Admission pattern and outcome of hypertensive disorders of pregnancy: a retrospective study of admitted cases at the Princess Christian Maternity Hospital in Freetown, Sierra Leone.

BACKGROUND: Hypertensive disorders of pregnancy (HDP) are major contributors to maternal and neonatal mortality, particularly in low-resource settings. Pregnancy-induced hypertension accounted for 16% of maternal deaths in 2016, ranking as the second leading cause of maternal mortality in Sierra Leone. The country faces challenges of HDP management due to limited primary healthcare resources. This study investigated the admission patterns and outcomes of HDP at the Princess Christian Maternity Hospital (PCMH) in Freetown, Sierra Leone.

METHODS: A retrospective cross-sectional study was conducted, reviewing medical records of 572 pregnant women admitted with HDP at PCMH from January to December 2022. Hypertensive patients were classified according to established criteria for hypertensive pregnancy. Maternal and neonatal outcomes were categorised as favourable and unfavourable outcomes based on set criteria. The Chi-square Test and Fisher's exact test were performed to determine the association between admission patterns/management with maternal and neonatal outcomes using Statistical Package for Social Sciences version 27.

RESULTS: Out of the 572 HDP patients admitted cases reviewed, preeclampsia was the most common type of HDP 446 (78%). The majority of admissions occurred in the third trimester (95.6%) with common presenting symptoms including headache 64 (11.2%) and oedema 45 (7.9%). Most patients were treated with antihypertensive medications 547 (96%), predominantly combinations of two or more antihypertensive drugs 435 (76.0%). Maternal outcomes were favourable in 488 (85.3%), while neonatal outcomes were favourable in 396(69.2%). Gestational age on admission (p < 0.001), prolonged hospitalisation ≥ 7 days (p < 0.001), and elevated diastolic BP (p < 0.001) significantly predicted adverse neonatal outcomes, while gestational age on admission (p < 0.001) and prolonged hospitalisation ≥ 7 days (p < 0.001) were significantly associated with maternal outcome.

CONCLUSION: This study underscores the substantial burden of hypertensive disorders of pregnancy in Sierra Leone, with preeclampsia as the most common presentation, largely diagnosed in the third trimester. Despite favourable maternal outcomes, neonatal outcomes remain suboptimal. These findings underscore the need for improved antenatal screening, enhanced neonatal care, and adoption of predictive tools to support early detection and targeted intervention, particularly among younger, previously overlooked at-risk populations.