|Year : 2022 | Volume
| Issue : 2 | Page : 197-200
Maternal and perinatal outcomes of preeclampsia at a tertiary hospital in lagos, Nigeria
Aloy O Ugwu1, Emmanuel Owie2, Ayodeji A Oluwole2, Adaiah P Soibi-Harry1, Sunusi R Garba1, Kehinde S Okunade2, Christian C Makwe2, Sunday I Omisakin2, Nneoma K Ani-Ugwu3, Lulu G Ojiefoh3, Ifunanya T Okafor3, Augustine Egba1, Rasheed A Olatunji1, Salimat A Yusuf-Awesu1
1 Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Lagos, Nigeria
2 Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Lagos, Nigeria; Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, Lagos, Nigeria
3 Department of Medicine, Lagos University Teaching Hospital, Lagos, Nigeria
|Date of Submission||24-Nov-2021|
|Date of Decision||05-Jan-2022|
|Date of Acceptance||27-Jan-2022|
|Date of Web Publication||3-Mar-2022|
Aloy O Ugwu
Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Lagos.
Source of Support: None, Conflict of Interest: None
Background: Preeclampsia (PE) is a pregnancy-specific condition, with a serious impact on the health and quality of life of both mother and child. PE is a multisystem progressive disorder that occurs following placental and maternal vascular dysfunction and resolves postpartum over a variable period of time. Objectives: The study was aimed to determine the incidence as well as the perinatal and maternal outcomes of PE at the Lagos University Teaching Hospital (LUTH), Nigeria. Materials and Methods: This was a retrospective review of patients managed in the labor and postnatal wards of the LUTH, Idi-Araba, Nigeria, over a 5-year period. A study proforma was used to collect relevant data which were entered and analyzed using the IBM Statistical Package for Social Sciences (SPSS Statistics) Version 23. Results: A total of 426 pregnancies were complicated with PE giving an incidence of 10.2% of all deliveries during the study period. Several maternal complications recorded included: acute kidney injury (1.9%), abruptio placentae (2.1%), postpartum hemorrhage (2.4%), maternal mortality (3.8%). The perinatal mortality rate was 16.7%, and 35.4% of the live births required neonatal intensive care unit admission. Conclusion: PE contributed a sizeable proportion of deliveries in LUTH, Nigeria during the study period. It also played a significant role in maternal and perinatal complications.
Keywords: Complications, hypertension, Lagos, mortality, preeclampsia, pregnancy
|How to cite this article:|
Ugwu AO, Owie E, Oluwole AA, Soibi-Harry AP, Garba SR, Okunade KS, Makwe CC, Omisakin SI, Ani-Ugwu NK, Ojiefoh LG, Okafor IT, Egba A, Olatunji RA, Yusuf-Awesu SA. Maternal and perinatal outcomes of preeclampsia at a tertiary hospital in lagos, Nigeria. Int J Med Health Dev 2022;27:197-200
|How to cite this URL:|
Ugwu AO, Owie E, Oluwole AA, Soibi-Harry AP, Garba SR, Okunade KS, Makwe CC, Omisakin SI, Ani-Ugwu NK, Ojiefoh LG, Okafor IT, Egba A, Olatunji RA, Yusuf-Awesu SA. Maternal and perinatal outcomes of preeclampsia at a tertiary hospital in lagos, Nigeria. Int J Med Health Dev [serial online] 2022 [cited 2022 Dec 7];27:197-200. Available from: https://www.ijmhdev.com/text.asp?2022/27/2/197/339034
| Introduction|| |
Hypertensive disorders of pregnancy are a significant cause of maternal and perinatal morbidity, long-term disability, and death., Globally, it is a leading cause of maternal mortality., Preeclampsia (PE) stands out as a pregnancy-specific condition, with a serious impact on the health and quality of life of both mother and child. It is a multi-systemic progressive disorder, characterized by elevated blood pressure and evidence of end-organ damage and/or uteroplacental dysfunction with or without proteinuria occurring after 20 weeks of gestation.,,
In a cross-country survey conducted in Nigeria, hypertensive disorders ranked as the leading cause of maternal death account for an estimated 29% of cases. Eclampsia was the most frequent hypertensive disorder accounting for one-fifth of all maternal deaths, whereas PE contributed 6.9% of the cases. PE complicates between 2% and 10% of all pregnancies globally and in Nigeria, the prevalence ranges from 2% to 16%.,,,,,
PE can be classified based on the time of onset in pregnancy as early-onset PE (if it occurs at <34 + 0 weeks of gestation), preterm PE (if it occurs at ≥ 34 + 0, but <37 + 0 weeks of gestation), late-onset or term PE (if it occurs at ≥37 + 0 weeks of gestation)., These subcategories of PE are widely accepted to represent the different forms of the disease; however, it is pertinent to note that these are interwoven and not separate disease entities., Early-onset PE is commonly associated with intrauterine growth restriction, abnormal uterine and umbilical artery Doppler waveforms, and adverse maternal and neonatal outcomes., The adverse maternal outcome could be in the immediate or long term. In contrast, late-onset PE is usually associated with mild maternal disease and minimal fetal adverse outcome.,,,
