Morbidity and mortality associated with pre-eclampsia at two tertiary care hospitals in Sri Lanka

Abstract

Aim: To report the occurrence of morbidity and mortality associated with carefully phenotyped pre-eclampsiain a sample of nulliparous Sinhalese women with strictly defined disease.Methods: A phenotyping database of 180 nulliparous women with pre-eclampsia and 180 nulliparous nor-motensive pregnant women who were recruited for a study into genetics of pre-eclampsia was analyzed.Results: Women who developed pre-eclampsia had significantly higher systolic blood pressure (SBP;P = 0.002) and diastolic blood pressure (DBP; P = 0.002) at booking (at approximately 13 weeks of gestation).38.3%, 28.3% and 33.3% of women delivered at <34 weeks, at 34–36 weeks, and at term, respectively. 78%required a cesarean section. Complications included SBP ⱖ 160 mmHg (75.5%); DBP ⱖ 110 mmHg (83.8%);proteinuria ⱖ3 + (150 mg/dL) in the urine protein heat coagulation test (87%); renal failure requiring dialysis(2%); platelet counts <100 ¥ 109/L (13%); ⱖ70 U/L in aspartate and/or alanine aminotransaminase (15%);placental abruption (4%); eclampsia (9%); and one maternal death. Maternal complications indicative of severedisease, apart from the incidence of SBP ⱖ 160 mmHg and DBP ⱖ 110 mmHg, were not significantly differentin early and late-onset pre-eclampsia; fetal outcome was better with late-onset disease. 48% of babies weresmall for gestational age. Only 80 of 135 babies of women with pre-eclampsia whose condition could beconfirmed at 6 weeks post-partum were alive.Conclusions: Pre-eclampsia in Sinhalese women is associated with severe maternal morbidity and fetalmorbidity and mortality, suggesting that modification of the Western diagnostic criteria and/or guidelines formedical care may be necessary. There is an urgent need to improve neonatal intensive care services in SriLanka.