RESUMEN
Hypertensive disorders in pregnancy (HDP) are a group of conditions-including chronic hypertension, gestational hypertension, preeclampsia with and without end-organ damage, and acute complications, which include HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome and eclampsia-that could lead to severely adverse outcomes for both mother and fetus. The incidence of HDP has increased, affecting one out of seven delivery hospitalizations. Physicians should be aware of HDP for early identification and proper treatment to improve patient outcomes.
Asunto(s)
Hipertensión Inducida en el Embarazo , Médicos , Femenino , Embarazo , Humanos , Hipertensión Inducida en el Embarazo/diagnóstico , Hipertensión Inducida en el Embarazo/epidemiología , Hipertensión Inducida en el Embarazo/terapia , Pacientes , Síndrome , Atención al PacienteRESUMEN
BACKGROUND: Pre-eclampsia is a leading cause of preventable maternal and perinatal deaths globally. While health inequities remain stark, removing financial or structural barriers to care does not necessarily improve uptake of life-saving treatment. Building on existing literature elaborating the sociocultural contexts that shape behaviours around pregnancy and childbirth can identify nuanced influences relating to pre-eclampsia care. METHODS: We conducted a cross-cultural comparative study exploring lived experiences and understanding of pre-eclampsia in Ethiopia, Haiti and Zimbabwe. Our primary objective was to examine what local understandings of pre-eclampsia might be shared between these three under-resourced settings despite their considerable sociocultural differences. Between August 2018 and January 2020, we conducted 89 in-depth interviews with individuals and 17 focus group discussions (n = 106). We purposively sampled perinatal women, survivors of pre-eclampsia, families of deceased women, partners, older male and female decision-makers, traditional birth attendants, religious and traditional healers, community health workers and facility-based health professionals. Template analysis was conducted to facilitate cross-country comparison drawing on Social Learning Theory and the Health Belief Model. RESULTS: Survivors of pre-eclampsia spoke of their uncertainty regarding symptoms and diagnosis. A lack of shared language challenged coherence in interpretations of illness related to pre-eclampsia. Across settings, raised blood pressure in pregnancy was often attributed to psychosocial distress and dietary factors, and eclampsia linked to spiritual manifestations. Pluralistic care was driven by attribution of causes, social norms and expectations relating to alternative care and trust in biomedicine across all three settings. Divergence across the contexts centred around nuances in religious or traditional practices relating to maternal health and pregnancy. CONCLUSIONS: Engaging faith and traditional caregivers and the wider community offers opportunities to move towards coherent conceptualisations of pre-eclampsia, and hence greater access to potentially life-saving care.
Asunto(s)
Comparación Transcultural , Conocimientos, Actitudes y Práctica en Salud/etnología , Preeclampsia/etnología , Condicionamiento Psicológico , Etiopía/etnología , Femenino , Haití/etnología , Modelo de Creencias sobre la Salud , Humanos , Embarazo , Investigación Cualitativa , Características de la Residencia , Zimbabwe/etnologíaRESUMEN
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.
Asunto(s)
Desprendimiento Prematuro de la Placenta/epidemiología , Hipertensión Inducida en el Embarazo/epidemiología , Recién Nacido de Bajo Peso , Nacimiento Prematuro/epidemiología , Mortinato/epidemiología , Adulto , Estudios de Casos y Controles , Recolección de Datos , Femenino , Haití/epidemiología , Hospitales/estadística & datos numéricos , Humanos , Hipertensión Inducida en el Embarazo/mortalidad , Mortalidad Materna , Vigilancia de la Población , Embarazo , Prevalencia , Estudios Retrospectivos , Adulto JovenRESUMEN
OBJECTIVE: To assess the placental morphometry in pregnancies with hypertensive disorders of pregnancy (HDP) and its relationship with birth weight (BW). STUDY DESIGN: Cohort study of placental morphometry and fetal outcomes of 954 pregnancies at a university hospital in Ribeirão Preto, São Paulo, Brazil, in 2010. HDP categories were: chronic (CH), gestational (GH), preeclampsia (PRE) and pre-eclampsia superimposed on chronic hypertension (CHâ¯+â¯PRE). Associations between BW and placental measures (PM) in pregnancies were evaluated by multiple linear regression analyses. MAIN OUTCOME MEASURES (PM): Placental weight (PW, g), largest and smallest diameters (cm), thickness (cm), eccentricity, area (cm2), volume (cm3), BW/PW ratio and PW/BW ratio (efficiency). RESULTS: The frequencies of each HDP categories were 6.5% CH; 7.6% GH; 6.1% PRE, and 2.0% CHâ¯+â¯PRE. PW, largest and smallest diameters, area and BW/PW ratio were statistically different between HDP and the normotensive group, with the lowest values for CHâ¯+â¯PRE; the remaining measures showed no difference. BW was lower in HDP than in the normotensive group (pâ¯=â¯0.016). BW and PW were highly correlated in the presence of HDP (râ¯=â¯0.79, pâ¯<â¯0.001). Sixty-seven percent of BW variability was accounted for PM (pâ¯<â¯0.001), and increased to 81% when maternal variables, gestational age and sex were added (pâ¯<â¯0.001). CONCLUSIONS: Hypertensive disorders of pregnancy significantly influence the growth of both the placenta and the fetus. PM explain 67% of BW variability, and CHâ¯+â¯PRE was the category with the strongest association to the results.