High Blood Pressure and Pregnancy: Epidemiological, Diagnostic, Therapeutic and Prognostic Aspects at the Maternity Unit of the Institute of Social Hygiene of Dakar (Senegal)
Objectives: To specify the
epidemiological and clinical profile of the patients, to determine the methods
of management and to evaluate the maternal and perinatal prognosis in the
association of arterial hypertension and pregnancy (HTA) at the Institute of
Social Hygiene of Dakar. MaterialandMethods: This was a
retrospective, descriptive and analytical study on the management of the
association of hypertension and pregnancy in the maternity ward of the
Institute of Social Hygiene of Dakar between January 1st, 2019 and
on December 31st, 2020. Results: During the study period, we
recorded 326 cases of hypertension associated with pregnancy among the 4290
pregnant women, i.e. a frequency of
7.6%. The epidemiological profile of the patients was that of a woman with an average
age of 29, nulliparous (48.2%), married (99.1%), at a low socioeconomic level
(61.3%) and with a personal history preeclampsia (14.4%). Most patients (83.1%)
were evacuated or referred with pre-ec- lampsia as the main reason (40.8%). The average gestational age was 37
weeks of amenorrhea (SA) with extremes of 20 SA 6 days and 41 SA 5 days. Term
pregnancies were the most represented (76.7%). Prenatal follow-up (CPN) was
carried out in 319 patients (97.8%) with an average number of CPN of 3 and
extremes of 1 and 9. Severe diastolic and severe systolic hypertension
concerned respectively 19.3% and 16, 9% of patients. One hundred and eighty
patients (55.2%) presented with oliguria. Strip albuminuria was performed in
235 patients (72.1%). It found 3 or more crosses in 38.3% of cases. We recorded
53 cases of anemia (16.3%), 16 cases of significant proteinuria (5%), hepatic
cytolysis in 22 patients (6.7%), thrombocytopenia in 37 patients (11.3%), and
43 cases of hyperuricaemia (13.2%). Obstetric ultrasound found 36 cases of
severe oligohydramnios (11%), 8 twin pregnancies (2.4%) and an umbilical Doppler anomaly in 10 patients (3.1%).
Pre-eclampsia was the most common
clinical form (70.5%), followed by chronic hypertension (15.1%) and
pregnancy-induced hypertension (14.4%). In our study, 32 patients (9.8%) had
received resuscitation. The most used anti-hypertensives were alpha methyl-dopa
(46.1%) and nicardipine (24.5%). The obstetrical treatment consisted of uterine
evacuation which was most often done by caesarean
References
[1]
Fauvel, J.P. (2016) Hypertensions et grossesse: Aspects épidémiologiques, définition. La Presse Médicale, 45, 618-621. https://doi.org/10.1016/j.lpm.2016.05.015
[2]
Cordoliani, Y.S. (2005) Risques liés à l’exposition d’une grossesse aux rayonnements ionisants. Journal de Radiologie, 86, 601-606.
https://doi.org/10.1016/S0221-0363(05)81414-3
[3]
Organisation Mondiale de la Santé (2007) Département pour une grossesse à moindre risque. Prise en charge intégrée de la grossesse et de l’accouchement. Interventions recommandées par l’OMS pour améliorer la santé de la mère et du nouveau-né. OMS 2007, Genève, p. 6.
[4]
Regal-Cart, V. (2010) Hypertension artérielle et grossesse. Archives des Maladies du Coeur et des Vaisseaux-Pratique, 2020, 8-14.
https://doi.org/10.1016/S1261-694X(10)70015-8
[5]
Todisoa (2009) HTA et grossesse: Pronostic materno foetal de la prééclampsie vue au CHU de Mahanjaga. Thèse Med, Universite de Mahajanga, 28-47.
[6]
Traoré, T., Sidibé, K. and Traoré, B. (2021) Hypertension artérielle et grossesse: Aspects épidémiocliniques et complications à l’Hopital Nianankoro Fomba de Ségou du 1er Aout 2015 au 31 Juillet 2016 concernant 283 cas d’hypertension artérielle. Health Sciences and Diseases, 22, 94-97.
[7]
Mboudou, E.T. (2009) HTA au cours de la grossesse: Aspects clinique et épidé- miologiques à l’hopital gynécologique obstétrique et pédiatrique de Yaoundé, Ca- meroun. Clin. Clinics in Mother and Child Health, 6, 1087-1093.
[8]
Diallo, F. (2007) HTA et grossesse dans le service de gynécologie et obstétrique du CHU Gabriel Touré de 2003-2006. Thèse Med, Faculté de Médecine de Pharmacie et d’Odontostomatologie de Bamako, 93-100.
[9]
Cissé, C.T. and Thiam, M. (2005) Prééclampsie en milieu africain: Epidémiologie et pronostic au CHU de Dakar. Lettre du Gynécologue, 301, 1-9.
[10]
Itoua, A.S.N. (2013) HTA et grossesse: Epidémiologie et pronostic materno-foetal au CHU de Brazzaville. Médecine d’Afrique noire électronique, 60, 2-9.
[11]
Ambresin, A. and Borruat, F.X. (2015) Hypertension artérielle et oeil. Revue Médicale Suisse, 11, 2366-2372.
[12]
Beevers, G., Lip, G.Y.H. and O’Brien, E. (2001) ABC of Hypertension, the Pathophysiology of Hypertension. BMJ, 322, 912-916.
https://doi.org/10.1136/bmj.322.7291.912
[13]
Marti, J. and Herrmann, U. (1977) Immunogestosis: A New Etiologic Concept of Essential EPH Gestosis, with Special Consideration of the Primigravid Patient; Preliminary Report of a Clinical Study. American Journal of Obstetrics & Gynecology, 128, 489-493. https://doi.org/10.1016/0002-9378(77)90030-8
[14]
Pierre-Gérald, M. (2011) HTA et grossesse au CHU de Kamenge. Mémoire de spécialiste en gynécologie obstétrique Université de Kamenge, 55-56.
[15]
Feukou, K. (2013) HTA et grossesse au service de gynécologie obstétrique du CHU de Gabriel Touré. Thèse Med, Université de Bamako, Bamako, 90-91.
[16]
Traoré-Doumbia, F. (2010) HTA et grossesse dans le service de gynécologie obsté- trique du centre de santé de référence la commune VI du Mali. Thèse Med, Faculté de Médecine, de Pharmacie et d’Odontostomatologie de Bamako, 72-88.
[17]
Baragou, S. (2014) Hypertension artérielle et grossesse à Lomé (Afrique sub-saha- rienne): Aspects épidémiologiques, diagnostiques et facteurs de risque. Annales de Cardiologie et d’Angéiologie, 63, 145-150.
https://doi.org/10.1016/j.ancard.2014.05.006