Identified risk factors associated with the development of PE include nulliparity, extremes of maternal age, previous history of PE, change in partner, short and long inter-pregnancy interval, pregnancy following assisted reproductive techniques, chronic hypertension, family history of PE, offspring of preeclamptic pregnancies, obesity, diabetes mellitus, chronic kidney disease, autoimmune diseases, primigravida, multiple pregnancies, high altitudes, hemoglobinopathies, among others.,,
This current study aimed to determine the incidence as well as the perinatal and maternal outcomes of PE at the Lagos University Teaching Hospital (LUTH) over a period of 5 years from January 2015 to December 2019.
| Materials and Methods|| |
Study design and setting
This was a retrospective cross-sectional review of patients managed in the labor and postnatal ward of the LUTH, Idi-Araba, Nigeria over 5 years. LUTH is the teaching hospital of the College of Medicine, University of Lagos. It has about 800-bed spaces and serves as a referral center for other government-owned and private hospitals in the state. It is located on the mainland of Lagos which has a population of over 20 million inhabitants.
Study population and eligibility criteria
The antenatal and neonatal case notes of all deliveries complicated with PE between January 1, 2015 and December 31, 2019 were retrieved from the Medical Records Department. Babies from multiple births, congenital malformations, and those born for mothers with sickle cell anemia were excluded from the study.
Data collection and analysis
A study proforma was used to collect relevant data such as patients’ sociodemographic data, parity, gestational age (calculated from the last menstrual period and/or early ultrasound scan), gestational age at onset of PE, maternal outcome, and perinatal outcome.
Data were entered and analyzed using the IBM Statistical Package for Social Sciences (SPSS Statistics) Version 23, IBM Corp., Armonk, NY, USA. Categorical variables were summarized and presented as frequency distribution tables, whereas continuous variables were presented as mean and standard deviation.
Definition of terms
The criteria for diagnosis of PE were blood pressure of at least 140/90 mmHg recorded on at least two separate occasions and at least 4 h apart and in the presence of at least 2+ proteinuria in a clean catch urine sample.,,
Maternal outcome measures
The maternal outcome measures were pulmonary embolism, visual loss, cerebrovascular accident, acute pulmonary edema, HELLP syndrome, acute kidney injury, abruptio placentae, maternal death, intensive care unit admission, and eclampsia.
Perinatal outcome measures
The perinatal outcome measures were prematurity, birth asphyxia, neonatal sepsis, stillbirth, low birth weight, early neonatal death, and neonatal unit admission.
Ethical approval was obtained from the Health Research Ethics Committee (HREC) of LUTH. Approval number was ADM/DCST/HREC/APP/3299. Ethical principles according to Helsinki’s declaration were observed throughout the study duration.
| Results|| |
During the 5-year retrospective review, we had a total of 4,181 deliveries, out of which 436 women were managed for PE, out of which 426 patients had all their data retrieved (97.7%) and were used for analysis of maternal and perinatal outcomes. The incidence of PE in our study is 10.2%. The yearly prevalence of PE ranged from 8.3% to 12.9% [Figure 1].
The mean age of the women was 31.5 ± 6.0 years. Nulliparous and primiparous women were 78.9%. With regard to the booking status, the majority, 304 (71.4%), were unbooked, whereas 122 (28.6%) had their antenatal care in our facility. Most of the participants [267 (62.7%)] developed PE between 34 and 37 weeks [Table 1].
|Table 1: Socio-demographic characteristics of the study participants (n = 426)|
Click here to view
Among our participants, majority of the babies had neonatal unit admission [151 (35.4%)], the next common complication was prematurity which accounted for 23%. Forty-one babies (9.6%) weighed less than 2500 g, whereas 30 (7.04%) had neonatal sepsis. Twenty-seven (6.3%) had birth asphyxia. Unfortunately, 39 (9.2%) were stillbirth, whereas 32 (7.5%) suffered early neonatal death [Table 2].
