Description of the contributing factors to deaths secondary to hypertensive disorders associated with pregnancy in Antioquia, Colombia (2012-2020)
Journal: Advances in Medicine and Engineering Interdisciplinary Research DOI: 10.32629/ameir.v3i3.4745
Abstract
Objective: To describe the characteristics of the affected population and the delays that contributed to maternal mortality secondary to hypertensive disorders of pregnancy. Materials and Methods: Descriptive and retrospective study based on the epidemiologic surveillance of sentinel cases of early maternal deaths of women residing in Antioquia, Colombia, during pregnancy, delivery and the 42 days after delivery occurring in the period 2012-2020. A database was created in Microsoft Access 2007 (Microsoft, Redmond, WA, USA), and data were analyzed in Microsoft Excel and SPSS version 22. Results: There were 266 maternal deaths, of which 38 were secondary to hypertensive disorders of pregnancy. Eclampsia was the cause of 15 deaths; 12 due to HELLP syndrome, 9 due to intracerebral hemorrhage, and 2 due to placental abruption and disseminated intravascular coagulation. In 13 of the 38 cases, there was no adequate magnesium sulfate regimen, 19 did not receive indicated antihypertensive treatment, and 17 did not have adequate antihypertensive control. Conclusion: Antenatal care is a critical opportunity for detection, prevention, and risk stratification. All obstetric care centers should be prepared to manage emergencies associated with hypertensive disorders of pregnancy. Outcomes improve with the use of standardized, organized emergency protocols and the participation of multidisciplinary teams that ensure quality care and a positive impact on preventable maternal morbidity and mortality.
Keywords
maternal mortality; hypertensive disorders of pregnancy; maternal deaths; pregnancy; eclampsia; HELLP syndrome; intracerebral hemorrhage; placental abruption; magnesium sulfate; antihypertensive
Full Text
PDF - Viewed/Downloaded: 0 TimesReferences
[1] Say L, Chou D, Gemmill A, Tunçalp Ö, Moller AB, Daniels J, et al. Global causes of maternal death: A WHO systematic analysis. Lancet Glob Heal 2014; 2 (6): 1-11. https://doi.org/10.1016/S2214-109X(14)70227-X
[2] Magee LA, Nicolaides KH, Von Dadelszen P. Preeclampsia. N Engl J Med 2022; 386 (19): 1817-32. https://www.binasss.sa.cr/mayo/37.pdf
[3] Hypertension G. Gestational hypertension and preeclampsia: ACOG Practice Bulletin, Number 222. Obstet Gynecol 2020; 135 (6): e237-60. https://doi.org/10.1097/AOG.0000000000003891
[4] Márquez L, Plana A, Villarroel MC. Mortalidad materna en pueblos indígenas y fuentes de datos: alcances y desafíos para su medición en países de América Latina. 2017. https://hdl.handle.net/11362/42029
[5] Instituto Nacional de Salud INS. Dirección de Vigilancia y Análisis del Riesgo en Salud Pública. Boletín epidemiológico semanal. Boletín 5, Semana epidemiológica 52 de 2022. Publicación en línea: ISSN 2357-6189. https//doi.org/10.33610/23576189.2022.52
[6] Agalakova NI, Kolodkin NI, Adair CD, Trashkov AP, Bagrov AY. Preeclampsia: Cardiotonic Steroids, Fibrosis, Fli1 and Hint to Carcinogenesis. Int J Mol Sci 2021; 22 (4): 1941. https://doi.org/10.3390/ijms22041941
