Hypertensive disorders in pregnancy at the Federal Medical Centre, Yenagoa, South-South Nigeria: a 5-year review
Keywords:Hypertensive disorders, Eclampsia, Pre-eclampsia, Outcomes, Morbidity, Mortality
Background: Hypertensive disorders complicate 5.2%-8.2% of pregnancies, and contribute significantly to perinatal and maternal morbidity and mortality worldwide. The objective of this study is to determine the incidence, clinical characteristics, maternal and perinatal outcomes of hypertensive disorders in pregnancy at the Federal Medical Centre, Yenagoa, Bayelsa State, South-South Nigeria.
Methods: This retrospective study was conducted between 1 January, 2016 and 31 December, 2020. Relevant data was retrieved, entered into a pre-designed proforma, and analysed using IBM SPSS version 25.0.
Results: Out of the 4,571 obstetric patients that were managed in our Centre in the period under review, 335 of them had HDP, giving an incidence rate of 7.32%. The most common HDP were pre-eclampsia (189, 56.4%) and eclampsia (82, 24.5%), while the least common was chronic hypertension (3, 0.9%). A little more than one-half (171, 51.0%) of the women delivered preterm, with a mean gestational age at delivery of 35.5 weeks. The most common route of delivery was emergency Caesarean section (205, 61.2%). There were three maternal deaths, giving a case fatality rate of 0.9%. Two of the maternal deaths were due to eclampsia, and one, from pre-eclampsia.
Conclusions: Women should be adequately counseled to embrace preconception care, early booking and regular antenatal care visits, with proper monitoring of blood pressure and urine protein. Prompt diagnosis and management are key in preventing the maternal and perinatal morbidity and mortality that are associated with these disorders.
Nour NM. An Introduction to maternal mortality. Rev Obstet Gynecol. 2008;1(2):77-81.
Duley L. The global impact of pre-eclampsia and eclampsia. Semin Perinatol. 2009;33(3):130-7.
Umesawa M, Kobashi G. Epidemiology of hypertensive disorders in pregnancy: prevalence, risk factors, predictors and prognosis. Hypertens Res. 2017;40(3):213-20.
Itam IH, Ekabua JE. Socio-demographic determinants of eclampsia in Calabar; A ten-year review. Mary Slessor J Med. 2003;3:72-4.
Ugwu E, Dim CC, Okonkwo CD, Nwankwo TO. Maternal and perinatal outcome of severe pre-eclampsia in Enugu, Nigeria after introduction of magnesium sulphate. Niger J Clin Pract. 2011;14(4): 418-21.
Ebeigbe PN, Aziken ME. Early onset pregnancy-induced hypertension/eclampsia in Benin City, Nigeria. Niger J Clin Pract. 2010;13(4):388-93.
Kwawukume EY, Ekele BA. Hypertension in pregnancy. In: Kwawukume EY, Ekele BA, Danso KA, Emuveyan EE, editors. Comprehensive Obstetrics in the tropics. 2nd ed. Accra-North: Assemblies of God Literature Centre Ltd, 2015:219-31.
Jido TA, Yakasai IA. Preeclampsia: A review of the evidence. Ann Afr Med. 2013;12(2):75-85.
Rădulescu C, Bacârea A, Huțanu A, Gabor R, Dobreanu M. Placental Growth Factor, Soluble fms-Like Tyrosine Kinase 1, Soluble Endoglin, IL-6, and IL-16 as Biomarkers in Preeclampsia. Mediators Inflamm. 2016:3027363. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5069373/DOI:10.1155/2016/3027363 Accessed on 21 August 2021.
Bilano VL, Ota E, Ganchimeg T, Mori R, Souza JP. Risk Factors of Pre-Eclampsia/Eclampsia and Its Adverse Outcomes in Low- and Middle-Income Countries: a WHO Secondary Analysis. PLoS One. 2014;9(3):e91198 A
Waugh JS, Smith MC. Hypertensive disorders. In: Edmunds DK, editor. Dewhurst’s textbook of Obstetrics and Gynaecology. 8th ed. UK: John Wiley and Sons, Ltd; 2012:101-10.
Sutherland A, Cooper DW, Howie PW, Liston WA, MacGillivray I. The incidence of severe pre-eclampsia amongst mothers and mothers-in-law of pre-eclamptics and controls. Br J Obstet Gynaecol. 1981;88(8):785-91.
Norwitz ER. Early pregnancy prediction of preeclampsia. UpToDate; 2021. Available at: https://www.uptodate.com/contents/early-pregnancy-prediction-of-preeclampsia?source=history_widget. Accessed on 21 August 2021.
Norwitz ER. Preeclampsia: Management and prognosis preeclampsia. UpToDate; 2021. Available at: https://www.uptodate.com/contents/preeclampsia-management-and-prognosis?source=history_widget. Accessed on 21 August 2021.
Orisabinone IB, Onwudiegwu U, Adeyemi AB, Oriji CP, Makinde OI. Shortened versus standard post-partum maintenance therapy of magnesium sulphate in severe pre-eclampsia: a randomised control trial. Int J Reprod Contracept Obstet Gynecol. 2020;9(4): 1646-53.
