Effect of Hypertensive Disorders of Pregnancy on Maternal Health Outcomes at Primary Health Care Centers in Gaza Strip – Palestine

Abstract

Aims: To identify the possible effects of hypertensive disorders of pregnancy (HDP) on maternal health outcomes of women attended primary health care centers (PHCCs) in Gaza Strip – Palestine. Study Design:  A cross-sectional comparative design. Place and Duration of Study: The study was conducted at 6 PHCCs from August 2016 to May 2017. Methodology: Two groups of 215 hypertensive mothers and 215 normotensive mothers in the last pregnancy were recruited by 3-stage stratified random sampling technique. A detailed questionnaire filled through face to face interviews in addition to medical records revision in 2017. Pearson's Chi-square and t-tests were used to compare the outcomes between the two groups. Results: HDP in 215 women were classified as pregnancy-induced hypertension (n = 153, 71.2%) and chronic hypertension (n = 62, 27.8%). The mean age of HDP women was 28.8 ± 6.8 years. About 40.9% live in refugee camps; 23.7% had gravida ≥ 7; 54.6% had BMI > 30 and 21.9% had a history of twice or more abortions. Only 20% of HDP women received preconception care. Cesarean section and assisted delivery were significantly higher among hypertensive mothers (37.2% and 26.9%) compared with non-hypertensive (16.3% and 8.4%) respectively (P = 0.001). Incidence of preeclampsia/eclampsia, antepartum hemorrhage and postpartum hemorrhage, were significantly higher among HDP women (29.3%, P = 0.001; 14%, p=0.001; 7%, P = 0.003 respectively) while no significant differences in abrupio placenta (0.9%; P = 0.25), placenta previa (0.5%, P = 0.75) HELLP syndrome (0.9%, P = 0.24) were found between the two groups. 20.9% mothers with pregnancy-induced hypertension were not recovered and developed chronic hypertension. Conclusion: Women with HDP are at higher risk to have adverse maternal outcomes compared to normotensive women in GS. Preconception care, early diagnosis and prenatal follow-up would improve maternal and fetal prognosis.