[7] Roos N, von Xylander SR. Why do maternal and newborn deaths continue to occur? Best Pract Res Clin Obstet Gynaecol 2016; 36: 30-44. https://doi.org/10.1016/j.bpobgyn.2016.06.002
[8] Ma'ayeh M, Costantine MM. Prevention of preeclampsia. Semin Fetal Neonatal Med 2020; 25 (5): 101123. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8237364/pdf/nihms-1717595.pdf
[9] Zuleta-Tobón JJ, Pandales-Pérez H, Sánchez S, Vélez-Álvarez GA, Velásquez-Penagos JA. Errors in the treatment of hypertensive disorders of pregnancy and their impact on maternal mortality. Int J Gynecol Obstet 2013; 121 (1): 78-81. https://doi.org/10.1016/j.ijgo.2012.10.031
[10] Thaddeus S, Maine D. Too To Walk : Maternal Mortality in. Soc Sci Med 1994; 38 (8): 1091-110. https://doi.org/10.1016/0277-9536(94)90226-7
[11] Maine D, Akalin MZ, Ward VM, Kamara A. Diseño y evaluación de programas para mortalidad materna. Programa Nac Unidas para el Desarrollo 1997; 1-72. https://www.researchgate.net/profile/Murat-Akalin-2/publication/265872457_Diseno_y_evaluacion_de_programas_para_mortalidad_materna/links/54b75eaf0cf2e68eb2800e72/Diseno-y-evaluacion-de-programas-para-mortalidad-materna.pdf
[12] Scottish Programme for Clinical Effectiveness in Reproductive Health, Adamson L, Penney G. Scottish confidential audit of severe maternal morbidity: 4th annual report 2006. Edinburgh: Scottish Programme for Clinical Effectiveness in Reproductive Health; 2007. https://www.ossyr.org.ar/pdf/bibliografia/2.8.pdf
[13] Departamento Administrativo Nacional de Estadística DANE. Nacimientos y defunciones. https://www.dane.gov.co/index.php/estadisticas-por-tema/demografia-y-poblacion/nacimientos-y-defunciones.
[14] Ghulmiyyah L, Sibai B. Maternal Mortality From Preeclampsia/Eclampsia. Semin Perinatol 2012; 36 (1): 56-9. https://doi.org/10.1053/j.semperi.2011.09.011
[15] Nyfløt LT, Ellingsen L, Yli BM, Øian P, Vangen S. Maternal deaths from hypertensive disorders: lessons learnt. Acta Obstet Gynecol Scand2018; 97 (8): 976-87. https://doi.org/10.1111/aogs.13357
[16] Instituto Nacional de Salud. Boletín epidemiológico semanal 52 de 2021. Boletín epidemiológico Sem 2021; 1-29. https://doi.org/10.33610/23576189.2021.52
[17] Lawrence ER, Klein TJ, Beyuo TK. Maternal Mortality in Low and Middle-Income Countries. Obstet Gynecol Clin North Am 2022; 49 (4): 713-733. https://doi.org/10.1016/j.ogc.2022.07.001
[18] Nyfløt LT, Ellingsen L, Yli BM, Øian P, Vangen S. Maternal deaths from hypertensive disorders: lessons learnt. Acta Obstet Gynecol Scand 2018; 97(8): 976-87. https://doi.org/10.1111/aogs.13357
[19] Schutte J, Steegers E, Schuitemaker N, Santema J, de Boer K, Pel M, et al. Rise in maternal mortality in the Netherlands. BJOG An Int J Obstet Gynaecol 2010; 117 (4): 399-406. https://doi.org/10.1111/j.1471-0528.2009.02382.x
[20] Verona-Balcázar M, Fernández-Mogollón JL, Neciosup-Puican E. Características epidemiológicas, clínicas y demoras en el proceso de atención en casos de muerte materna, Región Lambayeque, 2011-2016. Rev del Cuerpo Médico del HNAAA 2019; 12 (2): 97-103. https://doi.org/10.35434/rcmhnaaa.2019.122.504
[21] Harris M, Henke C, Hearst M, Campbell K. Future Directions: Analyzing Health Disparities Related to Maternal Hypertensive Disorders. J Pregnancy 2020; 2020: 1-5. https://doi.org/10.1155/2020/7864816
