Preeclampsia: prevalence, risk factors, complications and management

Supervisor

Dr.Iyad Ali

Abstract

Background:Development of hypertensive disorders is the most common medical complication during pregnancy, affecting 10% to 20% of all pregnancies worldwide and commonly observed during second trimester of pregnancy, combined with overly rigid criteria for diagnosis of preeclampsia: blood pressure >140/90, proteinuria ≥+2, with or without oedema . Moreover, in women with preeclampsia (PE), dysfunction of many organs such as kidney and liver is often compromised, while in the fetus, growth restriction is sometimes observed. The purpose of this study was to determine the prevalence of PE, risk factors, complications and management among Palestinian women.

Methods: This is a case control study carried out at Rafidia governmental surgical hospital, Nablus, Palestine. The study included 109 preeclamptic and 109 non preeclamptic women. Preeclampsia was defined in the beginning as blood pressure ≥140/90 mmHg and ≥+2 proteinuria, where the controls were healthy pregnant women. The P value for various kinds of variables was calculated by chi-square. Different variables were studied including risk factors, birth outcomes, mode of delivery, PE severity, complications, medications and laboratory findings.

Results:  The prevalence of PE was 1.99% and the gestational age in preeclamptic women was found to be significantly lower than the control (P value <0.001). It was found that first pregnancy significantly associated with PE (P value <0.001), while there were no significant association between the incidence of PE and maternal age, number of pregnancies, abortion, multiple pregnancy, chronic hypertension, baby gender and previous PE. Preeclampsia was significantly associated with baby weight (P value<0.001), neonatal intensive care unit admission (NICU) (P value <0.0001(, delivery method (P value <0.001) and birth outcome (P value =0.035). It was found that Hydralazine (P value <0.001), Magnesium sulfate (P value <0.001), and Labetalol (P value = 0.037) are significantly associated with treatment of PE. While there were no significant differences between Nifedipine, Sodium nitroprusside, Corticosteroid, and Methyldopa with treatment of PE.

Conclusion:The major cause of low gestational age, low baby weight, and death of fetus was PE.  First pregnancy was the most common risk factor associated with PE. Neonatal whose mothers suffer from PE had more opportunity to go to NICU admission than neonates whose mothers were without PE. Most of women with PE were delivered by cesarean. Magnesium sulfate and Hydralazine were the most commonly used medication that eliminated PE symptoms and complications. Used of Magnesium sulfate as prophylaxis in women with preeclampsia was reduce the rate of eclampsia, complications and progression to seizure. Hydralazine and Labetalol were used for rapid control of blood pressure in severe hypertension in pregnancy whose suffered from PE.

Key words: preeclampsia, diagnosis, Risk factors, management, Pregnancy.