MADDA WALABU UNIVERSITY SHASHEMENNE CAMPUS

SCHOOL OF HEALTH SCIENCE DEPARTMENT OF NURSING

ADVERSE PERINATAL OUTCOMES AND ASSOCIATED

FACTORS AMONG PREGNANT MOTHERS WITH
HYPERTENSIVE DISORDERS OF PREGNANCY WHO GAVE
BIRTH AT WEST ARSI ZONE AND SHASHEMENNE TOWN
PUBLIC HOSPITALS, 2023

PRINCIPAL INVESTIGATOR: ADEM GEMECHU KEDIR (BSC)

A RESEARCH PROPOSAL TO BE SUBMITTED TO MADDA WALABU

UNIVERSITY SHASHEMENE CAMPUS POST GRADUATE
COORDINATOR OFFICE SCHOOL OF HEALTH SCIENCE DEPARTMENT
OF NURSING FOR PARTIAL FULFILLMENT OF MASTERS OF SCIENCE
DEGREE IN MATERNITY AND REPRODUCTIVE HEALTH NURSING

MARCH, 2023

SHASHEMENE, ETHIOPIA
MADDA WALABU UNIVERSITY SHASHEMENNE CAMPUS
SCHOOL OF HEALTH SCIENCE DEPARTMENT OF NURSING

ADVERSE PERINATAL OUTCOMES AND ASSOCIATED

FACTORS AMONG PREGNANT MOTHERS WITH
HYPERTENSIVE DISORDERS OF PREGNANCY WHO GAVE
BIRTH AT WEST ARSIS ZONE AND SHASHEMENNE TOWN
PUBLIC HOSPITALS, 2023

ADVISORS: 1. MR. GAROMA MORKA (MSC, ASS’T PROF.)

2, MR. TURA KOSHE (MSC)

A RESEARCH PROPOSAL TO BE SUBMITTED TO MADDA WALABU

UNIVERSITY SHASHEMENE CAMPUS POST GRADUATE
COORDINATOR OFFICE SCHOOL OF HEALTH SCIENCE DEPARTMENT
OF NURSING FOR PARTIAL FULFILLMENT OF MASTERS OF SCIENCE
DEGREE IN MATERNITY AND REPRODUCTIVE HEALTH NURSING

MARCH, 2023

SHASHEMENE, ETHIOPIA

I
Declaration
I, the undersigned, declare that the work entitled with “adverse perinatal outcomes and
associated factors among pregnant mothers with hypertensive disorders of pregnancy at West
Arsi Shashemenne town Public hospitals from May 16 - June 16, 2023” is my original work
(proposal) in partial fulfillment of the requirement for a Master of Science degree in
Maternity and Reproductive Health Nursing. This paper is not submitted to any other
institution anywhere for the award of any academic degree.
Investigator: Signature Date

1. Adem Gemechu ____________ _________

Approved by:

Advisors:

1. Mr. Geroma Morka (MSc, Assistant professor) _________ __________

2. Mr. Tura Koshe (BSc, MSc) _________ ___________

Examiner signature Date

1. Mr. Habtamu Jarso (MSc, Assistant professor) ___________ _________

2. Mr. Aman Urgessa(MSc, Phd fellow) __________ ________

II
Proposal Summary
Background: Hypertensive disorders of pregnancy (HDP) are the leading cause of perinatal
and maternal morbidity and mortality. About 5–10% of pregnancies are complicated by one
of the hypertensive disorders of pregnancy. Hypertensive disorders of pregnancy have adverse
maternal and neonatal outcomes. In Ethiopia, there is limited study on adverse neonatal
outcome among hypertensive disorders of pregnancy. As per our search knowledge, there is
no published study on the study area. Therefore; the aim of the study is to assess adverse
perinatal outcomes and associated factors among pregnant women with hypertensive
disorders of pregnancy.
Objective: The objective of this study is to assess adverse perinatal outcome and its
associated factors among pregnant mothers with hypertensive disorders of pregnancy at West
Arsi Public hospitals from May 16 – June 16, 2023
Methods: A hospital based cross sectional study will be conducted among 589 women with
hypertensive disorders of pregnancy who give birth at or after 28 weeks of gestation in three
randomly selected West Arsi zone and Shashemenne town public hospitals .Systematic
random sampling will be used to select study participants. The data will be collected by face
to face interview and reviewing medical record through structured questionnaire which will
be prepared after reviewing relevant literature. The pretest will be conducted on 5% of
respondents outside of the study setting. Data will be entered in to Epi-data version 3.1 and
then exported to STATA version 14.5 for analysis. Binary and multivariable logistic
regression will be used to identify association of explanatory variable with outcome variable.
A p-value <0.05 will be considered statistically significant.
Keywords: neonatal, adverse perinatal outcomes, hypertensive disorders of pregnancy and
West Arsi Zone.

III
Acknowledgement

First of all, I would like to extend my acknowledgment to Madda Walabu University

Shashemene Campus School of health science Department of nursing for proving an
opportunity to develop this research proposal. Secondly, I also want to give my thanks to my
advisors, Mr. Garoma Morka (M.Sc., assistant prof.) and Mr. Tura Koshe (M.sc) for their
advice and support during the entire proposal development. Thirdly, I want to give thanks to
West Arsi hospitals administrative and staffs for their unforgettable cooperation.

IV
Contents Page
Acknowledgement..................................................................................................................................IV
Acronyms/Abbreviation.........................................................................................................................IX
Chapter one............................................................................................................................................1
1. Introduction........................................................................................................................................1
1.1. Background.................................................................................................................................1
1.2. Problem statement..................................................................................................................3
1.3. Significance of the study..................................................................................................................4
Chapter Two...........................................................................................................................................5
2.1. Literature review....................................................................................................................5
3. Objectives.........................................................................................................................................10
Chapter 4..............................................................................................................................................11
4. Methodology.....................................................................................................................................11
4.1. Study area and periods...............................................................................................................11
4.2. Study design..............................................................................................................................11
4.3. Source population......................................................................................................................11
4.4. Study populations......................................................................................................................11
4.5. Eligibility criteria......................................................................................................................11
4.6. Sample size determination sampling techniques........................................................................12
4.7. Variables.....................................................................................................................................14
4.8. Operational definitions and........................................................................................................16
4.9. Data collection tools and procedure...........................................................................................17
4.10. Data quality assurance.............................................................................................................17
4.11. Data processing and analysis...................................................................................................18
4.13. Ethical consideration...............................................................................................................19
4.14. Dissemination of the study......................................................................................................20
Annex 1: References.............................................................................................................................23

