Gynecology & Obstetrics
Open Access
ISSN: 2161-0932
ISSN: 2161-0932
MM Niang, F Samb, CT Cisse and T Willane
Objectives: Determine the frequency of severe preeclampsia, specify the epidemiological and clinical profile of patients, assess the management and the maternal and perinatal prognosis and specify the factors associated with the risk of complications in patients treated for severe preeclampsia at the maternity ward of the hospital Institute of Social Hygiene of Dakar.
Material and methods: This was a retrospective, descriptive and analytical study conducted over a period of two years (January 1st, 2019 to December 31st, 2020) and focusing on severe preeclampsia. We studied the socio-demographic characteristics of the patients, the clinical and paaclinical data, the maternal and perinatal prognosis and the factors associated with the risk of complications.
Results: During the study period, we recorded 110 cases of Severe Preeclampsia (SPE) among the 4290 parturients, i.e. a frequency of 2.6% of deliveries. The epidemiological profile of the patients was that of a woman with an average age of 29, nulliparous (50%), nulliparous (45.4%), and married (96%), at the average socio-economic level (55.4%), with history of pregnancy-induced hypertension (8.3%). The average gestational age at admission was 33 weeks of amenorrhea with extremes between 27 SA and 42 SA + 4 days. Most of the pregnant women were carriers of a pregnancy whose term was greater than or equal to 37 WA (60%). Prenatal follow-up Chronic Progressive Nephropathy (CPN) was carried out in all our patients and was most often of good quality (60%). On general examination, severe diastolic and severe systolic hypertension was each observed in 27% of our study population. The biological examinations carried out had objectified 14 cases of anemia (12.7%), thrombocytopenia in 11 patients (10.1%), massive proteinuria in 1.8% of cases, hepatic cytolysis in 4 pregnant women (3, 7%), renal failure with elevated serum creatinine in 5 cases (4.5%) and hyperuricemia in 22 patients (20%). Obstetric ultrasound found 16 cases of oligohydramnios (15%) and a high resistance index of the umbilical artery in 2 patients (2%). In our study, 10 patients (9%) had benefited from intensive care unit resuscitation. Magnesium sulphate was used in 38 patients (34.5%) intravenously according to the Zuspan protocol. Lung maturation was performed in 38 patients (34.5%) with betamethasone. Antihypertensive treatment was instituted in 77 patients (71%) orally (43.6%) or parenterally (56.4%). The molecules used were dominated by alpha methyl-dopa (36.4%) and nicardipine (63.6%). The obstetrical treatment consisted of a uterine evacuation which was most often done by caesarean section (90%). Maternal complications were dominated by retroplacental hematoma (9.1%), HELLP syndrom (9.1%) and eclampsia (2.1%). We have not recorded any maternal deaths. Prematurity (45.8%) and Intrauterine Growth Restriction (IUGR) (26.8%) were the most common perinatal complications. The Apgar score at the 5th minute was normal in 105 newborns (96.3%). Neonatal asphyxia only affected 4 newborns (3.7%). Birth weight averaged 3177 grams with extremes of 800 grams and 4000 grams. Low birth weight concerned 70 newborns (63%). We recorded 97 live birth (87.4%) and 14 perinatal deaths, i.e. a stillbirth of 144.3‰ live birth. During the postnatal follow-up, we noted a normalization of the blood pressure figures in 85.5% of the patients. Contraception was instituted in 107 patients (97.2%). These were most often progestogen implants (76.4%) or Intrauterine Device (IUD) (14.5%). We did not find any factors significantly associated with the risk of maternal and perinatal complications.
Conclusion: Despite the severity of the c linical cases and the difficulties encountered in the management, severe preeclampsia is associated with a relatively favorable maternal and perinatal prognosis in our practice.
Published Date: 2024-05-01; Received Date: 2023-08-29