|Year : 2014 | Volume
| Issue : 3 | Page : 133-136
The prevalence of pre-eclampsia among pregnant women in the University of Calabar Teaching Hospital, Calabar
Mary Esien Kooffreh1, Mabel Ekott2, Dorcas O Ekpoudom1
1 Department of Genetics and Biotechnology, University of Calabar, Calabar, Nigeria
2 Department of Obstetrics and Gynaecology, University of Calabar Teaching Hospital, Calabar, Nigeria
|Date of Web Publication||7-Oct-2014|
Mary Esien Kooffreh
Department of Genetics and Biotechnology, University of Calabar, PMB - 1115, Calabar
Source of Support: None, Conflict of Interest: None
Background: Pre-eclampsia is a pregnancy-specific disorder recognized clinically by the onset of hypertension and proteinuria. It complicates about 2%-10% of pregnancies worldwide and contributes to maternal and foetal morbidity and mortality. However there is paucity of information on its prevalence in Calabar. Aims: To determine the prevalence of pre-eclampsia in the University of Calabar Teaching Hospital, Calabar, Nigeria over a period of 3 years for the purpose of further genetic studies. Settings and Design: A descriptive epidemiologic study that consisted of all documented cases of Pre-eclampsia in a tertiary referral center from 2009 to 2011. Materials and Methods: Data on pre-eclamptic patients were obtained from the Records Department of the hospital. Statistical Analysis: The results were anaylzed using SPSS version 17, percentages, mean and standard deviations were used to describe data. Results and Conclusions: A total of 8,524 deliveries and 104 cases of pre-eclampsia were documented giving an overall prevalence of 1.2%. The prevalence in 2009, 2010, and 2011 was 0.7%, 1.2%, and 1.5%, respectively. Fifty-nine case notes were available for analysis (56.7% retrieval). The mean age of the patients was 27 ± 4.9 and majority; 25 (42.4%) were in the age group 25-29 years. The mean parity was 1.1 ± 1.4 and 26 (44.1%) were nulliparous. 11 (18.6%) had family history of hypertension, 2 (3.4%) had personal history of hypertension, and 2 (3.4%) had a personal history of pre-eclampsia. The slight increase in the prevalence rate over the years underscores the need for close surveillance.
Keywords: Calabar, Nigeria, pre-eclampsia, prevalence, women
|How to cite this article:|
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
|How to cite this URL:|
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 [serial online] 2014 [cited 2019 Sep 20];3:133-6. Available from: http://www.saudijhealthsci.org/text.asp?2014/3/3/133/142317
| Background|| |
Pre-eclampsia is a pregnancy-specific disorder characterized by hypertension, significant proteinuria, with or without edema.  It is multifactorial and forms an integral part of the continum of hypertensive disorders of pregnancy.  The end stage of pre-eclampsia is eclampsia which is defined by generalized tonic-clonic seizures, with or without raised blood pressure and proteinuria, occurring during or after pregnancy with or without other identifiable cause. The cause is usually multifactorial including cerebral vasoconstriction, ischemia, vasogenicedema, or other pathology. Although eclampsia occurs mostly in women with severe pre-eclampsia, there is no convincing test for predicting its onset. 
Globally, pre-eclampsia complicates about 2%-10% of pregnancies.  According to the World Health Organization (WHO) its incidence is seven times higher in developing countries (2.8% of live births) than in developed countries (0.4%). 
Pre-eclampsia is a potentially life-threatening multisystem disorder. It contributes to maternal and perinatal mortality and morbidity worldwide. ,, Over the years, studies reveal that there is variation in its incidence and prevalence.  However, in Nigeria, the incidence of eclampsia lies in the range of 0.3 per 1000 deliveries in Calabar (Cross River State) to as high as 9 per 100 deliveries in Birnin Kudu (Jigawa State). ,,,,, But there is paucity of information on the prevalence of pre-eclampsia in Calabar, certain gene polymorphism has been implicated in the development of pre-eclampsia, there is need to assess its prevalence since pre-eclampsia is the precursor to eclampsia and also as baseline information for subsequent molecular studies to identify gene polymorphisms that might be associated with disease.