Orisabinone IB, Onwudiegwu U, Adeyemi AB, Oriji PC, Makinde OI. Pattern of occurrence of severe preeclampsia among pregnant women in South-West Nigeria. Yen Med J. 2020;2(1):38-42.
Obagah L, Kasia BE, Jeremiah I, Allagoa DO, Aigere EOS, Kotingo EL, et al. Serum uric acid: a biochemical prognostic indicator of pregnancy outcomes among pre-eclampsia patients at the Federal Medical Centre, Yenagoa. Int J Reprod Contracept Obstet Gynecol. 2020;9(11):4344-9.
Obagah L, Jeremiah I, Allagoa DO, Aigere EOS, Kasia BE, Kotingo EL, et al. Prognostic accuracy of β hcg level in predicting pregnancy outcomes among pre-eclamptic patients at the Federal Medical Centre, Yenagoa. Yen Med J. 2020;2(2):30-7.
Aigere EOS, Allagoa DO, Kotingo EL, Obagah L, Kasia BE, Oriji PC. Accuracy of combined measure of serum uric acid and beta human chorionic gonadotropin (β hCG) versus serum beta human chorionic gonadotropin alone as prognostic indicators of pregnancy outcome of preeclampsia. J Advances Med Med Res. 2020;32(22):1-9.
Ghulmiyyah L, Sibai B. Maternal mortality from preeclampsia/eclampsia. In: Seminars in perinatology. USA: WB Saunders; 2012;36(1):56-9.
English FA, Kenny LC, McCarthy FP. Risk factors and effective management of preeclampsia. Integr Blood Press Control. 2015;8:7-12.
Fokom-Domgue J, Noubiap JJ. Diagnosis of hypertensive disorders of pregnancy in sub Saharan Africa: a poorly assessed but increasingly important issue. The J Clin Hypertens. 2015;17(1):70-3.
Bembalgi S, Kamate V, Shetty S. A comparative study of antepartum and postpartum eclampsia at a tertiary care centre. Int J Reprod Contracept Obstet Gynecol. 2016;5(6):1728-31.
Agida ET, Adeka BI, Jibril KA. Pregnancy outcome in eclamptics at the University of Abuja Teaching Hospital, Gwagwalada, Abuja: a 3-year review. Niger J Clin Pract. 2010;13(4):394-8.
Chames MC, Livingston JC, Ivester TS, Barton JR, Sibai BM. Late postpartum eclampsia: a preventable disease? Am J Obstet Gynecol. 2002;186(6):1174-7.
Orubuloye IO, Caldwell JC, Caldwell P. Sexual networking in the Ekiti District of Nigeria. Stud Fam Plan. 1991;22(2):61-73.
Okafor NI, Joe-Ikechebelu NN, Ikechebelu JI. Perceptions of infertility and in vitro fertilization treatment among married couples in Anambra State, Nigeria. Afr J Reprod Health. 2017;21(4):55-66.
Bartal MF, Sibai BM. Eclampsia in the 21st century. Am J Obstet Gynecol. 2020. S0002-9378(20)31128-5.
Hutcheon JA, Lisonkova S, Joseph KS. Epidemiology of pre-eclampsia and the other hypertensive disorders of pregnancy. Best Pract Res Clin Obstet Gynaecol. 2011;25(4):391-403.
Ananth CV, Savitz DA, Luther ER, Bowes Jr WA. Preeclampsia and preterm birth subtypes in Nova Scotia, 1986 to 1992. Am J Perinatol. 1997;14(01): 17-23.
Hypertension in pregnancy: diagnosis and management. NICE guideline NG133. Published 25 June 2019. Available at: https://www.nice.org.uk/ guidance/ng133/chapter/Recommendations#management-of-gestational-hypertension. Accessed on 21 August 2021.
Guidelines for the management of severe preeclampsia and eclampsia. Available at: https://sogon.org/sogon-publications/sogon-guidelines-protocols/. Accessed on 21 August 2021.
Delgado De Pasquale S, Velarde R, Reyes O, De La Ossa K. Hydralazine vs labetalol for the treatment of severe hypertensive disorders of pregnancy. A randomized, controlled trial. Pregnancy Hypertens. 2014;4(1):19-22.
Duley L, Gülmezoglu AM, Henderson-Smart DJ, Chou D. Magnesium sulphate and other anticonvulsants for women with pre-eclampsia. Cochrane Database Syst Rev. 2010;2010(11): CD000025.
The Eclampsia Trial Collaborative. Which anticonvulsant for women with eclampsia? Evidence from the collaborative eclampsia trial. Lancet. 1995; 345(8963):1455-63.
Allagoa DO, Oriji PC, Tekenah ES, Obagah L, Ohaeri OS, Mbah KM, et al. Caesarean Section in a Tertiary Hospital in South-South, Nigeria: A 3-year Review. EJMED. 2021;3(2):122-7.