Severe pre-eclampsia in the gynecology and obstetrics department of the CHR of Koudougou: epidemiological, clinical, therapeutic and prognostic aspects
Keywords:Severe pre-eclampsia, Prognosis, Treatment, Regional hospital center of Koudougou, Burkina Faso
Background: To study the epidemiological, clinical, therapeutic and prognostic aspects of severe pre-eclampsia in the gynecology and obstetrics department of the CHR of Koudougou.
Methods: descriptive cross-sectional study with prospective collection from January 1 to December 31, 2018. The variables studied focused on clinical socio-demographic characteristics, treatment and prognosis. The women admitted to the department and meeting the criteria for severe pre-eclampsia were included, more than 20 weeks of amenorrhea with an increase in blood pressure, presence of albumin in the urine and signs of clinical or biological seriousness.
Results: Severe pre-eclampsia represented 2.3% of admissions and 3% of deliveries. The clinical profile was that of a young housewife (51.2%), married (72.4%), nulliparous (44.1%) with a pregnancy in the 3rd trimester. Symptoms were dominated by headache (53.5%) and diastolic blood pressure ≥110 mmHg (66.9%), with albuminuria greater than two crosses and hyperuricemia. Magnesium sulfate and clonidine were the most commonly prescribed anticonvulsant and antihypertensive drug, respectively. Cesarean section was performed in 53% of cases.
Maternal complications were noted in 57.5% of cases without death. However, the fetus took a heavy toll with 50.7% morbidity and 14% perinatal mortality.
Conclusions: Severe pre-eclampsia is responsible for heavy morbidity - perinatal mortality. Improving maternal and fetal prognosis will require compliance with treatment protocols and greater accessibility of care at all levels of the health pyramid.
Say L, Chou D, Gemmill A, Tunçalp Ö, Moller AB, Daniels J, Gülmezoglu AM, Temmerman M, Alkema L. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014;2(6): e323-33.
Raphael V, Levasseur JE. EncyclMédChir. Emergency Med. 2007;25:45-9.
Tchaou BA, Salifou K, Hounkponou FM, Hountovo S, Chobli M. Management of severe preeclampsia in the university hospital of Parakou (Benin). RAMUR. 2012;17(2):22-9.
National Institute of Statistics and Demography of Burkina Faso. 2006 general population and housing census. Ouagadougou. Available at: http://ghdx. healthdata.org/organizations/national-institute-statistics-and-demography-burkina-faso. Accessed on 20 January 2021.
Burkina Faso Ministry of Health. Statistical yearbook 2010. Ouagadougou: general directorate for health information and statistics. Available at: https://www.un-spider.org/sites/default/files/Burkina Faso_Health_Care_Development_Support_Project_Centre_-_East_and_North_Regions_Appraisal_Report. pdf. Accessed on 20 January 2021.
Burkina Faso Ministry of Economy and Finance. Statistical yearbook 2014. Ouagadougou: National Institute of Statistics and Demography. Available at the URL: http://www.insd.bf/n/contenu/pub_periodi ques/annuaire_stat/Annuaire_stat_nationaux_BF/Annuaire_stat_2014.pdf. Accessed on 20 January 2021.
Gabriel RM. Beaufils: Nephrology. France : Editions Marketing; 1988:287-92.
Lamazou F, Salama S. Obstetric gynecology. 2nd ed. Netherlands: Elsevier; 2010:119-26.
Harioly NOJ, Rasolonjatovo TY, Andrianirina M, Randriambololona DMA, Ranoaritiana DB, Andrianjatovo JJ, et al. Epidemiological profile of preeclampsia and eclampsia admitted to the intensive care unit of adults in the Befelatanana maternity hospital. Rev D'Anes-Réanim and Med d'Urg. 2009; 1(3):22-4.
Lankoandé J, Toure B, Ouédraogo A, Ouédraogo CMR, Ouattara P, Bonané B, et al. Eclampsia in the maternity ward of the Yalgado Ouédraogo National Hospital in Ouagadougou (Burkina Faso), epidemiological, clinical and evolutionary aspects. Med Afr Noire. 1998;45:399-402.
Prevention, treatment of eclampsia and preeclampsia: summary of recommendations. Available at: http: //whqlibdoc.who.int/hq/2011/WHO_RHR_11.30_eng.pdf. Accessed on 20 January 2021.
Beaufils M. Pregnancy-related hypertension. Rev Med Interne. 2002;23(11):927-38.
Haddad B, Beaufils M, Bavoux F. Management of preeclampsia. In: French obstetricians. Paris: Vigot Editions; 2001;5:34.
Chaoui A, Tyane M, Belouali R. Management of pre-eclampsia and eclampsia. 2nd national consensus conference Morocco. Marrakech. 2002;19:20-1.
MacKay AP, Berg CJ, Atrash HK. Pregnancy-related mortality from preeclampsia and eclampsia. Obstet Gynecol. 2001;97(4):533-8.
Merviel P, Challier JC, Foidart JM, Uzan S. Precis of obstetric gynecology; implantation and placentation: physiologies, pathologies, and treatments. France: Elseviers Masson; 2000:372.
Sbai H, Khatouf M, Smail L, Bouazzaoui H, Essatara Y, Harrandou M, et al. Management of severe preeclampsia and l eclampsia in surgical intensive care. About 97 cases. J Magh Réa Méd Urg. 2008;15: 172-5.
Rizk NW, Kalassian KG, Gilligan T, Druzin MI, Daniel NL. Obstetric complications in pulmonary and critical care medicine. Chest. 1996;110(3):791-808.
Schiff E, Friedman SA, Kao L, Sibai BM. The importance of urinary excretion during conservative management of severe preeclampsia. Am J Obstet Gynecol. 1996;175:1313-6.
Landau R, Irion O. Data on physiopathology and recommendation for management (preeclampsia from physiopathology to treatment). Rev Méd Suisse Angiolol Hemostasis. 2005;1(4):290-5.
Haddad B, Barton JR, Livingston JC, Chahine R, Sibai BM. HELLP syndrome versus severe preeclampsia: onset at <28 weeks gestation. Am J Obstet Gynecol. 2000;183(6):1475-9.
Moignet C, Diemunsch P, Pottecher T. Anesthesia, resuscitation and preeclampsia. Obstet Gynecol. 1998;91(6):909-16.
Sibai BM. Diagnosis, controversies and management of the syndrome of hemolysis, elevated liver enzymes, and low platelet count. Obstet Gynecol. 2004;103(5): 981-91.
Courbiere B, Carcopino X. Obstetric Gynecology: National Classifying Tests (ECN). France: Vernazobres-Grego; 2007;51-62.
Getaneh W, Kumbi S. Use of magnesium sulfate in preeclampsia and eclampsia in teaching hospitals in Addis Ababa: a practice audit. Ethiopian Med J. 2010;48(2):157-64.
Magpie trial follow-up study collaborative group. The Magpie trial: a randomized trial comparing magnesium sulfate with placebo for pre-eclampsia. Outcome for women at 2 years. BJOG. 2007;114:300-9.
Kumari A, Chakrawarty A, Singh A, Singh R. Maternal and fetal complications and their association with proteinuria in a tertiary care hospital in a developing country. J Pregnancy. 2014; 2014:6-27.