Maternal death associated with preeclampsia in Indonesia

OBJECTIVE: 

To assess the clinical factors linked to maternal mortality due to preeclampsia (PE) in Indonesia, spanning from risk factors to maternal and perinatal outcomes. Our objective is to offer valuable insights that can be used to enhance healthcare policies and interventions for pregnant women in Indonesia. 

METHODS: 

A multicenter retrospective cohort study was conducted across 30 hospitals in Indonesia from January 2022 to December 2023. Data were collected from medical records of pregnancies complicated by PE. Maternal risk factors, complications, and perinatal outcomes were analyzed in maternal survivors and maternal deaths.

RESULTS: 

Among 6,763 cases, 1,808 with complete medical records were included (1,784 survivors, 24 deaths; 1.33 % mortality). No significant differences were found in maternal age, BMI, parity, chronic hypertension, diabetes, or previous PE. Pulmonary edema (aOR = 3.97; 95 % CI: 1.51-10.49; p = 0.005) and the need for ICU admission (aOR = 5.25; 95 % CI: 2.19-12.62; p < 0.001) were substantially correlated with an elevated risk of maternal mortality. HELLP syndrome (aOR = 1.94; 95 % CI: 0.76-4.95; p = 0.167) and acute kidney injury [AKI] (aOR = 3.10; 95 % CI: 0.95-10.09; p = 0.060) exhibited a tendency for increased risk (p > 0.05). Maternal death was also correlated with worse perinatal outcomes such as higher intrauterine fetal death rate (OR: 6.2; 95 % CI: 2.4-15.99; p < 0.001) and neonatal mortality (OR: 2.80; 95 % CI: 0.94-8.32; p = 0.06). 

CONCLUSION: 

This investigation underlines the still significant risk of PE as a cause of maternal death in Indonesia, with pulmonary edema, AKI, and HELLP syndrome, as critical risk factors. Initiatives aimed at decreasing maternal mortality should prioritize the screening and early identification of PE, as well as the implementation of effective preventative interventions during antenatal care.