Hypertensive disorders of pregnancy impact 10% of pregnant women globally (17). Chronic (preexisting) hypertension, gestational hypertension, and preeclampsia cause 14% of maternal fatalities globally and the rate of recurrent eclampsia in subsequent pregnancies is believed to be around 2% (18, 16).Preeclampsia is the most prevalent medical complication of pregnancy and major cause of maternal, fetal and newborn morbidity and mortality (19). It complicates 5 to 8% of all pregnancies, which equates to 8.5 million cases every year worldwide (20).
Clark et al (21), reported 95 maternal fatalities in 1,461,270 pregnancies after evaluating all maternal deaths in the United States among nearly 1.5 million deliveries in 124 hospitals (6.5 per 100,000 pregnancies). The average maternal age of the women who died was 29 years (range, 13–42). In our study, the average age was more than 20 years. These complications can be classified into obstetric and non-obstetric complications. Obstetric problems caused by preeclampsia include intrauterine growth restriction (IUGR), intrauterine fetal death (IUFD), early delivery, HELLP syndrome, and eclampsia. On the other hand, heart failure, peripartum cardiomyopathy, pulmonary edema, posterior reversible encephalopathy syndrome, stroke, renal failure, acute kidney injury, future risk of end-stage renal disease, liver failure, hepatic rupture, and coagulopathy are non-obstetric complications in preeclampsia(22).
Preeclampsia is a major risk for both early and late complications affecting both the mother and the infant. These complications include pulmonary thromboembolism, amniotic fluid embolism, obstetric hemorrhage, sepsis, acute renal failure, postpartum cardiomyopathy and neurologic complications including cerebral venous thrombosis and intracerebral hemorrhage (12, 23). In this study, the death rate was so high among those with severe infections and acute renal failure.
In addition to this early complication, women with preeclampsia have a high risk of developing late complications like chronic hypertension (3.7 times higher risk of developing hypertension later in life), coronary heart disease (2.2 times increased risk), and stroke (1.8 times higher risk) (24). Despite significant efforts to identify predicted risk factors for maternal and prenatal outcomes, preeclampsia typically has an unexpected prognosis, with maternal and fetal health deteriorating within hours (25). Early suspicion and diagnosis, as well as early treatment, are important for good results. Early management includes fluid balance, pressure control with intravenous (IV) antihypertensive agents balanced with the risk of acute fetal compromise, and MgSO4(26). In some patients with ongoing oliguria, pulmonary edema, or other complicating medical issues, intensive monitoring via central venous pressure may be appropriate. The goal of antihypertensive medication is to keep systolic blood pressure (BP) between 140 and 155 mm Hg and diastolic blood pressure (BP) between 90 and 105 mm Hg (14). Even though both labetalol and nifedipine are as effective as hydralazine in the acute setting and are much less likely to cause abrupt, profound hypotension, no single antihypertensive has been shown to be superior to another (27, 28). By ACOG recommendation, Intravenous (IV) hydralazine, labetalol, and oral nifedipine are for acute hypertensive urgency, and oral calcium channel blockers and labetalol are recommended for long-term control (29).
Although delivery is the definitive treatment for pre-eclampsia and eclampsia, the method of delivery must be tailored to each case. A team of obstetricians and intensive care unit specialists decided when the delivery should be done, and an anesthesiologist decided what type of anesthesia should be used. The delivery criteria should be based on gestational age at diagnosis (estimated fetal weight) and severity of preeclampsia. In general, both general and regional anesthetic procedures are equally suitable for cesarean delivery in pregnant women with severe preeclampsia if precautions are taken to establish a careful approach to either treatment (30). Although it is an avoidable death, the mortality rate was high in our study, so it is mandatory to take action to reduce pre-eclampsia-related mortality and morbidity complications. The Millennium Development Goal 5 goal was to reduce maternal mortality by three-quarters between 1990 and 2015(31). Time is one of the main strategies to reduce maternal mortality, as the late decision to seek care, the late arrival at a health center, as well as the late offering of appropriate care, have major influences on maternal mortality (32).
The main factors that may increase mortality in our society include a lack of knowledge and awareness of pregnancy-related hypertension, a lack of antenatal care during pregnancy, and even an increased level of those who make deliveries in traditional non-hospital areas. Family planning, balanced nutritional status, increasing maternal knowledge and awareness, and taking the necessary prenatal care are factors that are required to reduce the occurrence of preeclampsia-related complications.