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 ...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. Material and Methods: 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 1<sup>st</sup>, 2019 and on December 31<sup>st</sup>, 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 section (63.1%). Maternal complications were dominated by retroplacental hematoma (16.3%) followed by eclampsia (7.4%) and HELLP syndrome (6.7%). We have not recorded any maternal deaths. Prematurity (19.3%) and intrauterine growth restriction (IUGR) (16.3%) were the most common perinatal complications. Severe and moderate neonatal asphyxia concerned respectively 14.8% and 14.4% of newborns. The birth weight was on average 2400 grams with extremes of 400 and 4500 grams. Low birth weight accounted for 49.5% of the sample. One hundred and twelve newborns (34.4%) were referred to neonatology most often for neonatal asphyxia (29.2%). We recorded 37 fetal deaths in utero (11.3%) and 10 neonatal deaths (3.1%), representing a perinatal mortality of 168.5 per 1000 live births. During the postnatal follow-up, we noted a normalization of the blood pressure figures in 98.8% of the patients. Contraception was instituted in 150 patients (46.1%). These were most often progestogen implants (32.2%) or intrauterine device (IUD) (11.7%). The choice of delivery route was significantly associated with the clinical form. Indeed, caesarean section was more frequent in case of preeclampsia compared to pregnancy-induced hypertension (p = 0.03). Maternal and perinatal complications such as HELLP syndrome (86.4%), PRH (64.2%), eclampsia (79.2%) and UFID (23.6%) were more frequent in cases severe preeclampsia (p = 0.028, p = 0.0001). Conclusion: The association of hypertension and pregnancy is frequent in our practice. Its prognosis is marked by the risk of prematurity, IUGR and maternal complications.展开更多
文摘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. Material and Methods: 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 1<sup>st</sup>, 2019 and on December 31<sup>st</sup>, 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 section (63.1%). Maternal complications were dominated by retroplacental hematoma (16.3%) followed by eclampsia (7.4%) and HELLP syndrome (6.7%). We have not recorded any maternal deaths. Prematurity (19.3%) and intrauterine growth restriction (IUGR) (16.3%) were the most common perinatal complications. Severe and moderate neonatal asphyxia concerned respectively 14.8% and 14.4% of newborns. The birth weight was on average 2400 grams with extremes of 400 and 4500 grams. Low birth weight accounted for 49.5% of the sample. One hundred and twelve newborns (34.4%) were referred to neonatology most often for neonatal asphyxia (29.2%). We recorded 37 fetal deaths in utero (11.3%) and 10 neonatal deaths (3.1%), representing a perinatal mortality of 168.5 per 1000 live births. During the postnatal follow-up, we noted a normalization of the blood pressure figures in 98.8% of the patients. Contraception was instituted in 150 patients (46.1%). These were most often progestogen implants (32.2%) or intrauterine device (IUD) (11.7%). The choice of delivery route was significantly associated with the clinical form. Indeed, caesarean section was more frequent in case of preeclampsia compared to pregnancy-induced hypertension (p = 0.03). Maternal and perinatal complications such as HELLP syndrome (86.4%), PRH (64.2%), eclampsia (79.2%) and UFID (23.6%) were more frequent in cases severe preeclampsia (p = 0.028, p = 0.0001). Conclusion: The association of hypertension and pregnancy is frequent in our practice. Its prognosis is marked by the risk of prematurity, IUGR and maternal complications.