The aims and objectives of the study were to determine the prevalence of pre-eclampsia in the University of Calabar Teaching Hospital, for a period of three years from 2009 to 2011 and to assess the demographic predisposing factors.
| Materials and methods|| |
This was a descriptive study carried out on the prevalence of pre-eclampsia among pregnant women in the University of Calabar Teaching Hospital (UCTH) between 2009 and 2011. The study was granted ethical approval by the Health Research Ethics Committee of the University of Calabar Teaching Hospital, Calabar. Data were retrieved from the Records Department which is situated at the permanent site of the hospital. The study population consisted of all documented cases of Pre-eclampsia in the hospital from 2009 to 2011.
The case folders of Pre-eclamptic patients within 2009 and 2011 were identified and retrieved by record personnel using the hospital's code on the index cards for pre-eclampsia. Each of the folders was examined and information obtained included age, parity, gestational age at delivery, mode of delivery, a family or personal history of hypertension, personal history of pre-eclampsia, infant birth weight, systolic and diastolic blood pressure, and proteinuria at presentation. Pre-eclampsia was defined as blood pressure greater than or equal to 140/90 mmHg with proteinuria of greater than or equal to two pluses (2+) dipstick with or without edema after the twentieth (20 th ) week of gestation.  Data obtained were analyzed using Statistical package for Social Sciences (SPSS) version 17. Descriptive statistics was utilized to analyzed the data; continuous variables were summarized with mean and standard deviations, discrete variables were summarized using numbers and percentages.
| Results|| |
During the period under review, out of the 104 cases, 59 case notes were available for analysis. The case note retrieval was therefore 56.7%. The mean age of the patients was 27.7 years with standard deviation of 4.9 and majority (42.4%) of the patients were in the age group 25-29 years [Table 1]. The mean parity was 1.1 ± 1.4 and 26 (44.1%) of the patients were nulliparous. Eleven of the pre-eclamptic patients (18.6%) had family history of hypertension, 2 (3.4%) were hypertensive with superimposed pre-eclampsia and 2 (3.4%) had personal history of pre-eclampsia. Out of the two with personal history of pre-eclampsia, one had a family history of hypertension while the other was hypertensive with superimposed. The most common (39%) gestational age at presentation was in the range of 34-38 weeks [Table 1].
The mean systolic blood pressure for the women was 158 ± 19.3; mean diastolic pressure was 101.7 ± 14.9. The mean proteinuria observed with dipstick was 2.4 ± 0.7 and the mean birth weight was 2.6 ± 0.8 [Table 2].
A total of 8,524 deliveries were recorded and 104 cases of pre-eclampsia were documented thus giving a prevalence of 1.2%. Similarly, there were 2,395 deliveries in 2009 and 17 documented pre-eclamptic cases thus giving a prevalence of 0.7%. In 2010, there were 2647 deliveries and 33 cases of pre-eclampsia, accounting for 1.2% prevalence, while in 2011; there were 3482 deliveries and 54 pre-eclamptic cases, thus the prevalence was 1.5% [Table 3].
Forty-two (71.2%) patients had caesarean section, 7 (11.9%) had spontaneous vaginal delivery (SVD), while information on 10 (16.9%) cases were missing. The caesarean sections were performed because of severe preeclampsia in 35 (83.3%) of the women. Other indications for caesarean section were: Preeclampsia coexisting with multiple pregnancy 3 (7.1%), failed induction 2 (4.8%), breech and abruption placenta with live fetus 1 (2.4%). Majority (42.4%) of the patients delivered at gestational age of 37 weeks and above while 20 (33.9%) patients delivered prematurely at less than 37 weeks of gestation because of worsening pre-eclampsia from the 59 pre-eclamptic pregnancies, there were 56 singletons and 3 twin deliveries. The mean birth was 2.67 kg with standard deviation of 0.8. Thirty-four (54.84%) babies' birth weight was in the range 2.5-4.0 kg. Seventy-eight percent of the patients had systolic blood pressure greater than or equal to 160 mmHg while 22% had diastolic blood pressure greater than or equal to 130 mmHg.