V
Lists of tables

Table 1: shows Sample size calculation using second objective for proposal on adverse neonatal outcome among
pregnant mothers with HDPs, 2022........................................................................................................................13
Table 2: Work plan for proposal on assessment of adverse neonatal outcome among pregnant mothers with
HDPs, 2022.............................................................................................................................................................21
Table 3: Proposal budget for proposal on assessment of adverse neonatal outcome among pregnant mothers
with HDPs, 2022.....................................................................................................................................................22

VI
List of figures
Figure 1: Conceptual framework for study variables on adverse perinatal outcomes among pregnant mothers
with Hypertensive disorders of pregnancy in West Arsis Zone public Hospitals, 2023 (Getaneh, 2020)................9
Figure 2: schematic presentation on adverse perinatal outcomes among pregnant mothers with Hypertensive
disorders of pregnancy in West Arsi Zone public Hospitals, 2023.........................................................................14

VII
VIII
Acronyms/Abbreviation
ACOG: American College of Gynecology

ANC: Antenatal Care

APGAR: Appearance Pulse Grimace Activity Respiration

CDC: Communicable Disease and Control

DBP: Diastolic Blood Pressure

EDHS: Ethiopian Demographic and Health survey

FGR: Fetal Growth Restriction

FMOH: Federal Ministry of Health

HDP: Hypertensive disorders of pregnancy

IUFD: Intrauterine Fetal Death

IUGR: Intra Uterine Growth Restriction

LBW: Low Birth Weight

LMIC: Low and Middle Income Countries

MDSR: Maternal Death and Response

MSC: Masters of Science

NGO: Non-Governmental Organization

NICU: Neonatal Intensive Care Unit

PDSR: Prenatal Death Surveillance and Response

PE: Pre eclampsia

PHEM: Public Health Emergency Management

IX
PIH: Pregnancy Induced Hypertension

RDS: Respiratory Distress Syndrome

SDG: Sustainable Development Goals

SGA: Small for Gestational Age

SPSS: Statistical Product and Service Solution

SBP: Systolic Blood Pressure

USA: United States of America

X
 Chapter one
1. Introduction

1.1. Background

Hypertension should be defined as systolic blood pressure (SBP) ≥ 140 mmHg and/or DBP ≥
90 mmHg based on the mean of at least two measurements (Magee et al., 2022).The
International Society for the Study of Hypertension in Pregnancy classifies hypertensive
disorders of pregnancy into: gestational hypertension, preeclampsia-eclampsia, chronic
hypertension, and superimposed preeclampsia (Magee et al., 2022). Hypertensive disorders
of pregnancy (HDP) are the leading cause of maternal and perinatal death, particularly in low-
and middle-income countries (LMIC), where almost all deaths occur (Lazo-vega et al., 2022).
Any hypertension during pregnancy can lead to preeclampsia, and it affects up to 35% of
women with gestational hypertension and 25% of women with chronic hypertension
(Braunthal and Brateanu, 2019). The pathogenesis of preeclampsia is considered to be
abnormal remodeling of the uterine arteries and poor differentiation of placental tissues,
leading to placental oxidative stress and damage to the vascular endothelium (Tousty et al.,
2022). Globally in the incidence of hypertensive disorders of pregnancy increased from 16.30
million to 18.08 million, an overall increase of 10.92%. The death from hypertensive
pregnancy disorders was about 27830 (Wang et al., 2021). HDP was diagnosed in 15.9% of
hospital births (Barbieri, 2022). Research conducted in United State of America (USA),
indicated that among maternal deaths that occurred during delivery hospitalization, 31.6%
were due to any hypertensive disorders of pregnancy, 24.3% because of pregnancy-associated
hypertension. Chronic or unspecified maternal hypertension accounts for 7.4% of deaths
(Ford et al., 2022). In Sub-Saharan African countries, the prevalence of hypertensive
disorders of pregnancy (all types combined) was 8%. The most common forms of specific
hypertensive disorders of pregnancy were preeclampsia and gestational hypertension with a
prevalence of 4.1% and 4.1%, each. The less common types of specific hypertensive disorders
of pregnancy were chronic hypertension and eclampsia (Gemechu and Assefa, 2020). In our
country, the overall prevalence of hypertension during pregnancy in was 6.07% (Berhe et al.,

1
2018). Hypertensive pregnancy disorders complicate approximately 57.8% of newborns,
including intrauterine growth retardation in newborns and intrauterine fetal death in 8.89% of
cases. Pregnancy-associated hypertension is a significant cause of adverse maternal and fetal
outcomes, particularly in developing regions of the world (Nisa, Shaikh and Kumar, 2019).
Adverse neonatal outcomes are defined as low birth weight (LBW), prematurity, low Apgar
scores 1 and 5 minutes after birth, early or late neonatal death, low birth weight at gestational
age, and/or severe neonatal condition (Workineh and Worki, 2022). Severe HDPs
significantly increased the risk for an adverse perinatal outcome (Kodan et al., 2021). The
first month of life is the riskiest time for a child, there was a newborn death every 13 seconds,
bringing the total to 2.4 million deaths per year alone. Stillbirth remains an urgent problem
with nearly 2 million stillbirths per year (Kantorova et al., 2021). In Latin America, 44.2% of
women with severe HDPs gave birth to a baby with an adverse perinatal outcome, out of
which, 18.1% suffered a perinatal death, 26.0% experienced a neonatal near miss, Stillbirth
occurred in 13.5% of cases, early neonatal deaths in 4.7% of cases, a preterm baby in 67.1%
of the cases), a baby with low birth weight in 62.2% of cases, and a baby with a low 5-minute
Apgar score in 20.5% of cases (Kodan et al., 2021). In Rwanda, among neonate born to
mothers with hypertensive disorders of pregnancy, 50% of neonates had asphyxia, 50.4%
were admitted to Neonatal Intensive Care Unit (NICU), 75.4% had Low Birth Weight(LBW)
and 22.8 % died(Uwizeyimana et al., 2020).
In Ethiopia, there were 61.7% adverse perinatal outcomes observed in the pre-eclampsia out
of which 37.5% were LBW, 34.7% low APGAR score at 1st and 5th minutes, 6.1% were
IUGR, 5.8% were still birth, 27% were LBW, 26.4 % were preterm, 24,2% were admitted to
NICU, 10.7% had birth asphyxia and perinatal death occurred in 9.6% (Jikamo et al., 2022).

Maternal and perinatal mortality in Ethiopia is estimated at 412/100,000 live births and
46/1,000 live births respectively (Survey, 2016). Ethiopia's FMOH aims to eliminate
preventable maternal and perinatal deaths and has implemented maternal death surveillance
and response (MDSR) since 2013, which has been integrated into the National Public Health
Emergency Management System (PEHM) since 2014. Currently, Perinatal Death Surveillance
and Response (PDSR) is being rolled out by building a PHEM on this platform and
integrating it into the existing MDSR system (FMOH, 2017) .

