Clinical, Systemic, and Preventable Determinants of Maternal Mortality in Hypertensive Disorders of Pregnancy: A Multicenter Study

Abstract

Background:
Hypertensive disorders of pregnancy (HDP), encompassing preeclampsia and eclampsia, remain a leading cause of maternal mortality worldwide.
Objectives: To identify key clinical, organizational, and laboratory determinants associated with maternal mortality in patients with HDP.
Materials and methods: This multicenter case-control study analyzed data from 32 cases of maternal death resulting from HDP complications (case group) and 128 severely ill surviving patients with preeclampsia or eclampsia (control group). Maternal health status, gestational age at delivery, occurrence of HELLP syndrome, acute kidney injury (AKI), and placental abruption were evaluated.
Results: The primary direct causes of death were intracerebral hemorrhage (43.8%), multiorgan failure associated with HELLP syndrome (31.3%), and acute respiratory distress syndrome (15.6%). Multivariable logistic regression identified the following independent determinants of maternal mortality: lack of regular antenatal care (OR = 4.85; 95% CI: 1.98–11.88; p < 0.001), delayed administration of magnesium sulfate (OR = 3.62; p = 0.004), severe uncontrolled systolic hypertension (> 160 mmHg; OR = 3.12; p = 0.011), and development of AKI (OR = 5.24; 95% CI: 2.10–13.08; p < 0.001).
Conclusions: Delayed diagnosis, inadequate blood pressure management, and omitted or delayed eclampsia prophylaxis with magnesium sulfate represent key preventable determinants of maternal mortality in HDP.

Keywords:
Hypertensive Disorders, Preeclampsia, Eclampsia, Maternal Mortality, HELLP Syndrome, Magnesium Sulfate.