Out of the 426 women who were managed for PE, 379 (88.9%) had no maternal complication, 31 (7.3%) were admitted into the intensive care unit, 8 (1.9%) had acute kidney injury. Over four hundred women (96.2%) were discharged home alive whereas 16 (3.8%) died [Table 3].
| Discussion|| |
This study reviewed the maternal and perinatal outcomes of pregnancies complicated with PE over a 5-year period. A total of 426 pregnancies were complicated with PE giving an incidence of 10.2% of all deliveries during the study period. This figure is slightly higher than the incidence of 3.6% and 7.6% reported in previous studies., The high incidence reported in our study may be because our center serves as a tertiary referral center for Lagosians and other population from the surrounding State of Ogun. This rate also appears higher than the prevalence of 7.6% reported about 16 years ago by Anorlu et al. in the same facility. This may, however, be due to the increased patient load experienced over the period. However, the finding in our study is lower than the 15.2%, 16.6%, and 37% reported in other studies.,, This may be because of the differences in the population and mean age of the participants studied.
The high proportion of primigravida with PE in our study (46.2%) is similar to the 46.6% and 49.4% earlier reported in Ile-Ife and Enugu, respectively., This finding agrees with the common knowledge of an increased risk of PE in primigravida women. The most plausible and widely acceptable explanation is that the immune system of primigravida women may have had limited exposure to the male (paternal) antigens, leading to inadequate antigen exposure or poor desensitization with resultant development of PE.
Several maternal complications were recorded in our study, and these include acute kidney injury (1.9%), abruptio placentae (2.1%), postpartum hemorrhage (2.4%), maternal mortality (3.8%), intensive care unit admission (7.3%), and eclampsia in 7.7% of the study population. This maternal mortality rate of 3.8% is lower than 12.1%, 7.9%, 8%, and 9%, 12%, 15.6%, and 23% in other studies.,,,,, This low maternal mortality may be attributed to the improvement in prenatal care facility that is evidenced in our center.
In our study population, 7.7% developed eclampsia. This differs from the 0.6% reported by Ajah et al. in Abakaliki. Majority of the participants (77.2%) had a cesarean delivery. This is similar to other studies, in which most of the preeclamptic women were also delivered via cesarean section.,,,, Furthermore, 85.9% of the study participants developed late-onset PE; an occurrence that is also similar to studies that reported similar findings.,
The perinatal mortality rate among the PE patients in our study is 16.7%, whereas 35.4% required neonatal intensive care unit admission. The perinatal mortality rate is higher than the 10% reported by Oladokun et al., but lower than 22.7%, 29%, and 40% reported in other studies, respectively.,, Early or preterm delivery may have a significant impact on perinatal morbidity and mortality. However, improvement in the neonatal intensive care facility may have also contributed to this lower rate.
| Conclusion|| |
PE contributed a sizeable proportion of deliveries in our facility during the study period. It also played a significant role in maternal and perinatal complications.
We are grateful to the nurses in our labor ward and antenatal clinic who assiduously provided adequate care to these mothers.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Babah OA, Owie E, Ohazurike EO, Akinajo RO. Prevalence and pattern of medical disorders in pregnancy at the time of delivery at Lagos University Teaching Hospital, Lagos, Nigeria. Sub-Saharan Afr J Med 2018;5:93-8. [Full text]
Oladapo OT, Adetoro OO, Ekele BA, Chama C, Etuk SJ, Aboyeji AP, et al
. When getting there is not enough: A nationwide cross-sectional study of 998 maternal deaths and 1451 near-misses in public tertiary hospitals in a low-income country. BJOG Int J Obstet Gynaecol 2016;123:928-38.
Chaiworapongsa T, Chaemsaithong P, Yeo L, Romero R. Pre-eclampsia part 1: Current understanding of its pathophysiology. Nat Rev Nephrol 2014;10:466-80.
Tunau KA, Sulaiman R, Garba JA, Aliyu FB, Panti AA, Hassan M. Presentation and outcome of preeclampsia: A five-year review in Uduth, Sokoto. Caliphate Med J 2018;6:1-4.