2
 1.2. Problem statement
Globally, nearly 2.5 million children die in the 1st month of life every year, and an additional
2.6 million babies are stillborn (Goals, 2019). Almost 1 in 5 babies born with an adverse
perinatal outcome were born to women with severe morbidity out of which, 79.2% had severe
hypertensive disorders of pregnancy. Severe hypertensive disorders of pregnancy significantly
increased the risk for an adverse perinatal outcome (Kodan et al., 2021). Rates of neonatal
adverse outcomes were higher in gestational hypertension (Lin et al., 2021). Adverse neonatal
outcomes have a significant impact on perinatal and neonatal survival and the risk of
developmental disabilities and diseases later in life (Workineh and Workie, 2022). Adverse
birth outcomes such as prematurity, low birth weight, stillbirth and birth defects are common
problems worldwide (Gedefaw, Alemnew and Demis, 2020). Adverse events in newborns are
a very distressing, emotionally difficult, and traumatic event for parents, producing feelings of
fear, helplessness, depression, and anger (Basta et al., 2022)
One of the most important Sustainable Development Goals (SDGs) to be achieved
by 2030 is a reduction in maternal and child mortality, including improved health, but child
mortality remains a concern (Division and Affairs, 2022). Hypertensive pregnancy disorders
increase the risk of preterm birth, intrauterine growth restriction (IUGR), low birth weight,
low Apgar score, stillbirth, and neonatal mortality (Basta et al., 2022).
In Ethiopia, there is limited study on adverse perinatal outcomes among hypertensive
disorders of pregnancy. As per our search knowledge, there are no published studies on the
study area. This study will focus on adverse perinatal outcomes among mothers with
hypertensive disorders of pregnancy and therefor; the aim of the study is to assess adverse
perinatal outcomes and associated factors among pregnant women with hypertensive
disorders of pregnancy.

3
 1.3. Significance of the study
Ethiopia is striving to reduce neonatal mortality by 2030. Conducting such study in our
country provides an input for future improvement of perinatal health especially in the area
where the study was not be conducted. This study will investigate the adverse impact of
maternal hypertensive disorders of pregnancy on perinatal outcomes that can determine the
gaps in health care that needs to be addressed in order to improve neonatal health. The finding
of this research provides health care providers, client, NGOs and policy makers with
information about the adverse impact of hypertensive disorders of pregnancies on neonatal
outcomes. This research is also used as a baseline for other researchers for assessing the
adverse impact of hypertensive disorders of pregnancy on neonatal outcome. The gaps in
neonatal morbidity and mortality provides information for policy makers and program
implementers to design strategy to reduce problems associated with adverse neonatal outcome
among pregnant mothers with hypertensive disorders of pregnancy, making evidence based
decision making and targeting neonatal outcome while considering objectives and
implementation of research initiatives practices.

4
 Chapter Two

2. Literature review
2.1. Magnitude of adverse perinatal outcomes

Hypertensive disorder of pregnancy (HDP) is the leading causes of maternal and fetal
morbidity and mortality, affecting up to 10% of pregnancies globally (Huang et al.,2022).
Hypertensive disorders of pregnancy increase the risk of adverse maternal and fetal outcomes
(Metoki et al., 2022) . The Communicable Disease and Control (CDC) reported that among
maternal deaths occurring during the delivery hospitalization, 32% of the decedents had
documented hypertension (Barbieri, 2022).
A research conducted in India showed that the most common neonatal complication observed
in neonates delivered to women with HDP was Respiratory distress (24.9%) followed by low
birth weight (19.5%) (Kumar and Yadav, 2020).
Another study conducted in Haiti indicated that 9.3% of neonates born to hypertensive
mothers were preterm deliveries, 15.6% were low birth weight babies, and 4.9% were
stillbirths (Yang et al., 2022).
Similar study conducted in Suriname, South America showed that Stillbirth occurred in
13.5% of cases and early neonatal deaths occurred in 4.7% of cases. Women with severe HDP
gave birth to a preterm baby in 67.1% of the cases , a baby with low birth weight in 62.2% of
cases and a baby with a low 5-minute Apgar Score in 20.5% of cases (Kodan et al., 2021).
Research conducted in Karachi indicated that 48% of neonates born to mothers with HDP had
Preterm, 35% had Low Birth Weight and 2.5% had Early Neonatal Death (Mumtaz et al.,
2022).
Research conducted in Rwanda showed that the majority of neonates (59.6%) were
premature, 32.4% of neonates had intrauterine growth restriction (IUGR), 38.6% and 30.5%
had APGAR score that shows sever asphyxia at 1 minute and 5 minutes respectively. More
than half (50.4%) of the neonates were admitted to Neonatal Intensive Care Unit (NICU) and
22.8% of neonates died (Uwizeyimana et al., 2020).
A study conducted in Tigray also showed that 50.3% newborns of the hypertensive mothers
ended up with having complications. Out of this, 23.1% with low Apgar score, 20.7% with
5
low birth weight, 20.7% with preterm, 10.2% NICU admission, 10.1% with IUGR, 8.9%
with neonatal asphyxia, and 6.1% was stillbirth (Syoum et al., 2022).

Another research conducted in Tigray showed that nearly 66.4% of women with Pregnancy
Induced Hypertension (PIH) had adverse perinatal outcomes in their newborns. Early neonatal
death occurred in 5.0%, Stillbirths occurred in 10.0%, preterm births occurred in 40.8%,
admission to the neonatal intensive care unit occurred in 28.8% , low birth weight babies
occurred in 37.7, birth asphyxia occurred in 46.5% , and stillbirths occurred in 10.0% of
mothers with PIH (Berhe et al., 2020).

Similar study conducted at Wolaita Sodo indicated that 57.8% of neonates of pregnant
mothers with hypertensive disorder of pregnancy were with complications out of which,
25.8% of them had intrauterine growth restriction. In addition, intrauterine fetal death
occurred in 8.89% of the cases(Obsa et al., 2019).

A cross sectional study conducted in Jimma indicated that 23.13 % of the fetuses had
developed at least one complication(unfavorable outcome) out of which, 20.3 % of cases
were low birth weight , 11.9 % of cases were very low birth weight , 14.4 % were still birth
at delivery and16 % neonates were admitted to NICU (Assefa, Siraneh and Kumsa, 2020).

Study conducted in Woliso also showed that 51.8% of neonates born to mothers who had
hypertensive disorders of pregnancy encountered unfavorable neonatal outcome; 16.2% of
neonates expired (Hailu, et al, 2020).