[22] Ronsmans C, Campbell O. Quantifying the fall in mortality associated with interventions related to hypertensive diseases of pregnancy. BMC Public Health 2011; 11 (Suppl 3): S8.https://doi.org/10.1186/1471-2458-11-S3-S8
[23] Hauspurg A, Jeyabalan A. Postpartum preeclampsia or eclampsia: defining its place and management among the hypertensive disorders of pregnancy. Am J Obstet Gynecol 2022; 226 (2S): S1211-S1221. https://doi.org/10.1016/j.ajog.2020.10.027
[24] Hauspurg A, Countouris ME, Catov JM. Hypertensive Disorders of Pregnancy and Future Maternal Health: How Can the Evidence Guide Postpartum Management? Curr Hypertens Rep 2019; 21 (12): 96. https://doi.org/10.1007/s11906-019-0999-7
[25] Poniedziałek-Czajkowska E, Mierzyński R, Leszczyńska-Gorzelak B. Preeclampsia and Obesity-The Preventive Role of Exercise. Int J Environ Res Public Health 2023; 20 (2): 1267. https://doi.org/10.3390/ijerph20021267
[26] Rolnik DL, Nicolaides KH, Poon LC. Prevention of preeclampsia with aspirin. Am J Obstet Gynecol2022; 226 (2S): S1108-S1119. https://doi.org/10.1016/j.ajog.2020.08.045
[27] Fishel Bartal M, Sibai BM. Eclampsia in the 21st century. Am J Obstet Gynecol 2022; 226 (2): S1237-53. https://doi.org/10.1016/j.ajog.2020.09.037
[28] Duley L, Henderson-Smart DJ, Chou D. Magnesium sulphate versus phenytoin for eclampsia. Cochrane Database Syst Rev 2010; (10): CD000128.. https://doi.org/10.1002/14651858.CD000128.pub2
[29] Henderson-Smart DJ, Walker GJ, Chou D. Magnesium sulphate versus diazepam for eclampsia. Cochrane Database Syst Rev 2010. https://doi.org/10.1002/14651858.CD000127.pub2
[30] Belfort MA, Anthony J, Saade GR, Allen JC. A Comparison of Magnesium Sulfate and Nimodipine for the Prevention of Eclampsia. N Engl J Med 2003; 348(4): 304-11. https://doi.org/10.1056/NEJMoa021180
[31] Altman D, Carroli G, Duley L, Farrell B, Moodley J, Neilson J, et al. Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial: a randomised placebo-controlled trial. Lancet 2002; 359 (9321): 1877-90. https://doi.org/10.1016/S0140-6736(02)08778-0
[32] Karolinski A, Mazzoni A, Belizán JM, Althabe F, Bergel E, Buekens P. Lost opportunities for effective management of obstetric conditions to reduce maternal mortality and severe maternal morbidity in Argentina and Uruguay. Int J Gynaecol Obstet 2010; 110 (2): 175-80. https://doi.org/10.1016/j.ijgo.2010.05.002
[33] Sinkey RG, Battarbee AN, Bello NA, Ives CW, Oparil S, Tita ATN. Prevention, Diagnosis, and Management of Hypertensive Disorders of Pregnancy: a Comparison of International Guidelines. Curr Hypertens Rep 2020; 22 (9): 66. https://doi.org/10.1007/s11906-020-01082-w
[2] Magee LA, Nicolaides KH, Von Dadelszen P. Preeclampsia. N Engl J Med 2022; 386 (19): 1817-32. https://www.binasss.sa.cr/mayo/37.pdf
[3] Hypertension G. Gestational hypertension and preeclampsia: ACOG Practice Bulletin, Number 222. Obstet Gynecol 2020; 135 (6): e237-60. https://doi.org/10.1097/AOG.0000000000003891
[4] Márquez L, Plana A, Villarroel MC. Mortalidad materna en pueblos indígenas y fuentes de datos: alcances y desafíos para su medición en países de América Latina. 2017. https://hdl.handle.net/11362/42029
