Medical records of pregnant patients between January 1997 and December 2002 at the Olabisi Onabanjo University Teaching Hospital, Sagamu (in southwestern Nigeria) were retrieved and analyzed. The obstetrics department of the hospital had its full complement of specialist obstetricians about late 1996. Patients who were labeled as hypertensive and satisfied the inclusion criteria as stated below were identified.
HTN was defined as systolic BP of 140 mmHg or greater and/or diastolic BP of 90mmHg or greater on at least two readings in patients who were not on regular antihypertensive therapy. Patients who were on regular antihypertensive therapy before pregnancy were also considered as hypertensive. Preterm birth was assumed if the baby was born before 36 weeks of gestation. A patient was graded as illiterate if she had less than six years of formal schooling. A patient with more than these years of schooling and could read and write the English language was graded as literate.
Information was obtained for variables, such as age, parity, literacy level, comorbid state and regularity of ANC attendance. Clinic attendance of at least 75% was graded regular, less than 25% poor and between as fair. The highest BP recorded was noted and patients graded as: a) chronic HTN (preexisting), b) gestational (de-novo) HTN, c) pre-eclampsia/eclampsia and d) PET (superimposed) on chronic HTN.
Antihypertensive drugs administered previous drug compliance in chronic hypertensive patients and whether BP was controlled on discharge was also examined. Target organ damage as staged by the World Health Organization (WHO) was recorded. Maternal outcomes noted included PET/eclampsia, abruptio, HELLP (hemolytic, elevated liver enzymes and low platelet) syndrome and maternal death. The fetal outcomes included mode of delivery, respiratory distress (Apgar score at five minutes <2 with subsequent admission to the special baby care unit), birth-weight, gestational age at delivery and fetal death. canadian cialis
Patients were stratified according to WHO recommendation as high-risk (severe HTN and/or target organ damage) or low-risk, (mild-to-moderate HTN without target organ damage). Mild, moderate and severe HTN were as recommended by WHO. The measurement of BP and the definitions of PET and eclampsia were as recommended by the National High Blood Pressure Working Group.
Statistical analysis was carried out using the STATA 7 window software. Chi-squared test was used to test for statistical difference in categorical variables. ANOVA was used in comparing groups that were more than two, while logistic regression was used to test for the effect of confounding variables and its 95% confidence interval (CI) determined. Level of significance was put at p<0.05.