The age distribution of the patients was as shown in [Table 4]. The incidence of pre-eclampsia peaked at 25-29 age group (25,42.4%) and in the nulliparous 26 (44.1%). It declined thereafter to a nadir of 2 (3.4%) among 40-44 years of age and Para≥5.
| Discussion|| |
Pre-eclampsia is a potentially dangerous complication of the second half of pregnancy, labor or early period after delivery which can be managed. Eclampsia is the end stage of the disorder characterized by generalized seizures.  Pre-eclampsia occurs in about 2-10 percent of pregnancies worldwide. 
The prevalence of pre-eclampsia over the period under review was 1.2%. This rate is higher than the finding of 0.74% by Thapa and Jha.  in Nepal, South Asia but lower than 3.3% reported by Ugwu et al.,  in Enugu. This prevalence is however higher than 0.3% reported on eclampsia by Itam and Ekabua  in Calabar. Pre-eclampsia could be managed once detected such that they are prevented from progressing to eclampsia and this lends credence to the low incidence of eclampsia observed in Calabar.
Over the study period, there was a slight increase in the prevalence from 0.7% in 2009 to 1.2% in 2010 and 1.5% in 2011. The factors responsible for this slight increase are not clear from this study. The distribution of the patients by age and parity revealed that majority of the patients (44.1%) were nulliparous which is lower than the report of 81.4% from Birnin Kudu  but similar to the report of 49.4% from the University of Nigeria Teaching Hospital Enugu.  This is because pre-eclampsia is a disease of the nulliparous. The etiology of preeclampsia is diverse. It is believed that immune maladaptation of the primigravidae is responsible for the higher incidence of preeclampsia in this group. This mal-adaptation is lost in subsequent pregnancies, hence the decreasing incidence of preeclampsia in the multiparae. Pregnancy by a new partner is also implicated in preeclampsia in parous women. ,, It was also observed that majority of the patient (42.4%) were in the age range 25-29 years which is higher than the observation of 31.3% in Ladoke Akintola University of Technology Teaching Hospital  but lower than 50.6% in Enugu.  This however differs from the report in Liaquat University Hospital Hyderabad, of a high incidence (38.4%) among patients less than 20 years of age. This difference may be due to the sample size of this study. Up to 18.6% of the patients had family history of hypertension while 3.4% had superimposed preeclampsia on a background medical history of chronic hypertension. This could be based on the fact that pre-eclampsia share the same etiology with hypertension.  Two patients (3.4%) had a personal history of pre-eclampsia which supports the fact that pre-eclamptic women are at risk of developing the disorder again in subsequent pregnancies.  Out of the two patients with history of pre-eclampsia, one had a family history of hypertension while the other was hypertensive. The low percentage in family and personal history could result from paucity of information.
A high proportion (42.4%) of the patients delivered at a gestational age greater than or equal to 37 weeks which differs from the finding (22.9%) Ladoke Akintola University of Technology Teaching Hospital (LAUTECH).  This may explain the observation that majority of the patients (39%) presented the disorder at a later gestational age. Up to 71.2% of the patients had caesarean section which is higher than the report (51.7%) from Birnin Kudu  but differs from the report in Murtala Mohammad Specialist Hospital, Kano, which 65.8% achieved vaginal delivery.  This high incidence indicates that most of the cases were severe or rapidly progressive necessitating immediate delivery. This is also supported by the elevation in the mean blood pressure at presentation, systolic (158.1 ± 19.3), diastolic (10114.9), and proteinuria (2.4 ± 0.7).
The mean birth weight of the infants was 2.670.8 kg which agrees with the report of 2.5 ± 0.7 in Ladoke Akintola University of Technology Teaching Hospital.  Low birth weight occurred in 24 percent of the babies, this was attributed to preterm deliveries occasioned by the severity of pre eclampsia. The definitive treatment of pre-eclampsia is delivery and this was carried out to save the mothers' lives.
