands; 7Department of Obstetrics and Gynaecology, Deventer Ziekenhuis, Deventer, The NetherlandsCorrespondence: Abera Kenay TuraSchool of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, POB 235, Harar, EthiopaEmail [email protected]: To assess life-threatening complications among women admitted with severe hypertensive disorders of pregnancy and compare applicability of World Health Organization (WHO) maternal near-miss (MNM) criteria and the recently adapted sub-Saharan African (SSA) MNM criteria in eastern Ethiopia.Methods: Of 1,054 women admitted with potentially life-threatening conditions between January 2016 and April 2017, 562 (53.3%) had severe preeclampsia/eclampsia. We applied the definition of MNM according to the WHO MNM criteria and the SSA MNM criteria. Logistic regression was performed to identify factors associated with severe maternal outcomes (MNMs and maternal deaths).Results: The SSA MNM criteria identified 285 cases of severe maternal outcomes: 271 MNMs and 14 maternal deaths (mortality index 4.9%). The WHO criteria identified 50 cases of severe maternal outcomes: 36 MNMs and 14 maternal deaths (mortality index 28%). The MNM ratio was 36.6 per 1,000 livebirths according to the SSA MNM criteria and 4.9 according to the WHO criteria. More than 80% of women in both groups had MNM events on arrival or within 12 hours after admission. Women without antenatal care, from rural areas, referred from other facilities, and with concomitant hemorrhage more often developed severe maternal outcomes.Conclusion: Regarding hypertensive disorders of pregnancy, the SSA tool is more inclusive than the WHO tool, while still maintaining a considerably high mortality index indicating severity of included cases. This may enable more robust audits. Strengthening the referral system and improving prevention and management of obstetric hemorrhage in women with hypertensive disorders of pregnancy are required to avert severe maternal outcomes.Keywords: severe maternal outcomes, hypertensive disorders of pregnancy, maternal near-miss, maternal mortality, sub-Saharan Africa

Keywords

• severe maternal outcomes
• hypertensive disorders of pregnancy
• maternal near miss
• maternal mortality
• sub-saharan africa