Review of the Hypertensive Disorders on Pregnancy in
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Transcript Review of the Hypertensive Disorders on Pregnancy in
• Burden Of Pre-Eclampsia
and Eclampsia in Ethiopia
Mengistu Hailemariam(MD),FMOH
Presentation Outline
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Background information
Maternal mortality in Ethiopia
Causes of Maternal mortality
Burden of Pre-eclampsia/Eclampsia
Interventions
Background Information, 2011
Ethiopia:
Nine Administrative
Regions
-Two City
Administration
-817 woredas (districts)
>15,000 Kebeles
Tot. Pop., 79,221,000
Annual Expected
Pregnancies≈3 million
3
Maternal mortality in Ethiopia
Maternal Mortality Ratio
MMR 1990 1068 (UN Estimate)
MMR 2000 871 (EDHS 2000)
MMR 2005 673 (EDHS 2005)
MMR2008 470( WHO 2008)
MDG target MMR 267
Causes of Maternal Death
unsafe
Abortion 13
%
Other, 15%
Sepsis, 15%
Hypertension
, 12%
Hemorrriage
25 %
Obstructed
labor 20 %
Burden of Preeclampsia/Eclampsia
• Though hypertensive disorders of pregnancy are
common in daily practice in our set up, there is
no national study &there are only few studies in
health institutions & there is a paucity of studies
in the area.
• A retrospective review of 6 articles on
hypertensive disorders of pregnancy were
identified from 1966 to 2007.
Summary of the Studies
No Author
Title
Years of
Study
Type of study
1
Jackson A
Eclampsia in Addis Ababa: pattern & treatment
(PTMH)
19661969
Retrospective
survey
2
Getachew
A
Outcome of pregnancies complicated with
preeclampsia-eclampsia disorders at SPH &TAH
1987
Case- control
3
Mekbib T
Pre-eclampsia/eclampsia at Yekatit 12 Hospital,
Addis Ababa, Ethiopia
19871989)
Descriptive
study
4
Abate M
Eclampsia, a 5 year retrospective review of 216
cases managed in two teaching hospitals,
AA(SPH &TAH)
1994-99
Descriptive
study
5
Teklu S
Prevalence & clinical correlates of hypertensive
disorders of pregnancy at TAH
2003-04
Descriptive
study
6
Kebede B
Maternal & perinatal outcome of severe
preeclampsia at the three teaching hospitals,
2007
Descriptive
study
Distribution of cases by age
Age
1
2
3
4
5
6
Total
15-19
10
13
91
69
12
18
213
20-24
11
42
86
56
47
49
291
25-29
11
41
77
58
68
72
327(29.
38%)
30-34
2
28
51
20
31
35
167
>=35
1
14
43
13
25
19
115
total
35
138
348
216
183
193
1113
Distribution of cases by diagnosis
Studi Mild
es
Preeclampsia
Severe
Eclampsia
Preeclamp
sia
1
Chronic
HPN/+superim
position
HELLP/par Total
tial HELLP
35
35
2
66
43
5
3
52
275
21
348
216
216
4
5
34
6
Total
85
104
152
507(45.55
%)
37
24
138
27
183
41
48
193
314(28.21% 92
)
48
1113
intervention
TYPE OF STUDY
1
intervention
Preterm delivery
Elective induction
Elective C/S
12(35%)
0(0%)
13(37.5%)
86(39.8%)
36(16.7%)
90(42%)
2
3
4
5
89(48.6%)
107(58.5%)
6
108(56%)
Total
313(28.12%)
22(11.4%)
58(5.2%)
97(50.4%)
289(25.9%)
Management of eclampsia
TYPE OF
STUDY
ANTICONVULSANT
1
LYTIC COCTAIL
(CPZ,Promethasin
and pethidin)
2
DIAZEPAM
3
DIAZEPAM
4
DIAZEPAM
5
DIAZEPAM
6
DIAZEPAM
CONTROL OF
CONVULSION
LYTIC COCTAIL+THIOPENT
37%
65.7%
MAGNISIUM SO4(60.6%)
73%
CASE FATALITY RATE
STUDIES
CFR
HDP
Preeclampsia
mild
Eclampsia
severe
1
2
17%
-----
--------
----------
3
20%
23.8%
4
13%
5
2.7%
------
6
4.1%
2.6%
7 (3.2%) mothers died before delivery
8%
PERINATAL MORTALITY
Still births
Early Neonatal
deaths
Total PN
deaths
PNMR
1
9
3
12
342/00
2
11
10
21
152/00
3
30
29
59
165/00
4
44
25
69
312.2/00
5
40
18
58
300/00
6
27
32
59
306/00
Total
161
117
278
Maternal morbidity
studies Study
population
ARF
Pulmonar Abr
y oedema upti
on
DIC
PPH
2.8
%
11.6%
ICU
Intracranial
referral haemorrhag
e
1
2
3
4
eclampsia
5.5%
6.9%
5
6
Severe
20.2% 17.6%
preeclampsia
26.9
%
12.4 15%
%
13%
Interventions to address preeclampsia/Eclampsia
-The nation has identified that PE/E is one of the
major causes of maternal mortality and
various endeavors are ongoing:
1.Capacity Buiding
-The preservice trainings of all health care providers have been made to
address the issue of PE/E adequately
-Inservice trainings on the management of PE/E using the gold standard
Mgso4 are being given for health care providers of both the public and
private health facilities
-National Obstetrics service guideline has been revised to include use of
Mgso4.
Interventions to address preeclampsia/Eclampsia
2. Logistics
-All the necessary supplies and equipments are
being availed to health facilities for
management of PE/E
3. Supportive supervision
Thank You