2.2. Factors associated with adverse perinatal outcomes

2.2.1. Socio demographic

A study conducted in Jimma zone indicated that Gestational age, having history of eclampsia,
antepartum onset of HDP of the mother had shown strong association with unfavorable
perinatal outcome (Assefa, Siraneh and Kumsa, 2020).

Research conducted in Gambella indicated that residence, age of mothers, marital status, and
educational status were factors associated with hypertensive disorders of pregnancy (Chala
Chemeda et al., 2022). Another research conducted in Amhara region showed that maternal

6
educational status and gestational age in weeks were associated with adverse perinatal
outcomes (Melese, Badi and Aynalem, 2019).

Research conducted in Ghana also indicated that there was a significant association level of
education and occupation (Adwoa et al., 2022). 
Research conducted in Poland indicated that Preeclampsia (PE) was associated with FGR risk
if delivery time was less than 34 weeks. This accounts for 82% of FGR/ IUGR cases for < 34
weeks (Stefanska et al., 2022). Another research conducted in Japan showed that Preterm
birth was associated with older age(Poudel et al., 2021).

2.2.2. Types of hypertensive disorders of pregnancy

A retrospective study conducted in Rwanda showed that past medical history hypertension
showed strong association with NICU admission, neonatal asphyxia and neonatal death
(Uwizeyimana et al., 2020).

A research conducted in Japan indicated that was associated with small for gestational age,
preterm birth and low birth weight with odds of 2.14, 2.94 and 4.1 respectively (Poudel et al.,
2021). A Study conducted in China also showed that mothers sever HDP was strongly
associated with adverse pregnancy outcomes in women with HDP and it was risk of preterm
birth, stillbirth, neonatal death and low Apgar score and also showed that Eclampsia or
preeclampsia led to higher risks of preterm delivery, small gestation age (SGA) , RDS and
neonatal hypoglycemia (Yang et al., 2022 and Huang et al.,2021 ). Another study in Haiti
indicated that eclampsia was associated with the greatest adverse events such as low birth
weight baby and stillbirths (Bridwell et al., 2019). A study in India also showed that severe
disease was associated with the adverse perinatal outcome with maximum neonatal morbidity
and mortality in eclampsia and pre-eclampsia group(Kumar and Yadav, 2020). Another
research conducted Malasia showed that adverse perinatal outcomes that were significantly
associated to preeclampsia and had a 6 times higher likelihood of preterm delivery, seven times
higher likelihood of low-birth weight babies, eight times greater risk of NICU admission and three
times greater odds of low 5-min Apgar scores (Sutan and Aminuddin, 2022). Another study
conducted in Pakistan also indicated that adverse perinatal outcomes that were significantly
associated to HDPs and had a 2 times higher likelihood of stillbirth, four times for low birth weight ,
five times for early neonatal death and six times for pre-term birth and among the four types of
7
 hypertensive disorders of pregnancy, eclampsia was associated with the greatest odds of adverse
perinatal events with five times the odds of having a stillbirth, more than seven times the odds for
pre-term birth and early neonatal death . Chronic hypertension was associated with the greatest
odds of low birth weight with six times the odds of having low birth weight(Basta et al., 2022) .

2.2.3. Service utilization

Research conducted in Waliso indicated that newborns of mothers diagnosed with HDP who
did not utilize antenatal care were 3.6 times higher likely developed unfavorable perinatal
outcomes (Hailu, Geta and Bazezew, 2020).
Study conducted in Jimma Zone indicated that others who didn’t attend ANC follow up were four
times more likely to have unfavorable perinatal outcomes than mothers who attend ANC follow up
(Mesganaw et al., 2021).
2.2.4. Obstetric factors

Study conducted in Jimma Zone indicated that parity was significantly associated with
adverse perinatal outcomes and the odds of having adverse perinatal outcomes were 4.6 and 3.1
times higher among mothers with HDP who were primipara and multipara respectively compared
with grand multipara(Mesganaw et al., 2021).
Research conducted in Sub Saharan African countries indicated nulliparous was significantly
associated with HDP (Meazaw et al., 2020).
2.2.5. Time of antihypertensive/ anticonvulsant given
A research conducted in Jimma zone indicated that the odds of having adverse perinatal
outcomes were 3.9 times higher among mothers with HDP who took drugs (anticonvulsant
or /and anti-hypertensive) lately compared with mothers who took the drug early (Mesganaw
etal.,2021). Another research conducted in Amhara region showed that the odds of having
adverse perinatal outcomes were 3.8 times higher among mothers with HDP who took drugs
(anticonvulsant or /and anti-hypertensive) lately compared with mothers who took the drug
early (Melese, Badi and Aynalem, 2019).
In conclusion, finding from different literature showed that HDP are associated with adverse
neonatal outcome such as LBW, preterm, low Apgar score, still birth, NICU admission, birth
asphyxia and neonatal death within 24 hours.
Socio economic and demographic
Obstetric factors: gravidity, parity,
characteristics: Age, marital
current birth interval, mode of
status, educational status, 8 current delivery and onset of labor
occupation, residence, referral
status and average monthly
 Adverse perinatal outcomes: preterm, low
birth weight, low Apgar score, neonatal
death, birth asphyxia, NICU admission

7=still birth
Types of HDPs: gestational
hypertension, preeclampsia, 8=congenital anomalies
eclampsia, chronic hypertension
and super imposed preeclampsia

Time anti-
hypertensive/anticonv
Service utilizations: ANC visit, ulsant given: before
time of ANC started, number of 34 weeks of gestation
ANC visit and Iron/folic acid and after 34 weeks of
supplementation gestation

Figure 1: Conceptual framework for study variables on adverse perinatal outcomes

among pregnant mothers with Hypertensive disorders of pregnancy in West Arsis Zone
public Hospitals, 2023 (Getaneh, 2020).

9
 Chapter Three

3. Objectives

3.1. General objective

 To assess adverse perinatal outcomes and associated factors among mothers with
Hypertensive Disorders of Pregnancy in West Arsi Zone and Shashemenne town
Public Hospitals from May 16 – June 16, 2023.
3.2. Specific objectives

 To determine the prevalence of adverse perinatal outcomes among pregnant mothers

with Hypertensive Disorders of Pregnancy in West Arsi Zone and Shashemenne town
Public hospitals from May 16 – June, 2023.
 To identify factors associated with perinatal outcomes among pregnant mothers with
Hypertensive Disorders of Pregnancy in West Arsi Zone and Shashemenne town
Public Hospitals from May 16 – June, 2023.