[5] Instituto Nacional de Salud INS. Dirección de Vigilancia y Análisis del Riesgo en Salud Pública. Boletín epidemiológico semanal. Boletín 5, Semana epidemiológica 52 de 2022. Publicación en línea: ISSN 2357-6189. https//doi.org/10.33610/23576189.2022.52
[6] Agalakova NI, Kolodkin NI, Adair CD, Trashkov AP, Bagrov AY. Preeclampsia: Cardiotonic Steroids, Fibrosis, Fli1 and Hint to Carcinogenesis. Int J Mol Sci 2021; 22 (4): 1941. https://doi.org/10.3390/ijms22041941
[7] Roos N, von Xylander SR. Why do maternal and newborn deaths continue to occur? Best Pract Res Clin Obstet Gynaecol 2016; 36: 30-44. https://doi.org/10.1016/j.bpobgyn.2016.06.002
[8] Ma'ayeh M, Costantine MM. Prevention of preeclampsia. Semin Fetal Neonatal Med 2020; 25 (5): 101123. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8237364/pdf/nihms-1717595.pdf
[9] Zuleta-Tobón JJ, Pandales-Pérez H, Sánchez S, Vélez-Álvarez GA, Velásquez-Penagos JA. Errors in the treatment of hypertensive disorders of pregnancy and their impact on maternal mortality. Int J Gynecol Obstet 2013; 121 (1): 78-81. https://doi.org/10.1016/j.ijgo.2012.10.031
[10] Thaddeus S, Maine D. Too To Walk : Maternal Mortality in. Soc Sci Med 1994; 38 (8): 1091-110. https://doi.org/10.1016/0277-9536(94)90226-7
[11] Maine D, Akalin MZ, Ward VM, Kamara A. Diseño y evaluación de programas para mortalidad materna. Programa Nac Unidas para el Desarrollo 1997; 1-72. https://www.researchgate.net/profile/Murat-Akalin-2/publication/265872457_Diseno_y_evaluacion_de_programas_para_mortalidad_materna/links/54b75eaf0cf2e68eb2800e72/Diseno-y-evaluacion-de-programas-para-mortalidad-materna.pdf
[12] Scottish Programme for Clinical Effectiveness in Reproductive Health, Adamson L, Penney G. Scottish confidential audit of severe maternal morbidity: 4th annual report 2006. Edinburgh: Scottish Programme for Clinical Effectiveness in Reproductive Health; 2007. https://www.ossyr.org.ar/pdf/bibliografia/2.8.pdf
[13] Departamento Administrativo Nacional de Estadística DANE. Nacimientos y defunciones. https://www.dane.gov.co/index.php/estadisticas-por-tema/demografia-y-poblacion/nacimientos-y-defunciones.
[14] Ghulmiyyah L, Sibai B. Maternal Mortality From Preeclampsia/Eclampsia. Semin Perinatol 2012; 36 (1): 56-9. https://doi.org/10.1053/j.semperi.2011.09.011
[15] Nyfløt LT, Ellingsen L, Yli BM, Øian P, Vangen S. Maternal deaths from hypertensive disorders: lessons learnt. Acta Obstet Gynecol Scand2018; 97 (8): 976-87. https://doi.org/10.1111/aogs.13357
[16] Instituto Nacional de Salud. Boletín epidemiológico semanal 52 de 2021. Boletín epidemiológico Sem 2021; 1-29. https://doi.org/10.33610/23576189.2021.52
[17] Lawrence ER, Klein TJ, Beyuo TK. Maternal Mortality in Low and Middle-Income Countries. Obstet Gynecol Clin North Am 2022; 49 (4): 713-733. https://doi.org/10.1016/j.ogc.2022.07.001
[18] Nyfløt LT, Ellingsen L, Yli BM, Øian P, Vangen S. Maternal deaths from hypertensive disorders: lessons learnt. Acta Obstet Gynecol Scand 2018; 97(8): 976-87. https://doi.org/10.1111/aogs.13357
[19] Schutte J, Steegers E, Schuitemaker N, Santema J, de Boer K, Pel M, et al. Rise in maternal mortality in the Netherlands. BJOG An Int J Obstet Gynaecol 2010; 117 (4): 399-406. https://doi.org/10.1111/j.1471-0528.2009.02382.x
