CHAPTER 1: INTRODUCTION

1.1. BACKGROUND

  Hypertensive disorders in pregnancy represent a frequent medical complication in pregnancy and complicates 5-10% of all pregnancies. They are one of the leading causes of morbidity, long term disability and death during pregnancy and postpartum and accounts for approximately 14% of all maternal deaths worldwide(1). Hypertensive disorders of pregnancy include: chronic hypertension; gestational hypertension; pre-eclampsia with or without severe features; eclampsia and chronic hypertension with superimposed pre-eclampsia/eclampsia(2).

Pre-eclampsia is a multisystemic disorder of pregnancy associated with new-onset hypertension, which occurs most often after 20weeks of gestation with the presence of proteinuria and/or signs or symptoms indicative of target organ injury(3). Pre-eclampsia complicates 2-8% of pregnancies globally and in Africa and Asia, 9% of maternal deaths are attributed to pre-eclampsia(4).

The World Health Organisation (WHO) estimates the incidence of pre-eclampsia to be seven times higher in developing countries (28%) compared to developed countries (4%)(5). In France, pre-eclampsia complicates 2.0% of pregnancies and women with preexisting hypertension are at high risk to develop preeclampsia during pregnancy(6). In the U.S, the prevalence of preeclampsia has increased over the past three decades, affecting 2.4% of pregnancies in 1980 to 3.8% in 2010. This increase in incidence seems, in part, due to recent trends of delaying pregnancies to a later age and the increased rate of obesity and cardiovascular risk factors among pregnant women(7). A study carried out showed an overall prevalence of preeclampsia in Sweden and China, 2.9 and 2.3%, respectively. In Sweden, a significantly higher risk of mild and severe preeclampsia was associated with nulliparity, history of diabetes, and gestational diabetes. In China there was no significant association with parity, and diabetes was the only associated risk factor of severe preeclampsia(8). The prevalence of pre-eclampsia is 14.4% in Bangladesh(9).

In Sub-Saharan Africa alone, pre-eclampsia remains a major public health problem as the reported prevalence of pre-eclampsia ranges from 1.8 to 16.7% and contributes to high rates of maternal mortality(2). The prevalence of pre-eclampsia among pregnant women in Dessie, Ethiopa was found to be 8.4%, women having family history of hypertension, chronic hypertension, age greater than or equal 35years, family history of diabetes mellitus and being unmarried were found to be associated with pre-eclampsia(10). Studies carried out in Benin city and Sokoto in Nigeria showed a prevalence of 5,6% and 6% respectively(5).

In Cameroon, Hypertensive disease is a pathological entity common in pregnancy, with a variety of clinical presentations. Pre-eclampsia is the most common variety of this condition. A study carried out, 2009 in the Yaounde Gynaeco-Obstetric and Pediatric Hospital showed that preeclampsia was the most frequent hypertensive disease in 77.88% of the patients, representing 4.97% of deliveries(11).  

1.2. JUSTIFICATION

        Hypertensive diseases are common causes of maternal and perinatal morbidity and mortality in our milieu, and preeclampsia is the most frequent type of HDP and is the major cause of hypertension in pregnancy. The increase rate in mortality and morbidity related to pre-eclampsia (complications, both maternal and perinatal, occur mainly in preeclampsia and eclampsia, especially in the superimposed forms, and this preferably in severe cases of the disease. Maternal complications are mainly placenta abruptio, while maternal mortality is mainly related to the occurrence of eclampsia, while perinatal mortality is associated with the severity of the hypertensive disease, the main fetal complication being prematurity.) and lack of epidemiological data in our locality (given that the majority of studies have been carried out at central and litoral regions) motivated this study in the Garoua Regional and Military Hospitals in order to have baseline data and also to improve the diagnosis, management and prevention of preeclampsia.

1.3. RESEARCH QUESTIONS

1. What is the prevalence of preeclampsia at the Garoua regional and military hospitals?
2. What are the associated risk factors?
3. What are the perinatal and maternal outcome of preeclampsia?

1.4. RESEARCH HYPOTHESIS

Preeclampsia is most likely to be the leading complication of pregnancy at the Garoua regional and military hospitals.

1.5. OBJECTIVES

 1.5.1. General Objective:

Evaluate the prevalence of preeclampsia, its determinants and perinatal-maternal outcome at the Garoua regional and military hospitals.

 1.5.2. Specific objectives:

1. Describe the sociodemographic characteristics of patients   

                   with preeclampsia at the regional and military hospitals.

2. Determine the Prevalence of preeclampsia in the two hospitals.
3. Identify the risk factors associated with preeclampsia.
4. Identify maternal and perinatal outcome of preeclampsia.
5. Compare maternal and perinatal outcome with women without preeclampsia.