10
 Chapter 4
4. Methods and materials

4.1. Study area and periods

West Arsis zone is found in southwest of Oromia and 250 km far from the capital city of
Ethiopia. It has an estimated surface area of 12,556 km 2 and situated in latitude of
N330598’’and longitude 118015’14’’. It has low level topography with an altitude of 1924m.
Administratively the zone divided into 13 rural woreda, 02 town administrates and 370
kebeles (324 rural). The zone has 7 public hospitals, 85 health centers and 342 health posts. It
has a total populations of 2,926,749 out of which 1,434,107 males and 1,492,642 females. The
Zone has a total of 101,558 pregnant and delivered mothers according to information obtained
from West Arsi Health bureau.
The study will be conducted from May 16 – June 16, 2023.

4.2. Study design

Hospital based cross sectional study design will be used.

4.3. Source population

All women with any type of hypertensive disorders of pregnancy who gave birth in the West
Arsi zone and Shashemenne town public hospitals who are diagnosed with any type of
hypertensive disorders of pregnancy who are alive after delivery during the study period will
be the source population.

4.4. Study populations

Randomly selected women with any type of hypertensive disorders of pregnancy, who gave
birth in the three selected West Arsi Zone and Shashemenne town public hospitals diagnosed
with any type of HDP who are alive during the study period and fulfill inclusion criteria

4.5. Eligibility criteria

4.5.1. Inclusion criteria

11
All mothers with hypertensive disorders of pregnancy, who gave birth after 28 weeks of gestation

4.5.2. Exclusion criteria

Mother who died on labor/delivery will be excluded

4.6. Sample size determination sampling techniques

Sample size is determined by using single population proportion formula:

n= (Z ᾳ/2) 2 p q
d2
Where, Z =1.96 corresponding to 95% level of confidence, p=proportion of adverse perinatal
outcomes= 0.58, q=1-p= 0.42, ᾳ= level of significant 0.05
n= (1.96)2x0.58 x0.42 =374

(0.05)2
By considering design effect, sample size is 374 X 1.5=561.

By adding 5% non-response rate, final sample size will be 589.

Sample size calculation using second objective

Sample size is also calculated using variables from previous study conducted in Jimma zone
on perinatal outcome and associated factors among women with hypertensive disorders of
pregnancy by using Epi-info version 7.2.5 software by considering the following assumption
as presented below:

12
Table 1: shows Sample size calculation using second objective for proposal on adverse
perinatal outcomes among pregnant mothers with HDPs at West Arsi public hospitals, 2023

S/ no Independent Confident Power AOR Sample Literature

variable level size for
both
groups
1 Parity 95% 80% 3.1 116 Cross sectional study,
2 ANC visit 95% 80% 4.2 224 Jimma city(Mesganaw
3 Time of drug 95% 80% 3.9 120 et al., 2021)
given .
4 Gestational age 95 80 6.3 52 (Hailu, Geta and
Bazezew, 2020).

Sampling techniques

From 7 public hospitals found in west Arsi Zone, 30% of public hospitals will be taken.
Simple random sampling techniques will be used to select the hospitals and the number of the
average of the two consecutive quarter’s cases of each hospital will be taken from each
hospital to estimate monthly available delivery cases. From the total of 7 hospitals found in
the West Arsi zone and Shashemenne town, 3 (Malka Oda general hospital, Shashemenne
referral hospital and Negelle Arsi primary hospital) will be selected for the study. Finally, all
eligible study participants will be selected by purposive sampling from each hospital.

13
Dodola Malka Odda SRH (250 Nagelle Loke Hospital Gambo Kokosa
Hospital (60)l Hospital (200 X 1.6=375) hospital (60 X (60) hospital Hospital
X1.3=300) 1.5=90) (30) (20(

30% of West Arsi public hospitals (3 hospitals from 7 hospitals) by simple random
sampling method

Malka Oda hospital (N=231) SRH (N=289) Negele hospital (N=90)

Systematic random sampling will be employed to select 765 from 589 mothers with
hypertensive disorders of pregnancy

Final sample size is 589

Figure 2: schematic presentation on adverse perinatal outcomes among pregnant mothers with
Hypertensive disorders of pregnancy in West Arsi Zone public Hospitals, 2023

14
4.7. Variables

4.7.1. Dependent variables

 Adverse perinatal outcomes

4.7.2. Independent Variable

 Socio economic and demographic characteristics: Age, marital status, educational

status, occupation, residence, referral status and average monthly income
 Types of hypertensive disorders of pregnancy: gestational hypertension,
preeclampsia, eclampsia, chronic hypertension and super imposed
 Time anti-hypertensive/anticonvulsant given: early and late
 Service utilizations: ANC visit, time of ANC started, number of ANC visit and
Iron/folic acid supplementation
 Obstetric factors: gravidity, parity, current birth interval, mode of current delivery
and onset of labor

15
 4.8. Operational definitions and definition of terms
Adverse perinatal outcomes are the occurrence of at least one of the following: LBW,
preterm inborn, low Apgar score at first or fifth minutes after birth, neonatal death within
24hrs, birth asphyxia, respiratory distress and sepsis.

Low birth weight (LBW) is defined by the World Health Organization (WHO) as weight at
birth less than 2500 g (Stevens, Lynm and Glass, 2002).

Preterm birth is birth born before 37 weeks of gestation(World Health Organization, 2022).

Low APGAR score is APGAR score less than 7 at 1st and 5th minutes(Stevens, Lynm and
Glass, 2002).

Birth asphyxia is defined as the failure to establish breathing at birth (WHO, 2012).

16
4.9. Data collection tools and procedure

Data collection tools will be prepared after reviewing different literature in English and
translated to local languages and translated back to English to check its consistency. Pretest
will be conducted on 5% mothers among similar population outside of the study area at Batu
General Hospital. After appropriate modification is made based on pretest, data will be
collected by using structured, interviewer-administered questionnaires. Data will be collected
by trained personnel and the principal investigator will monitor the overall data collection on
daily basis. The data will be collected by reviewing records of the pregnant mothers and
supplemented by interviewing the subjects on admission to labor ward and until discharged in
order to assess the presence and development of complications. Socio demographic Variables
such as marital status, educational status, occupation and monthly income can be obtained by
interviews and socio demographic variable like age and referral status; types of hypertensive
disorders of pregnancy, service utilization and time of antihypertensive/ anticonvulsant drug
is give will be obtained from records. The neonates admitted to neonatal intensive care unit
(NICU) will be followed for 7 possible complications until discharge. The neonates who will
be discharged immediately after 24 hours of delivery, the mothers will be informed to follow
the neonate for any complications every day and will be asked on phone about neonatal status
and for every complication at 7 days of life. On discharge, mothers will be communicated to
answer a phone call at the 7th day or send to call me back request with any available phone to
the data collector.

