Severe Preeclampsia Epidemiological, Diagnostic, Therapeutic and Prognostic Aspects at the Thies Regional Hospital Center about 443 Cases

Abstract

Objectives: Are to study the epidemiological, diagnostic, therapeutic and prognostic aspects of severe pre-eclampsia in the Obstetrics Gynecology Department of the Regional Hospital of THIES. Materials and Methods: This were a prospective, descriptive and analytical study of patients received for PES at the Maternity Department of the Regional Hospital of Thies between June 20, 2015 and June 20, 2017. We studied the diagnostic, epidemiological, therapeutic and prognostic aspects. The data were entered and analyzed by the EPINFO software version 6.04dfr. In order to study the influence of certain prognostic factors, we used the comparison of proportions and the Chi-square test with a significance level of 0.05. Results: We recorded 443 cases of Severe Peclampsia (SEP) out of 15,744 pregnant women, i.e. a frequency of 2.81%. It represented 52.05% of all hypertensive states associated with pregnancy during the study and a frequency of 3.12% of deliveries. The typical epidemiological profile found was that of a young woman aged 20-24 (25.05%), married (91.19%), housewife (80.8%) from the commune of Thies (50.56 %), primiparous (52.37%), carrier of a single pregnancy (96.4%), followed in a health post (97.21%) and evacuated in 89.4% of cases. The time between admission and delivery was on average 3.85 ± 3.91 days with extremities ranging from 0 to 42 days. The main signs found were: headache (96.61%), hypertension with SBP ≥160/110mmHg (93.90%), edematous syndrome (90.29%), proteinuria on the test strip ≥ ++ (95.48%), hyper uricemia >60mg/l (66.13%). Therapeutically, calcium channel blockers were the main antihypertensive agent used (99.32%). Magnesium sulfate was administered to almost all patients (97.29%). Corticosteroids were administered to 223 patients (50.23%). The blood transfusion had been done in 45 patients or 10.08%, and 05 of our patients had presented an acute renal failure requiring a transfer to Dakar for dialysis. Fetal evacuation was performed by Caesarean section in 49.88% of cases. Maternal complications were dominated by: eclampsia (24.78%), retro-placental hematoma (3.61%) and Hellp syndrome (3.61%). We recorded 18 cases of maternal death, i.e. a specific lethality of 4.06% and 69 cases of neonatal death, or a perinatal mortality rate of 4.87 per 1000 live births. On the fetal side, the main complications were fetal hypotrophy (51.46%) and prematurity (41.08%). The main factors of poor maternal prognosis were young age (20-24 years), primi gestity and primiparity. The fetal risk factors included prematurity and the low Apgar score.