Pattern and Factors Affecting the Outcome of Pregnancy: DISCUSSION

25 Jan
2010

hypertension

This is a retrospective study and so is subjected to limitations of the design of such studies. It is, however, a good tool to use to review past activities and make amends as appropriate. It is economical, produces rapid results and has been found useful in many developing economies. The total number of deliveries and the ratio fulfilling the criteria for HTN disorders of pregnancy was relatively small, and this understandably detracts from the power of significance.

There were 122 patients with hypertensive disorder of pregnancy, with about half belonging to the high-risk group with its attendant problems and adverse outcomes for both the mother and the fetus. Late presentation and inadequate control had been identified as some of the causes for development of florid target organ damage in our environment. This partly explains unacceptably high fetal and maternal mortality rates encountered in this study which are higher than the average for our environment at 35.5/1,000 live births and 1,468-1,936 per 100,000, respectively. It is noteworthy that only one maternal death was recorded in 8,852 hypertensive deliveries in a Chinese retrospective study. The late presentation for ANC is further compounded by the fact that more than half of the patients were illiterate and less than one out of three of them had regular ANC. viagra soft

The 5.3% of all our patients with hypertensive disorder of pregnancy is comparable with the figures worldwide, both in the developed and developing countries, but the complication rate in our environment appears very high even for similar, developing economies. The rates of abruptio at 0.52%, heart failure at 0.34% and chronic renal failure at 0.20% in a Chinese study are a far cry from similar figures of 4.9%, 4.1%, and 4.9%, respectively, in this study.

Most of the patients (54.1%) were in the PET/ eclampsia group. This subgroup of hypertensive patients is noted for poor maternal and fetal outcomes. In this study, they were likely to be high-risk and also likely to be illiterate. These two variables appear to account in part for the adverse outcomes observed in this study. The high ratio of patients with PET is regrettable, because initial adverse outcomes of chronic HTN in pregnancy have been shown to be substantially increased in women with superimposed PET. It has been estimated that only about half of women who developed superimposed PET on gestational HTN would remain normoten-sive thereafter.

Our study population was racially black. The incidence of PET/eclampsia has been noted to be higher in blacks. For example, it has been observed that African-American women with chronic HTN have more than two-fold risk of developing eclampsia when compared with their white counterparts. In a northern Nigerian retrospective study, the incidence of eclampsia was 0.42%, but in this study it was 2.76%, although the earlier study had many more deliveries. In the quoted northern Nigerian study, the maternal mortality was 42.1% in eclamptics compared with 6.1 % in this present work.

HELLP was not searched for in the earlier years of patient management; only in the last two years of the period of study were liver enzymes and platelet count routinely checked in eclamptics. Taking into account the number of our deliveries, the HELLP syndrome rate was 11.2% of patients with eclampsia.

The drugs that were commonly used were methyldopa in virtually all the cases in which the BP was greater than 150/100 mmHg, with occasional addition of hydralazine especially with onset of

PET. Lower BP readings were treated mainly with sedatives and anxiolytics. This is in keeping with the general trend that antihypertensive drugs might not be of particular benefit in mild HTN in pregnancy. Calcium antagonists, particularly nifedipine, were used in later years. The trend is similar to what is obtained in South Africa.

CONCLUSION

This study has shown that hypertensive disorders of pregnancy are as common in our environment as they are worldwide. This study population has, however, shown unacceptably high morbidity and mortality rates for mother and baby. ANC attendance was poor, and the BP of about 20% of the patients was poorly controlled at discharge. There was little evidence of follow-up in the hypertension medical outpatient clinic, as only about one out of five patients complied with the recommended follow-up care plan. This observation was one of the reasons that led to the present study. Furthermore, patients who develop eclampsia may be at risk for HTN and other associated diseases later in life, even if their BP is controlled at discharge. This study suggests that health education, regular ANC attendance, adequate drug therapy, postnatal care and follow-up in the medical HTN clinics are an important goal to achieve in this part of Nigeria. canadian pharmacy viagra

The limitation of the study resides in the small sample size and the retrospective design. A larger prospective study is, therefore, desirable to explore further some of the associations examined.

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