Pre-eclampsia is a systemic condition characterized by hypertensive disorders that can interfere with the normal course of pregnancy. It usually appears in the third trimester of pregnancy. It combines high blood pressure and pathological proteinuria with oedema of the lower member, which is an inconsistent feature [1] .

There are many risk factors, which may be genetic, immunological, physiological or environmental in nature, or related to associated maternal conditions (obesity, chronic kidney disease, high blood pressure) or gestational conditions (multiple pregnancies, gestational diabetes) [2] . Its severity is marked by a range of maternal complications (eclampsia, retroplacental hematoma, HELLP syndrome, acute pulmonary oedema, acute renal failure, intravascular coagulation disorder, hemorrhagic liver rupture, retinal detachment) and fetal complications (intrauterine growth restriction, intrauterine fetal death). It is the leading cause of morbidity and mortality in both mothers and fetuses [3] .

Its pathophysiology is now better understood, as far as the maternal aspect is concerned, involving in particular the secretion by the placenta of excessive amounts of soluble anti-angiogenic factors, which cause systemic maternal endothelial dysfunction [4] .

Globally, the overall prevalence of pre-eclampsia is estimated at between 3% to 5% of pregnancies, with a significantly higher incidence in developing countries.

In the United States, its prevalence is estimated to be between 0.7% to 1.5%, depending on the authors [5] .

In France, the prevalence is estimated around 1% in the general population, with average of 1.5% for primiparous women and 0.8% for multiparous women [6] .

In Africa, the prevalence of pre-eclampsia is significantly higher, accounting for 4% in the general population and reaching 18% in certain ethnic groups [7] . In Chad, according to a hospital source, its frequency is 2.9% [8] .

Pre-eclampsia is therefore a major public health problem and a source of social crisis in developing countries, particularly in its severe form, due to the occurrence of the complications. For this reason, we considered it necessary to perform this study aiming to analyze factors associated with severe pre-eclampsia.

This was a descriptive and analytical cross-sectional study with prospective data collection, covering a period of 12 months from 1^st April 2024 to 31^st March 2025 perform in the Gynecology and Obstetrics Department of the Chadian and Chinese Friendship University Hospital Center. Were included in this study all patients admitted for pre-eclampsia during the study period. With gestational term ≥20th weeks That accepted to participate at this study. We recruited all patients that met our inclusion criteria in the emergency department and delivery room, and they were monitored during their hospital stay and upon discharge through telephone contact. Studied variables were sociodemographic, clinical, paraclinical, therapeutic, and prognostic. The data were entered using Word and Excel 2016 software and analyzed using SPSS version 18.0 software. Statistical analysis was performed using then value (significant when ≤5%).

During the study period, we reported a frequency of 2.6%. This frequency is comparable to those reported by Randriamahavonjy et al. [9] in Madagascar in 2018, Lisonkova S et al. [10] in Canada in 2021 and Foumsou et al. [8] in Chad in 2022, who noted respectively 1.68%, 2.5% and 2.9%. However, it is lower than what reported by Tshabu et al. [11] in Benin in 2017, Randrianambinina et al. [12] in Madagascar in 2023, Ahmed et al. [5] in Morocco in 2020, Bamba et al. [13] in 2022 and Diallo et al. [14] in 2024 in Guinea, who found respectively the rates of 4.8%, 6.30%, 7%, 10.6% and 13.60%. These differences could be explained by the fact that the occurrence of pre-eclampsia remains dependent on known and identified factors that vary from one geographical area to another.

With regard to age, the group age of 16 - 20 accounting for 41.9% , with a medium age of 24.6 ± 6.66 years and extremes of 17 and 40 years. This result is similar to those of Diallo et al. [14] , who report that the 15 - 20 age group accounted for 40.86% of cases. Coulibaly et al. [15] in Côte d’Ivoire in 2018 found that 30.5% were aged between 15 and 25. Some authors, such as Elombila et al. [3] in Congo in 2022 and Ronald et al. [16] in Congo in 2024, Bamba Diallo et al. [13] in Guinea in 2022, and Annick et al. [17] in Cameroon in 2024, noted a higher proportion in the group age from 20 - 35, respectively of 66.5%, 70%, 68%, and 48.2%. This difference seems to be linked to marriage and pregnancy among adolescents, which are still common practices in our country. This can lead to motherhood or pregnancies enameled by with complications.

In terms of marital status, 97.5% of patients were married. This rate is similar to the findings of M’baye et al. [18] in Niger in 2024 and Diallo et al. [14] , who noted 98.26% and 100% of married patients. These results could be explained by the social stigma in our context linked to conception out of marriage.

According to the living area, 69.37% of patients came from urban areas, which is comparable to the findings of M’baye et al. [18] , Diallo et al. [14] and Konaté [19] in Mali in 2023, who reported respectively 65% and 81% of patients coming from urban areas. This result could be explained by the statute of the Chadian and Chinese University Hospital Center that preferred to consult this center that is the nearest for emergency and complication linked to the pregnancy.