4.10. Data quality assurance

One-day training will be given for data collectors and supervisors. The tool will be pretested
at Batu General public hospital on 5% of the sample size to ensure consistency and
completeness of questioners. Data collectors will be supervised throughout the course of data
collection period.
Then, the overall process will be coordinated and controlled by principal investigator.
Principal investigator, supervisors and data collectors will take a discussion meeting after data
collection to ensure completeness. Furthermore, the collected data will be entered in to Epi-
data computer programs version 3.1 to minimize data entry error.

17
4.11. Data processing and analysis

The collected data will be checked for completeness and consistency manually before entry
into the computer. Then, the questionnaires will be coded and data will be entered into Epi
data version 3.1 and exported to stata software version 14.5 for analysis. Descriptive
statistics like frequencies, cross tabulation, graphs, and percentages will be used. The
goodness of fit of data will be checked with the likelihood ratio (p-value=0.25). Both
bivariable and multivariable logistic regression analyses will be used to identify the candidate
variables and contributing factors for Neonatal outcomes among women with HDP
respectively. Bivariable logistic regression analysis will be used to identify the candidate
variables for multivariable logistic regression at a p-value ≤0.25. Adjusted odds ratio (AOR)
with 95%CI will be used to determine the predictor of the outcome variable independently
and to show the strength of an association p-value <0.05 will be considered as statistically
significant.

18
 4.13. Ethical consideration
Ethical approval will be obtained from Madda Walabu University Review Board. Approval
letter will be obtained from research ethical committee of Madda Walabu University.
Informed Verbal consent will be obtained from participants during data collection and the
information obtained from them will be kept confidential by omitting identifiers in the data
collection tools. For data obtained from maternal record, permission will be obtained from
hospital administration and perspective ward leader. The participants will have the right to
withdraw from interview if they feel uncomfortable.

19
 4.14. Dissemination of the study
The finding of the study will be disseminated to Madda Walabu University School of Health
Science Department of Nursing, Post Graduate Coordinator Office, West Arsi Health bureau,
West Arsi Hospitals administrative, Oromia health bureau, for seminar presentation and
publication.

20
Table 2: Work plan for proposal on assessment of adverse perinatal outcomes among pregnant
mothers with HDPs at West Arsis public hospitals from May 16 – June 16, 2023

Activities Responsibility Dec. Jan. Feb. March Apr. May June July
Proposal PI
development
Preparing of PI
study tool
Select data PI
collectors
Training for PI
data
collectors
Pretest PI
Data DCs
collection
Data entry PI
and cleaning
Data analysis PI
Submitting PI
report
Final defense PI

21
Table 3: Proposal budget for proposal on assessment of adverse perinatal outcomes among
pregnant mothers with HDPs at West Arsis public hospitals from May 16 – June 16, 2023

No Budget category Measurement Multiplying factor Total cost

1 Personnel Working per No. of staff Per diem Total cost
day
Principal investigator 8hours/ week 1 1000 4000
Supervisors 8 hours/ week 2 1000 8000
Data collectors 8hours/day 5 25/ 9,350
questionnaire
Sub total 21,350
2 Transportation cost No. of days/ trip No. of staff Cost per day Total cost
Public transport 1day/week 1 700/day 2,8000
Sub total 2,800
3 Supplies Measurement No. required Cost per item Total cost
unit
Questionnaire Pages 1.496pages 5 birr/ page 7,480
duplication
Printing questionnaires Pages 4 pages 6 birr per page 24
Printing proposal Pages 40 6birr/ page 222
Binding 100
Pen No. 5 20 100
Pencil No. 5 10/ unit 50
Sub total 7,976
4 Training Measurement Participants No Cost per day Total cost
unit of
days
Tea/ coffee Birr 5 One 200 1000
day
Sub total 1000
Grand total 33,126
ETB

22
Annex 1: References
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eclampsia among pregnant women at a local Teaching Hospital in Ghana’, medRxiv, pp. 1–19.
Available at: https://doi.org/10.1101/2022.05.18.22275250 LK -
http://rug.on.worldcat.org/atoztitles/link/?
sid=EMBASE&issn=&id=doi:10.1101%2F2022.05.18.22275250&atitle=Prevalence+and+de
mographic+distribution+associated+with+pre-
eclampsia+among+pregnant+women+at+a+local+Teaching+Hospital+in+Ghana&stitle=med
Rxiv&title=medRxiv&volume=&issue=&spage=&epage=&aulast=Adwoa&aufirst=Nyarko&
auinit=N.&aufull=Adwoa+N.&coden=&isbn=&pages=-&date=2022&auinit1=N&auinitm=.

Assefa, F., Siraneh, Y. and Kumsa, A.T. (2020) ‘OUTCOME OF HYPERTENSIVE

DISORDERS OF PREGNANCY AND ASSOCIATED OUTCOME OF HYPERTENSIVE
DISORDERS OF PREGNANCY AND ASSOCIATED FACTORS AMONG PREGNANT
WOMEN ADMITTED TO ABSTRACT METHOD : RESULT ’:, (May).

Barbieri, R.L. (2022) ‘An epidemic of hypertensive disorders of pregnancy’, 34(9), pp. 15–18.
Available at: https://doi.org/10.12788/obgm.022.

Basta, M. et al. (2022) ‘Impact of Hypertensive Disorders of Pregnancy on Stillbirth and

Other Perinatal Outcomes : A Multi-Center Retrospective Study’, 14(3), pp. 10–16. Available
at: https://doi.org/10.7759/cureus.22788.

Berhe, A.K. et al. (2020) ‘Effect of pregnancy induced hypertension on adverse perinatal
outcomes in Tigray regional state , Ethiopia : a prospective cohort study’, 6, pp. 1–11.

Braunthal, S. and Brateanu, A. (2019) ‘Hypertension in pregnancy : Pathophysiology and

treatment’. Available at: https://doi.org/10.1177/2050312119843700.

Bridwell, M. et al. (2019) ‘Hypertensive disorders in pregnancy and maternal and neonatal
outcomes in Haiti : the importance of surveillance and data collection’, 0, pp. 1–11.

23
Chala Chemeda, W. et al. (2022) ‘Factors associated with hypertensive disorders among
pregnant mothers attending antenatal care services at public health facilities in Gambella
Town, Southwest Ethiopia: Cross-sectional study’, International Journal of Africa Nursing
Sciences, 17(September 2021), p. 100478. Available at:
https://doi.org/10.1016/j.ijans.2022.100478.

FMOH (2017) ‘NATIONAL TECHNICAL GUIDANCE FOR MATERNAL AND

PERINATAL DEATH SURVEILLANCE AND RESPONSE’.

