Review of the Hypertensive Disorders on Pregnancy in

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• 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
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