Despite the urban setting, we found that some patients did not receive adequate prenatal care. Thus, 43.12% of patients had attended 1 - 3 antenatal care. This result is lower than that reported by authors such as Diallo et al. [14] and Bamba et al. [13] , who observed 59.14% and 61.1% of patients, respectively, had attended between 1 to 4 prenatal cares. This could be explained on one hand by the fact that antenatal care is not free in public facilities and on the other, by the fact that the majority of patients are not in schooled, that constitute the limits to know the benefits of antenatal care.

We reported that primigravida, accounting for 49.4%. This result is similar to those of Kichou et al. [4] in Algeria in 2015 and Diallo et al. [14] , who noted respectively 56% and 34.41% of primigravida This finding corroborates the assertions that revealed primigravida as the risk factor for pre-eclampsia.

Clinically, functional signs such as headaches and dizziness were observed in 40.5%. This is close to the 32.1% and 64.7% reported by Randrianambinina et al. [12] and Kichou et al. [4] . This result could be explained by the fact that headaches and dizziness are warning signs of severe pre-eclampsia.

According to gestational age, we noted that the gestational term from 36 to 40 weeks was the most common, with 75.6%. Our findings are similar to those of Diallo et al. [14] , who reported that 48.16% had a gestational age > 37 weeks. Different obstetric contexts could explain these findings.

On clinical examination, we observed that systolic blood pressure (BP) was ≥160 mm Hg in 45%. This is lower than the 76.7% and 96.8% reported by Tshabu et al. [11] and Randrianambinina et al. [12] , with systolic BP ≥ 160 mm Hg, respectively.

Considering diastolic blood pressure, we constated that it ranged between 90 - 109 mm Hg in 53.8%. This rate is lower than the findings of Diallo et al. [20] , who noted 63.3% of patients with diastolic BP between 90 - 109 mm de Hg. These different systolic BP and diastolic BP rates observed in this study are justified by the fact that most of our patients had received methyldopa as antihypertensive treatment prior to admission.

According to the presence of proteinuria in the urine, we found that it was 3 crosses (+++) in 27.5%. M’baye et al. [18] and Randrianambinina et al. [12] , observed respectively 39.95% and 64.01% of positive proteinuria w ith 3+ (+++) in their study. This difference could be explained by the fact that most of our patients did not undergo prenatal cares.

In terms of obstetric treatment, caesarean section was the main mode of delivery with 70.60%. This confirms the attitude of Tshabu et al. [11] , Elombila et al. [3] , and Randrianambinina et al. [12] , who reported respectively 77.3%, 80.3% and 83.76% of patients delivered by cesarean section. This high rate of caesarean section can be attributed to the rate of severe pre-eclampsia in this series. According to current recommendations [21] , when of severe pre-eclampsia is diagnosed, uterine evacuation must be performed within 24 following hours when the gestational term is ≥37 gestational weeks. Similarly, the use of anticonvulsants and antihypertensive drugs is strongly recommended. This study corroborates these assertions, with 96.9% and 48.1% of patients benefiting from magnesium sulphate and an antihypertensive drug.

During this study, we recorded 15.6% of maternal complications, which is lower than the findings of Elombia et al. [3] and Randrianambinina et al. [12] , who reported respectively the complications rate of 25.4% and 43.6%. This could be explained by the fact that the CCUHC is the third referral center in N’Djamena, which, due to its status, attracts patients from surrounding areas or those referred for the management of complications.

The maternal lethality rate was 3.12%. This result is higher than those reported by Diallo et al. [14] and Tshabu et al. [11] , noted respectively the lethality rate of 2.15% and 2.45%. This result can be explained by the systematic transfer of complications such as eclampsia and HELLP syndrome to other facilities due to the lack of intensive care services.

Fetal prognosis, cis enameled by the occurrence of 22% cases of complications. This result is like those of M’baye et al. [18] , Bamba et al. [13] that reported a high rate of fetal complications respectively 17.44% and 27.4%. This rate can be linked to factor like the induce prematurity and the perinatal asphyxia with is high in the context of hypertension and complications.

Pre-eclampsia is a serious condition that is becoming increasingly common at the Chadian and Chinses Friendship University Hospital Center and is responsible for both maternal and fetal complications.

This study shows that pre-eclampsia remains a public health problem, exposing pregnant women and fetuses to risks of morbidity and mortality. The socio-demographic profile is that of young, primigravida, married, uneducated women living in urban areas who often attend less to healthcare facilities.

Optimal and effective care must always be provided early and in a multidisciplinary manner in order to improve the prognosis for both mother and fetus. Thus, careful monitoring during pregnancy is necessary in order to prevent complications.