The limitation of the study is the small sample size analyzed due to problems with retrieval of case notes. Also, the study was conducted in a tertiary health care facility that manages high risk pregnancies so the prevalence may be higher than that of the general population. Another limitation is that the study did not explore the marital history of the women to identify pregnancies by new partners as this information was not available in the case notes. These limitations do not however affect the validity of the results as it captures the population of at risk women in the environment.
| Conclusion|| |
The study showed a rising trend in the incidence of pre-eclampsia over the years, though the overall prevalence was 1.2%. A little less than half of the women were nulliparous and majority had caesarean delivery. Preeclampsia was associated with iatrogenic preterm deliveries in a third of the women. A family history of hypertension was the underlying risk factor in a number of women.
We conclude that there is a rising trend in the prevalence of preeclampsia in our environment. This underscores the need to strengthen utilization of Antenatal care by our women to enable early detection and management of pre-eclampsia.
| References|| |
|1.||Lorquet S, Prequeux C, Munaut C, Foidart JM. Aetiology and physiopathology of pre-eclampsia and related forms. Acta Clin Belg 2010;65:237-41. |
|2.||Rudra P, Basak S, Patil D, Latoo MY. Recent advances in management of pre-eclampsia. BJMP 2011;4:a433. |
|3.||Osungbade KO, Ige OK. Public health perspectives of preeclampsia in developing countries: Implication for health system strengthening. J Pregnancy 2011;2011:481095. |
|4.||Dolea C, AbouZahr C. Global Burden of hypertensive disorders of pregnancy in the year 2000 Evidence and information for policy World Health Organization 2003:1-11 |
|5.||McClure EM, Saleem S, Pasha O, Goldenberg RL. Stillbirth in developing countries: A review of causes, risk factors and prevention strategies. J Matern Fetal Neonatal Med 2009;22:183-90. |
|6.||Shah A, Fawole B, M′imunya JM, Amokrane F, Nafiou I, Wolomby JJ, et al.Ceasarean delivery outcomes from the WHO global survey on maternal and perinatal health in Africa. Int J Gynaecol Obstet 2009;107:191-7. |
|7.||Itam IH, Ekabua JE. Socio-demographic determinants of eclampsia in Calabar; A ten year review. Mary Slessor Journal of Medicine 2003;3:72-4. |
|8.||Emen BA, Abasiatai AM, Umoiyoho AJ, Udoma EJ. Presentation and outcome ofeclampsia in Uyo, South-South Nigeria. Trop J Med Res 2005;9:9-11. |
|9.||Umezuike CC, Feyi-woboso PA, Whittaker RC. Treatment ofeclampsiawithmagnesium sulphate in Aba, South-Eastern Nigeria. Trop J Obstet Gynaecol 2006;23:20-2. |
|10.||Efetie ER, Okafor UV. Maternal outcome in eclamptic patients in Abuja, Nigeria - a five year review. Niger J Clin Pract 2007;10:309-13. |
|11.||Olatunji AO, Sule-Odu AO. Presentation and outcome of eclampsia at a Nigerian University Hospital. Niger J Clin Pract 2007;10:1-4. |
|12.||Tukur J, Umar BA, Rabi′u A. Pattern of eclampsia in tertiary health facilitysituated in semi-rural town on northern Nigeria. Ann Afr Med 2007;6:164-7. |
|13.||National High Blood Pressure Education Program. High blood pressure in pregnancy. Am J Obs Gyn 2000;183:S1-22. |