[20] Verona-Balcázar M, Fernández-Mogollón JL, Neciosup-Puican E. Características epidemiológicas, clínicas y demoras en el proceso de atención en casos de muerte materna, Región Lambayeque, 2011-2016. Rev del Cuerpo Médico del HNAAA 2019; 12 (2): 97-103. https://doi.org/10.35434/rcmhnaaa.2019.122.504
[21] Harris M, Henke C, Hearst M, Campbell K. Future Directions: Analyzing Health Disparities Related to Maternal Hypertensive Disorders. J Pregnancy 2020; 2020: 1-5. https://doi.org/10.1155/2020/7864816
[22] Ronsmans C, Campbell O. Quantifying the fall in mortality associated with interventions related to hypertensive diseases of pregnancy. BMC Public Health 2011; 11 (Suppl 3): S8.https://doi.org/10.1186/1471-2458-11-S3-S8
[23] Hauspurg A, Jeyabalan A. Postpartum preeclampsia or eclampsia: defining its place and management among the hypertensive disorders of pregnancy. Am J Obstet Gynecol 2022; 226 (2S): S1211-S1221. https://doi.org/10.1016/j.ajog.2020.10.027
[24] Hauspurg A, Countouris ME, Catov JM. Hypertensive Disorders of Pregnancy and Future Maternal Health: How Can the Evidence Guide Postpartum Management? Curr Hypertens Rep 2019; 21 (12): 96. https://doi.org/10.1007/s11906-019-0999-7
[25] Poniedziałek-Czajkowska E, Mierzyński R, Leszczyńska-Gorzelak B. Preeclampsia and Obesity-The Preventive Role of Exercise. Int J Environ Res Public Health 2023; 20 (2): 1267. https://doi.org/10.3390/ijerph20021267
[26] Rolnik DL, Nicolaides KH, Poon LC. Prevention of preeclampsia with aspirin. Am J Obstet Gynecol2022; 226 (2S): S1108-S1119. https://doi.org/10.1016/j.ajog.2020.08.045
[27] Fishel Bartal M, Sibai BM. Eclampsia in the 21st century. Am J Obstet Gynecol 2022; 226 (2): S1237-53. https://doi.org/10.1016/j.ajog.2020.09.037
[28] Duley L, Henderson-Smart DJ, Chou D. Magnesium sulphate versus phenytoin for eclampsia. Cochrane Database Syst Rev 2010; (10): CD000128.. https://doi.org/10.1002/14651858.CD000128.pub2
[29] Henderson-Smart DJ, Walker GJ, Chou D. Magnesium sulphate versus diazepam for eclampsia. Cochrane Database Syst Rev 2010. https://doi.org/10.1002/14651858.CD000127.pub2
[30] Belfort MA, Anthony J, Saade GR, Allen JC. A Comparison of Magnesium Sulfate and Nimodipine for the Prevention of Eclampsia. N Engl J Med 2003; 348(4): 304-11. https://doi.org/10.1056/NEJMoa021180
[31] Altman D, Carroli G, Duley L, Farrell B, Moodley J, Neilson J, et al. Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial: a randomised placebo-controlled trial. Lancet 2002; 359 (9321): 1877-90. https://doi.org/10.1016/S0140-6736(02)08778-0
[32] Karolinski A, Mazzoni A, Belizán JM, Althabe F, Bergel E, Buekens P. Lost opportunities for effective management of obstetric conditions to reduce maternal mortality and severe maternal morbidity in Argentina and Uruguay. Int J Gynaecol Obstet 2010; 110 (2): 175-80. https://doi.org/10.1016/j.ijgo.2010.05.002
[33] Sinkey RG, Battarbee AN, Bello NA, Ives CW, Oparil S, Tita ATN. Prevention, Diagnosis, and Management of Hypertensive Disorders of Pregnancy: a Comparison of International Guidelines. Curr Hypertens Rep 2020; 22 (9): 66. https://doi.org/10.1007/s11906-020-01082-w
Copyright © 2026 Sandra María Vélez Cuervo, Jonathan Rendón Zapata, Ana María Caicedo Bolaños
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License