Time Intervalbetween Onset of Symptoms of Severe Preeclampsia to Delivery: Effect on Pregnancy Outcomes at Mbarara Regional Referral Hospital, South Western Uganda

Abstract

Background: Hypertensive disorders of pregnancy (HDP) account for nearly 18% of all maternal deaths worldwide. Preeclampsia is a leading cause of direct maternal mortality worldwide, and the second in Uganda contributing about 9.1% of total maternal death. Expectant management of severe pre-eclampsia at 30–34 weeks is associated with good perinatal outcome and risk reduction for the mother. Methods: This was a retrospective cohort study done by reviewing maternal medical records from September 2009 to September 2011 and all mothers who had delivered at Mbarara Hospital with a diagnosis of severe pre-eclampsia (SPE) during study period were included in the study. Results: Primigravidae accounted for about 42.6% of the cases of severe preeclampsia studied and majority (66.7%) of the women were aged between 20-30 years. The overall good fetal outcome rate in this study was 47.5% and 68.3% of the women studied were more than 28 weeks of amenorrhoea and 31.2% had still births. The most common symptom was headache (47%) and over 35% of these women presented for delivery more than 72hours from onset of symptoms. Delivery between 0-18 hours was protective, (OR0.43, 95%CI : 0.29-0.5), p-value=0.013). Conclusions: The complication rate associated with severe preeclampsia is high and worsens with longer duration of symptoms before delivery. Delivery within 18 hours of onset of symptoms is associated with good fetal outcomes and this stresses the importance of early presentation for care by the mothers and timely decision making by the clinicians