TITLE:
High Blood Pressure and Pregnancy: Epidemiological, Diagnostic, Therapeutic and Prognostic Aspects at the Maternity Unit of the Institute of Social Hygiene of Dakar (Senegal)
AUTHORS:
Mouhamadou Mansour Niang, Fatou Samb, Kevin Nkondjio, Cheikh Tidiane Cisse
KEYWORDS:
HTA, Pregnancy, Preeclampsia, Caesarean Section, Prematurity
JOURNAL NAME:
Advances in Reproductive Sciences,
Vol.11 No.4,
November
22,
2023
ABSTRACT: Objectives: To specify the
epidemiological and clinical profile of the patients, to determine the methods
of management and to evaluate the maternal and perinatal prognosis in the
association of arterial hypertension and pregnancy (HTA) at the Institute of
Social Hygiene of Dakar. Material and Methods: This was a
retrospective, descriptive and analytical study on the management of the
association of hypertension and pregnancy in the maternity ward of the
Institute of Social Hygiene of Dakar between January 1st, 2019 and
on December 31st, 2020. Results: During the study period, we
recorded 326 cases of hypertension associated with pregnancy among the 4290
pregnant women, i.e. a frequency of
7.6%. The epidemiological profile of the patients was that of a woman with an average
age of 29, nulliparous (48.2%), married (99.1%), at a low socioeconomic level
(61.3%) and with a personal history preeclampsia (14.4%). Most patients (83.1%)
were evacuated or referred with pre-ec- lampsia as the main reason (40.8%). The average gestational age was 37
weeks of amenorrhea (SA) with extremes of 20 SA 6 days and 41 SA 5 days. Term
pregnancies were the most represented (76.7%). Prenatal follow-up (CPN) was
carried out in 319 patients (97.8%) with an average number of CPN of 3 and
extremes of 1 and 9. Severe diastolic and severe systolic hypertension
concerned respectively 19.3% and 16, 9% of patients. One hundred and eighty
patients (55.2%) presented with oliguria. Strip albuminuria was performed in
235 patients (72.1%). It found 3 or more crosses in 38.3% of cases. We recorded
53 cases of anemia (16.3%), 16 cases of significant proteinuria (5%), hepatic
cytolysis in 22 patients (6.7%), thrombocytopenia in 37 patients (11.3%), and
43 cases of hyperuricaemia (13.2%). Obstetric ultrasound found 36 cases of
severe oligohydramnios (11%), 8 twin pregnancies (2.4%) and an umbilical Doppler anomaly in 10 patients (3.1%).
Pre-eclampsia was the most common
clinical form (70.5%), followed by chronic hypertension (15.1%) and
pregnancy-induced hypertension (14.4%). In our study, 32 patients (9.8%) had
received resuscitation. The most used anti-hypertensives were alpha methyl-dopa
(46.1%) and nicardipine (24.5%). The obstetrical treatment consisted of uterine
evacuation which was most often done by caesarean section (63.1%). Maternal
complications were dominated by retroplacental hematoma (16.3%) followed by
eclampsia (7.4%) and HELLP syndrome (6.7%). We have not recorded any maternal
deaths. Prematurity (19.3%) and intrauterine growth restriction (IUGR) (16.3%)
were the most common perinatal complications. Severe and moderate neonatal
asphyxia concerned respectively 14.8% and 14.4% of newborns. The birth weight
was on average 2400 grams with extremes of 400 and 4500 grams. Low birth weight
accounted for 49.5% of the sample. One hundred and twelve newborns (34.4%) were
referred to neonatology most often for neonatal asphyxia (29.2%). We recorded
37 fetal deaths in utero (11.3%) and 10 neonatal deaths (3.1%), representing a
perinatal mortality of 168.5 per 1000 live births. During the postnatal
follow-up, we noted a normalization of the blood pressure figures in 98.8% of
the patients. Contraception was instituted in 150 patients (46.1%). These were
most often progestogen implants (32.2%) or
intrauterine device (IUD) (11.7%). The choice of delivery route was
significantly associated with the clinical form. Indeed, caesarean section was
more frequent in case of preeclampsia compared to pregnancy-induced
hypertension (p = 0.03). Maternal and perinatal complications such as HELLP
syndrome (86.4%), PRH (64.2%), eclampsia (79.2%) and UFID (23.6%) were more frequent in cases severe preeclampsia (p = 0.028,
p = 0.0001). Conclusion: The association of hypertension and pregnancy
is frequent in our practice. Its prognosis is marked by the risk of
prematurity, IUGR and maternal complications.