Singh S, Ahmed EB, Egondu SC, Ikechukwu NE. Hypertensive disorders in pregnancy among pregnant women in a Nigerian Teaching Hospital. Niger Med J 2014;55:384-8.
] [Full text]
Anorlu RI, Iwuala NC, Odum CU. Risk factors for pre-eclampsia in Lagos, Nigeria. Aust N Z J Obstet Gynaecol 2005;45:278-82.
Ugwu EO, Dim CC, Okonkwo CD, Nwankwo TO. Maternal and perinatal outcome of severe pre-eclampsia in Enugu, Nigeria after introduction of magnesium sulphate. Niger J Clin Pract 2011;14:418-21.
] [Full text]
Kooffreh ME, Ekott M, Ekpoudom DO. The prevalence of pre-eclampsia among pregnant women in the University of Calabar Teaching Hospital, Calabar. Saudi J Health Sci 2014;3:133-6. [Full text]
Ajah LO, Ozonu NC, Ezeonu PO, Lawani LO, Obuna JA, Onwe EO. The feto-maternal outcome of preeclampsia with severe features and eclampsia in Abakaliki, South-East Nigeria. JCDR 2016;10:QC18.
Poon LC, Andrew Shennan A, Hyett JA, Anil Kapur A, Hadar E, Divakar H, et al
. The International Federation of Gynecology and Obstetrics (FIGO) initiative on pre-eclampsia: A pragmatic guide for first-trimester screening and prevention. Int J Gynecol Obstet2019;145(Suppl. 1):1-33.
Charan J, Biswas T. How to calculate sample size for different study designs in medical research? Indian J Psychol Med 2013;35:121-6.
] [Full text]
Onoh RC, Mamah JE, Umeokonkwo CD, Onwe EO, Ezeonu PO, Okafor L. Severe preeclampsia and eclampsia: A 6-year review at the Federal Teaching Hospital, Abakaliki, Southeast Nigeria. Trop J Obstet Gynaecol 2019;36:418-23. [Full text]
Olusanya BO, Solanke OA. Perinatal outcomes associated with maternal hypertensive disorders of pregnancy in a developing country. Hypertens Pregnancy 2012;31:120-30.
Yakasai I, Morhason-Bello IO. Risk factors for pre-eclampsia among women at antenatal booking in Kano, Northern Nigeria. Healthc Low Resour Settings 2013;1:e12.
Yancey LM, Withers E, Bakes K, Abbott J. Postpartum preeclampsia: Emergency department presentation and management. J Emerg Med 2011;40:380-4.
Orisabinone IB, Onwudiegwu U, Adeyemi AB, Oriji PC, Makinde OI. Pattern of occurrence of severe preeclampsia among pregnant women in South-West Nigeria. Yen Med J 2020;2:38-42.
Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin Summary, Number 222. Obstet Gynecol2020;135:1492.
Ndaboine EM, Kihunrwa A, Rumanyika R, Im HB, Massinde AN. Maternal and perinatal outcomes among eclamptic patients admitted to Bugando Medical Centre, Mwanza, Tanzania. Afr J Reprod Health 2012;16:35-41.
Singhal SR, Deepika, Anshu, Nanda S. Maternal and perinatal outcome in severe pre-eclampsia and eclampsia. J South Asian Federat Obstet Gynecol 2009;1:25-8.
Oladokun A, Okewole AI, Adewole IF, Babarinsa IA. Evaluation of cases of eclampsia in University College Hospital Ibadan over a 10-year period. West Afr Med 2000;19:92-4.
Ozumba BC, Ibe AI. Eclampsia in Enugu, eastern Nigeria. Acta Obstet Gynecol Scand 1993;72:189-92.
Okogbenin SA, Eigbefoh JO, Omorogbe F, Okogbo F, Okonta PI, Ohihoin AG. Eclampsia in Irrua Specialist Teaching Hospital: A five-year review. Niger J Clin Pract 2010;13:149-53.
] [Full text]
Hypertension in Pregnancy: Diagnosis and Management. NICE Guidelines. Published June 25, 2019.
Onwuhafua PI, Onwuhafua A, Adze J, Mairami Z. Eclampsia in Kaduna State of Nigeria. A proposal for better outcome. Niger J Med 2001;10:81-4.
Endeshaw G, Berhan Y. Perinatal outcome in women with hypertensive disorders of pregnancy: A retrospective cohort study. Int Scholar Res Notices 2015;2015:1-8.
[Table 1], [Table 2], [Table 3]