Adverse prognostic factors for preeclampsia in Madagascar

Abstract

Hypertensive disorders of pregnancy are serious diseases that cause high rates of maternal and fetal morbidity and mortality. Our goal was to determine the epidemiological, clinical, and laboratory findings associated with complications in these patients after the onset of hypertension. This retrospective analytical study examined the files of women with hypertension who delivered at the Hospital of Gynecology Obstetrics in Befelatanana, Madagascar, in 2008-2010. During this four-year study period, 1320 women giving birth at our center had been hypertensive during pregnancy, for a prevalence of 5.11%; 409 (30.98%) had preeclampsia. The main maternal complications were eclampsia (14.46%), renal failure (3.40%), maternal death (3.03%), and placental abruption (2.95%). For the fetus, maternal preeclampsia was complicated by preterm birth (35.07%), perinatal death (21.42%), perinatal asphyxia (14.50%), and fetal growth restriction (9.71%). Patients younger than 20 years were at the highest risk of eclampsia (RR 2.18, 95% CI [(1.83 to 3.75]). Primiparity and history of eclampsia or fetal growth restriction were risk factors for eclampsia. Hyperproteinuria and elevated serum creatinine concentrations were associated with adverse fetal outcome. Isolated hyperuricemia was not associated with outcome. When preeclampsia has been diagnosed, some aspects of obstetric history and impaired kidney function are poor prognostic factors that can require early emergency delivery.