Ford, N.D. et al. (2022) ‘Hypertensive Disorders in Pregnancy and Mortality at Delivery
Hospitalization — United States, 2017–2019’, MMWR. Morbidity and Mortality Weekly
Report, 71(17), pp. 585–591. Available at: https://doi.org/10.15585/mmwr.mm7117a1.

Gedefaw, G., Alemnew, B. and Demis, A. (2020) ‘Adverse fetal outcomes and its associated
factors in Ethiopia : a systematic review and’, pp. 1–12.

Gemechu, K.S. and Assefa, N. (2020) ‘Prevalence of hypertensive disorders of pregnancy and
pregnancy outcomes in Sub-Saharan Africa : A systematic review and meta-analysis’.
Available at: https://doi.org/10.1177/1745506520973105.

Goals, S.D. (2017) ‘Maternal mortality Evidence brief’, (1), pp. 1–4.

Hailu, W.B., Geta, E.T. and Bazezew, L. (no date) ‘Prevalence and Determinants of
Pregnancy Outcomes among Mothers with Hypertensive Disorders at Woliso Saint Luke
Hospital , Southwest Ethiopia’. Available at: https://doi.org/10.37871/jbres1414.

Huang, C. et al. (no date) ‘Maternal hypertensive disorder of pregnancy and mortality in
offspring from birth to young adulthood : national population based cohort study’, pp. 1–10.
Available at: https://doi.org/10.1136/bmj-2022-072157.

Jikamo, B. et al. (2022) ‘Incidence of adverse perinatal outcomes and risk factors among
women with eclampsia , southern Ethiopia : a prospective open cohort study’, pp. 1–11.
Available at: https://doi.org/10.1136/bmjpo-2022-001567.

Kantorova, V. et al. (2021) Levels & Trends in.

24
Kodan, L.R. et al. (2021) ‘The burden of severe hypertensive disorders of pregnancy on
perinatal outcomes : a nationwide case-control study in Suriname’, (November). Available at:
https://doi.org/10.1016/j.xagr.2021.100027.

Kumar, N. and Yadav, A. (2020) ‘Perinatal Outcome in Women with Hypertensive Disorders
of Pregnancy in Rural Tertiary Center of Northern India: A Retrospective Cohort Study”’, pp.
71–78. Available at: https://doi.org/10.2174/1573396315666191017100030.

Lazo-vega, L. et al. (2022) ‘Articles ACOG and local diagnostic criteria for hypertensive
disorders of pregnancy ( HDP ) in La Paz-El Alto , Bolivia : A retrospective case-control
study’, 9(Lmic). Available at: https://doi.org/10.1016/j.lana.2022.100194.

Magee, L.A. et al. (2022) ‘Pregnancy Hypertension : An International Journal of Women ’ s

Cardiovascular Health The 2021 International Society for the Study of Hypertension in
Pregnancy classification , diagnosis & management recommendations for international
practice ☆’, Pregnancy Hypertension: An International Journal of Women’s Cardiovascular
Health, 27(September 2021), pp. 148–169. Available at:
https://doi.org/10.1016/j.preghy.2021.09.008.

Meazaw, M.W. et al. (2020) ‘Factors associated with hypertensive disorders of pregnancy in
sub-Saharan Africa: A systematic and meta-analysis’, PLoS ONE, 15(8 August), pp. 1–20.
Available at: https://doi.org/10.1371/journal.pone.0237476.

Melese, M.F., Badi, M.B. and Aynalem, G.L. (2019) ‘Perinatal outcomes of severe
preeclampsia / eclampsia and associated factors among mothers admitted in Amhara Region
referral hospitals , North West Ethiopia , 2018’, BMC Research Notes, pp. 1–6. Available at:
https://doi.org/10.1186/s13104-019-4161-z.

Mesganaw, A. et al. (2021) ‘Perinatal Outcomes and Associated Factors among women with
hypertensive Disorders of Pregnancy Delivered in Jimma Zone Hospitals , Southwest
Ethiopia’.

Metoki, H. et al. (2022) ‘Hypertensive disorders of pregnancy: definition, management, and

out-of-office blood pressure measurement’, Hypertension Research, 45(8), pp. 1298–1309.
Available at: https://doi.org/10.1038/s41440-022-00965-6.

25
Mumtaz, M. et al. (2022) ‘Fetal Outcome among Hypertensive Disorders in Pregnant Women
with Hyperuricemia’, 16(04), pp. 2020–2022.

Nisa, S.U., Shaikh, A.A. and Kumar, R. (2019) ‘Maternal and Fetal Outcomes of Pregnancy-
related Hypertensive Disorders in a Tertiary Care Hospital in Sukkur , Pakistan’, 11(8), pp. 1–
7. Available at: https://doi.org/10.7759/cureus.5507.

Obsa, M.S. et al. (2019) ‘Neonatal and Fetal Outcomes of Pregnant Mothers with
Hypertensive Disorder of Pregnancy at Hospitals in Wolaita’, pp. 4–8. Available at:
https://doi.org/10.22038/jmrh.2018.29240.1315.

Organisation, world health (2012) ‘Guidelines on B ASIC N EWBORN R

ESUSCITATION’, pp. 1–61.

Poudel, K. et al. (2021) ‘Hypertensive disorders during pregnancy (Hdp), maternal

characteristics, and birth outcomes among Japanese women: A hokkaido study’, International
Journal of Environmental Research and Public Health, 18(7). Available at:
https://doi.org/10.3390/ijerph18073342.

Stefanska, K.A. et al. (2022) ‘Perinatal and neonatal outcome in patients with preeclampsia’,
93(3), pp. 203–208. Available at: https://doi.org/10.5603/GP.a2021.0101.

Stevens, L.M., Lynm, C. and Glass, R.M. (2002) ‘Low birth weight’, Jama, 287(2), p. 270.
Available at: https://doi.org/10.1001/jama.287.2.270.

Survey, H. (2016) Ethiopia.

Sutan, R. and Aminuddin, N.A. (no date) ‘Prevalence , maternal characteristics , and birth
outcomes of preeclampsia : A cross-sectional study in a single tertiary healthcare center in
greater Kuala Lumpur Malaysia’.

Syoum, F.H. et al. (2022) ‘Fetomaternal Outcomes and Associated Factors among Mothers
with Hypertensive Disorders of Pregnancy in Suhul Hospital , Northwest Tigray , Ethiopia’,
2022.

Tousty, P. et al. (2022) ‘Adverse Neonatal Outcome of Pregnancies Complicated by

26
Preeclampsia’, pp. 1–10.

Uwizeyimana, P. et al. (2020) ‘Neonatal Outcomes from Mothers with Hypertension

Disorders of Pregnancy: A Retrospective Study at a Referral Hospital in Rwanda’, Rwanda
Journal of Medicine and Health Sciences, 3(2), pp. 193–203. Available at:
https://doi.org/10.4314/rjmhs.v3i2.9.

