Mode of Delivery and Caesarean Indications Among Women with Hypertensive Disorders in Pregnancy at Korle Bu Teaching Hospital

Abstract

Objective: To determine the relative proportions of vaginal and caesarean deliveries, and the common caesarean indications among women with hypertensive disorders in pregnancy (HDP).
Materials and methods: A cross sectional study conducted at the Maternity unit of Korle Bu Teaching Hospital in Accra from 1st January to 28th February 2013.
Results: A total of 368 women with HDP were recruited with 168 (45.7%) and 200 (54.3%) having caesarean and vaginal deliveries respectively. Regarding the caesarean delivery, 31 (18.5%) had gone into labour prior to the surgery whiles 137 (81.5%) were not in labour. Among the 368 women 68 (18.5%) had induction of labour out of which 46 (67.6%) achieved vaginal delivery. The risk of caesarean section was significanty higher in preeclampsia [(adjusted odds ratio 2.898 (1.741-4.824), p-value <0.001] and chronic hypertension [(adjusted odds ratio 2.474 (1.194-5.128), p-value =0.015] with reference to gestational hypertension. The Common
caesarean indications among women with HDP were previous caesarean birth (26.2%), unfavourable cervix (22.6%), fetal distress (14.9%), failure to progress (10.7%), fetal malpresentation (9.5%), failed induction (7.1%) and placental abruption (3.0%). A total of 65
(17.7%) women with HPD had had a prior caesarean birth.
Conclusion: This study has determined a high caesarean birth rate in women with HDP with the highest and lowest caesarean rates occurring in chronic hypertension and gestational hypertension respectively. The common caesarean indications among women with HDP were previous caesarean birth, unfavourable cervix, fetal distress, failure to progress, fetal malpresentation, failed induction of labour and placental abruption.