Acute complications of preeclampsia: prognosis and management at Pikine National Hospital in Dakar (Senegal)
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20175828Keywords:
Acute, Complication, Preeclampsia, PrognosisAbstract
ABSTRACT
Background: The objective of this study was to evaluate the prevalence of acute complications of preeclampsia in order to describe the epidemiological profile of the disease, to assess its prognosis and management.
Methods: This was a retrospective study of patients admitted to the Pikine National Hospital from 1 January 2010 to 31 December 2013 (48 months) with severe complicated pre-eclampsia. Included in this study were patients admitted or diagnosed with severe complicated pre-eclampsia and having given birth in the structure or not.
Results: The incidence of severe preeclampsia in childbirth varied from 9.7% to 11.5% during the four years of our study. Patients were largely paucigest (55.7% of cases) and paucipares (58.5% of cases). The mean age was 28.14 years with extremes of 14 and 47 years. More than half of the patients (57.7%) were between 21 and 34 years of age. They were mostly married (90.7%). Three-quarters of the patients (76.8%) had proteinuria with ≥ 3 cross-bands. Thrombocytopenia was found in 9.7% of patients, hepatic cytolysis in 12.1%, and elevation of serum creatinine in 13.8%. The level of transaminases was found to be greater than 2 in the normal range in 12.1%. Complicated forms were the most represented in our study. These were acute complications, with 715 cases, or 57.3% of the patients. They were either isolated (52.8%) or associated (4.5%). These included eclampsia (24.9%), followed by retroplacental hematoma (24.6%), fetal death in utero (23.7%), HELLP syndrome (3.4%). , Acute edema of the lungs (1.5%), and acute renal failure (1.4%). The lethality was 2.4%. The causes of maternal death were dominated by eclampsia (14 cases), DIC (3 cases) and OAP (2 cases). We counted 77.7% of live births and a stillbirth of 254.5 ‰.
Conclusions: Pre-eclampsia is a serious complication of pregnancy. Its frequency is still high in sub-Saharan Africa. In the presence of signs of severity, maternal (vital and functional) and neonatal prognosis are inevitably involved. If management is based on fetal extraction, resuscitation measures are a guarantee of maternal survival.
References
Merger R, Levy J, Melchior J. Anatomy and physiology of the egg. Accuracy of obstetrics. 5th ed. Paris, Masson;1985:3-71.
Winer N, Tsasaris V. Knowledge study: therapeutic management of preeclampsia. J Gynecol Obstet Biol Reprod. 2008;37:5-15.
Sene M. Contribution to the management of severe preeclampsia at the Pikine National Hospital. About 160 cases. Memory Gyneco Obstet Dakar. 2011;366.
Tchaou BA, Tshhabu-Aguemon TC, Hounkponou NFM, Adisso S, Aguemon AR, Chobli M. Severity and prognosis of patients treated for severe preeclampsia at the Departmental and University Hospital Center of Parakou (Benin). Med Afr Noire. 2013;60:489-495.
Koual M, Abbou H, Carbonnel M, Picone O, Ayoubi JM. Short-term outcome of patients with preeclampsia. Vascular Health and Risk Management. 2013;9:143-8.
Magee LA, Miremadi S, Li J, Cheng C, Ensom MH, Carleton B, Côté AM et al. Therapy with both magnesium sulfate and nifedipine does not increase the risk of serious magnesium-related maternal side effects in women with preeclampsia. Am J Obstet Gynecol. 2005;193:153-63.
Satsaris V, Fournier T, Winer N. Pathophysiology of preeclampsia. J Gynecol Obstet Biol Reprod 2008;37:16-23.
Wasseff S. Mechanisms of convulsions in eclampsia. Med Hypotheses. 2009;72:49-51.
Zeeman GG. Increased cerebral blood flow in preeclampsia with magnetic resonance imaging. Am J Obstet Gynecol. 2004;191:1425-9.
Belfort MA, Saade GR, Grunewald C, Dildy GA, Varner MA, Nisell H. Effects of blood pressure on orbital and middle cerebral artery resistances in healthy pregnant women and women with preeclampsia. Am J Obstet Gynecol. 1998;180:601-7.
Zeeman GG. Cerebral infarction in eclampsia. Am J Obstet Gynecol. 2004;190:714-20.
Bah AO, Diallo MH, Conde AM, Keita N. Hypertension and pregnancy: maternal and perinatal mortality. Med Afr Noire. 2001;48:461-4.
Beaufils M, Haddad B, Bavoux F. Hypertension in pregnancy: physiopathological aspects and long-term prognosis. Encycl Med Chir. Obstetric Gynecol. 2006;5-036-A-10:15.