Wang, W. et al. (2021) ‘Epidemiological trends of maternal hypertensive disorders of

pregnancy at the global , regional , and national levels : a population ‐ based study’, 2, pp. 1–
10.

Workineh, Y.A. and Workie, H.M. (2022) ‘Adverse Neonatal Outcomes and Associated Risk
Factors: A Case-Control Study’, Global Pediatric Health, 9. Available at:
https://doi.org/10.1177/2333794X221084070.

World Health Organization (2022) WHO recommendations for care of the preterm or low-
birth-weight infant, World Health Organization.

Yang, Y. et al. (2022) ‘Characteristics and fetal outcomes of pregnant women with
hypertensive disorders in China : a 9 - year national hospital - based cohort study’, pp. 1–10.
Available at: https://doi.org/10.1186/s12884-022-05260-3.

27
Annex I: Information Sheets on adverse perinatal outcomes among mothers with
hypertensive disorders of pregnancy who gave birth at West Arsi and Shashemenne
Town public Hospitals form May 16 – June 16, 2023

Objective: the aim of this study is to assess adverse perinatal outcomes and its associated
factors among pregnant mothers with hypertensive disorders of pregnancy at West Arsi Public
hospitals from May 16 - June 16, 2023

Hello, my name is ___________ and I am a data collector for Adem Gemechu’s study who
is a student at Madda Walabu University, currently conducting a research to assess adverse
perinatal outcomes and associated factors among pregnant mothers with hypertensive
disorders of pregnancy at West Arsi Public hospitals from May 16 - June 16, 2023

Length of participation:-I am requesting your cooperation to fill out the questions which
will take about 15-20 minutes to complete.

Voluntary participation:-Participation in this survey will be voluntary, and if you don’t want
to participate you could withdraw at any time.

Confidentiality:-I assure you all information that you provide will remain strictly private and
confidentiality of responses would be maintained during and after data collection.

Risk and Benefits:-Has no risk for the participants & only numbers will be assigned to each
copy and no name will be required on the questionnaire. The numbers would facilitate data
entry and analysis, so no one can link your identity with the registration numbers. Your
answers will not be discussed with the others member. Findings from this research are
believed to serve as design evidence-based programs. Moreover, studies on similar topics
which may be conducted in a different scale and depth can make use of this study as a
springboard. I hope you will participate in the survey as your feedback are important.

Person to be contacted: - If you need further clarification about the survey, please contact
me any time by phone number 0916131996 or Email:kenayeroket2022@gmail.com

28
Thank you for your willingness to be the study participant and for taking the time to fill out
this study questionnaire.

Are you a volunteer? 1. Yes 2. No; if yes proceed Thank you!

29
Annexes 2: Questionnaire on adverse perinatal outcomes among
mother with hypertensive disorders of pregnancy who gave at West
Arsi zone and Shashemenne town public hospitals, 2023

Code Questions Response

Part I: Socio- demographic factors
Q1 What is mother’s age in year? ----------------
Q2 What is marital status of the mother? 1=single
2=married
3=divorced/separate
4=widowed
Q3 What is mother’s educational status? 1=unable to read and write
2=able to read and write
3=elementary school
4=secondary school
5=college and above
Q4 Husbands education 1=unable to read and write
2=able to read and write
3=elementary school
4=secondary school
5=college and above
Q5 What is mother’s occupation? 1=house wife
2= employed
3= merchant
4= farmer
5= daily laborer
6= student
7=unemployed
Q6 Husband’s occupation 1= employed
2= merchant

30
 3= farmer
4= daily laborer
5= student
6=unemployed
Q7 From where the mother came? 1=rural
2=urban
Q8 Did the mother come with referral? 1=yes
2=no
Q9 What is the average monthly income? (ETB) ______________
Part II: type of hypertensive disorders of pregnancy
Q10 SBP of the mother 1= < 140 mm Hg
2= 140-159mmHg
3=>160 mm Hg
Q11 DBP of the mother 1=<90mmHg
2=90-109 mm Hg
3=.>110mmHg

Q12 What is the type of hypertension the mother 1=pre-eclampsia

diagnosed with? 2=eclampsia
3= gestational hypertension
4=chronic hypertension
5=superimposed
hypertension
Part 3:time of anti hypertensive drugs initiation
Q13 What is the time of anti hypertensive/anticonvulsant 1= early
drugs given? 2=late
Q14 Did the mother take dexamethasone? 1= yes
2=no
Part III: Obstetric factors
Q15 Number of neonate delivered 1= single

31
 2= twins
3=others
Q16 Gravidity 1= Primigravida
2= multigravida

Q17 Mother’s parity? 1= nullipara, if nullipara,

skipn to Q19
2=multipara
Q18 What is the current birth interval? 1=> <2 years (short inter
pregnancy interval)
2= 2-4 years (optimal inter
pregnancy interval)
3=5 years (long inter
pregnancy interval )
4= not applicable
(primigravida)
19 Gestational Age at delivery ( weeks) 1= extremely preterm
(<28wks)
2=very preterm (28-32wks)
3=moderate to late pre term
(32-37wks)
4= term (>37wks)
Q20 How the mother’s labor started? 1=spontaneous
2=induced
Q21 Mode of current delivery 1= spontaneous vaginal
delivery
2=Elective C/S
3=Emergency C/S
4=Instrumental delivery
Part IV: service utilization

32
Q22 Did the mother attend ANC visit? 1= yes, if yes answer Q23,24
and 25
2=no, I no skip to Q 126.
Q23 when did you start ANC visit? 1=in first trimester
2= in second trimester
3= in third trimester
Q24 How many ANC contact did you attend? 1= one time
2=two times
3= three times
4= four and above times
Q25 Did the mother receive iron/ folic acid 1= yes
supplementation? 2= no
Part V: perinatal outcomes
Q26 Fetal sex 1= male
2=female
Q27 Fetal BWT <1500g (VLBWT)
2=1500-2499g (LBWT)
3= 2500-3999g (normal)
>4000g (big baby)
Q28 1st minute APGAR score ------------------
Q29 5th minutes APGAR score ------------------
Q30 Perinatal outcomes 1=Without adverse outcomes
2=with adverse outcomes, if
Q30 is with adverse perinatal
outcome, answer Q31
129 Categories of adverse perinatal outcomes 1=preterm
2=low birth weight
3=low APGAR score
4=neonatal death
5=birth asphyxia
6=NICU admission

33
 7=still birth
8=congenital anomalies
9= others

.`

34