Quality of care and outcome of patients with pregnancy-induced hypertension: a retrospective observational study before and during the COVID-19 pandemic along the Wesfleur-New Somerset Hospital Axis, Cape Town, South Africa
Background: The COVID-19 pandemic disrupted global healthcare systems and may have affected care for non-COVID conditions like pregnancy-induced hypertension (PIH), which is a leading cause of maternal and perinatal deaths. This study aimed to evaluate the quality of care and outcomes for PIH patients along a single district-level referral pathway in Cape Town, South Africa, during the pandemic. Methods: A retrospective clinical study of clinical records was conducted on all 57 PIH cases identified over six months (January to June 2021) at Wesfleur and New Somerset Hospitals. We assessed the quality of care using the Donabedian framework, which includes structure, process, and outcomes. Analysis focused on demographics, adherence to clinical protocols, and maternal and foetal outcomes. We then compared these against pre-pandemic benchmarks. Statistical analyses included descriptive statistics, chi-square tests, and exploratory multivariate logistic regression. Results: The prevalence of PIH was 9.7%. Process indicators showed resilient care, with 100% adherence to clinical monitoring and referral protocols. This was a substantive improvement from the 66.1% compliance before the pandemic. Maternal complication rates were low, with eclampsia and HELLP syndrome both at 1.75%. However, rates of foetal distress were high at 23.0%, and preterm delivery was at 16.0%. Within the constraints of the sample size, multivariate analysis suggested un-booked status was a strong, independent predictor of maternal complications (aOR=4.3, p=0.010), while late antenatal booking predicted foetal distress (OR=2.9, p=0.022). The cohort showed high rates of modifiable risk factors, including smoking at 38.5% and obesity at 42.0%. Conclusion: This facility-level audit indicates that, within this specific pathway, adherence to essential PIH management protocols leads to low maternal complication rates. However, the consistently high adverse perinatal outcomes, related to late antenatal care seeking, highlight a significant gap in early intervention. These findings emphasise the need for early antenatal booking and strengthening community-oriented interventions to overcome patient-related barriers to care during public health emergencies.
Pregnancy-Induced Hypertension, PIH, COVID-19, Quality of Care, Maternal Health, Perinatal Outcomes, Clinical Audit, South Africa
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