|14.||Redman CW, Sargent IL. Latest advances in understanding preeclampsia. Science 2005;304:1592-4. |
|15.||Thapa K, Jha R. Magnesium sulphate: A life saving drug. J Nepal Med Assoc 2008;47:104-8. |
|16.||Ugwu EO, Dim CC, Okonkwo CD, Nwankwo TO. Maternal and perinatal outcome of severe pre-eclampsia in Enugu, Nigeria after introduction of magnesium Sulfate. Niger J Clin Pract 2011;14:418-21. |
|17.||Uzan J, Carbonnel M, Piconne O, Asmar R, Ayoubi J. Preeclampsia: Pathophysiology, diagnosis and management. Vasc Health Risk Manag 2011;7:467-74. |
|18.||Luo Zc, An N, Xu HR, Larante A, Audibert F, fraser WD. The effects and mechanisms of primiparity on the risk of pre-eclampsia: A systematic review. Paediatr perinat Epidemiol 2007;21 Suppl 1:36-45. |
|19.||Tubbergen P, Lachmeijer AM, Althuisius SM, Vlak ME, van Geijn HP, Dekker GA. Change in paternity: A risk factor for preeclampsia in multiparous women? J Reprod Immunol 1999;45:81-8.18. |
|20.||Adekanle DA, AkinbileTO. Eclampsia and pregnancy outcome at LautechTeaching Hospital Osogbo, South-West, Nigeria. Clinics in Mother and Child Health 2012;9:1-4. |
|21.||Dekker G, Sibai B. Primary, secondary and tertiary prevention of pre-eclampsia. Lancet 2001;357:209-15. |
|22.||22 Yakasai IA, Gaya SA. Maternal and fetal outcome in patients with eclampsia at Murtala Muhammad Specialist Hospital Kano, Nigeria. Ann Afr Med 2011;10:305-9.21. |
[Table 1], [Table 2], [Table 3], [Table 4]
|This article has been cited by|
||Plasma Calcium Levels in Preeclampsia Versus Normotensive Pregnant Women in a Tertiary Hospital: A Comparative Study
| ||Peter Pase Sende,Aliyu Yabagi Isah,Madueke Maxwell Nwegbu,Bissallah Ahmed Ekele,Teddy Eyaofun Agida,Francis Olayemi Adebayo |
| ||Journal of Fetal Medicine. 2019; |
|[Pubmed] | [DOI]|
||Maternal Serum Uric Acid as a Predictor of Severity of Hypertensive Disorders of Pregnancy: A Prospective Cohort Study
| ||Naina Kumar,Amit K. Singh |
| ||Current Hypertension Reviews. 2019; 15(2): 154 |
|[Pubmed] | [DOI]|
||Biomarkers for diagnosis of pre-eclampsia and endometriosis
| ||Braira Wahid,Shazia Rafique,Amjad Ali,Muhammad Waqar,Ghulam Nabi,Muhammad Wasim,Muhammad Idrees |
| ||Biomarkers in Medicine. 2018; |
|[Pubmed] | [DOI]|
||Incidence and natural history of preeclampsia/eclampsia at the university maternity of Antananarivo, Madagascar: high prevalence of the early-onset condition
| ||Andriamanetsiarivo Tanjona Ratsiatosika,Eric Razafimanantsoa,Valéry Bruno Andriantoky,Noël Ravoavison,Rakotovao Andrianampanalinarivo Hery,Malik Boukerrou,Silvia Iacobelli,Pierre-Yves Robillard |
| ||The Journal of Maternal-Fetal & Neonatal Medicine. 2018; : 1 |
|[Pubmed] | [DOI]|
||Macroscopic features of the kidneys of fetuses and newborns in preeclampsia: postmortem observational study
| ||Iryna Sorokina,Tetyana Ospanova,Mykhailo Myroshnychenko,Iryna Korneyko |
| ||International Journal of Reproductive BioMedicine. 2018; 16(2): 115 |
|[Pubmed] | [DOI]|
||Prevalence of Low Birth Weight before and after Policy Change to IPTp-SP in Two Selected Hospitals in Southern Nigeria: Eleven-Year Retrospective Analyses
| ||Nneka U. Igboeli,Maxwell O. Adibe,Chinwe V. Ukwe,Nze C. Aguwa |
| ||BioMed Research International. 2018; 2018: 1 |
|[Pubmed] | [DOI]|