Severe preeclampsia and eclampsia: A 6-year review at the Federal Teaching Hospital, Abakaliki, Southeast Nigeria

Abstract

Introduction: Severe preeclampsia and eclampsia are pregnancy-specific diseases associated with increased maternal and perinatal morbidity and mortality.
Objective: To evaluate the prevalence and outcomes of pregnancies complicated by severe preeclampsia and eclampsia in the Federal Teaching Hospital Abakaliki (FETHA).
Materials and Methods: This was a retrospective study of patients managed for severe preeclampsia/eclampsia from 1st January 2012 to 31st December 2017. Registers were reviewed, and the patient's case files were retrieved. Sociodemographic data, risk factors, and fetomaternal outcomes were extracted using a pro forma. The data were collated, imputed, and analyzed using Epi Info (Atlanta, USA) version 7. The proportion and outcomes of pregnancies complicated by preeclampsia and eclampsia within the period were estimated. A Chi-squared test was used to compare the relationship between the severe disease and sociodemographic characteristics and fetomaternal outcome at 5% level of significance. Ethical clearance was obtained from the research and ethics committee of FETHA.
Results: The overall prevalence of severe preeclampsia/eclampsia was 4.0% with severe preeclampsia accounting for 3.4% and eclampsia 0.6%. The peak prevalence was in 2017, 5.2%. The majority of the patients were between 20 and 34 years, mean age was 27.3 ± 5.2 years. The majority of the patients were rural dwellers 130 (51.4%). About 107 (51.4%) attained secondary level of education. Only 93 (36.6%) were booked in FETHA. Primigravidity was the commonest risk factor 76 (29.9%). More women had cesarean section 124 (48.8%). The mean gestational age was 35 weeks and mean birth weight was 2.4 ± 0.8 kg. Maternal and perinatal deaths were recorded in 0.8% and 29.1% of the parturient, respectively.
Conclusion: The prevalence of preeclampsia and eclampsia was high in this study and there was increased maternal and perinatal morbidity and mortality. There is an urgent need for wider antenatal coverage, timely diagnosis, and prompt intervention to reverse this trend.

Full text

418 © 2020 Tropical Journal of Obstetrics and Gynaecology | Published by Wolters Kluwer - Medknow
Original Article
ABSTRACT
Introduction: Severe preeclampsia and eclampsia are pregnancy‑specic diseases associated with increased maternal
and perinatal morbidity and mortality.
Objective: To evaluate the prevalence and outcomes of pregnancies complicated by severe preeclampsia and eclampsia
in the Federal Teaching Hospital Abakaliki (FETHA).
Materials and Methods: This was a retrospective study of patients managed for severe preeclampsia/eclampsia
from 1st January 2012 to 31st December 2017. Registers were reviewed, and the patient’s case les were retrieved.
Sociodemographic data, risk factors, and fetomaternal outcomes were extracted using a pro forma. The data were collated,
imputed, and analyzed using Epi Info (Atlanta, USA) version 7. The proportion and outcomes of pregnancies complicated
by preeclampsia and eclampsia within the period were estimated. A Chi‑squared test was used to compare the relationship
between the severe disease and sociodemographic characteristics and fetomaternal outcome at 5% level of signicance.
Ethical clearance was obtained from the research and ethics committee of FETHA.
Results: The overall prevalence of severe preeclampsia/eclampsia was 4.0% with severe preeclampsia accounting for
3.4% and eclampsia 0.6%. The peak prevalence was in 2017, 5.2%. The majority of the patients were between 20 and
34 years, mean age was 27.3 ± 5.2 years. The majority of the patients were rural dwellers 130 (51.4%). About 107 (51.4%)
attained secondary level of education. Only 93 (36.6%) were booked in FETHA. Primigravidity was the commonest risk
factor 76 (29.9%). More women had cesarean section 124 (48.8%). The mean gestational age was 35 weeks and mean
birth weight was 2.4 ± 0.8 kg. Maternal and perinatal deaths were recorded in 0.8% and 29.1% of the parturient, respectively.
Conclusion: The prevalence of preeclampsia and eclampsia was high in this study and there was increased maternal
and perinatal morbidity and mortality. There is an urgent need for wider antenatal coverage, timely diagnosis, and prompt
intervention to reverse this trend.
Key words: Eclampsia; morbidity; mortality; preeclampsia; pregnancy.
Introduction
Globally, the hypertensive disorders of pregnancy especially
preeclampsia-eclampsia make up one of the top three
leading causes of maternal and perinatal morbidity and
mortality.[1-3] They remain a major obstetric challenge
despite significant investment in understanding its
Severe preeclampsia and eclampsia: A 6‑year review at the
Federal Teaching Hospital, Abakaliki, Southeast Nigeria
12
Departments of Obstetrics and Gynaecology, 1Community Medicine and 2Paediatrics, Federal Teaching Hospital, Abakaliki,
Ebonyi State, Nigeria
Access this article online
Website:
www.tjogonline.com
Quick Response Code
DOI:
10.4103/TJOG.TJOG_45_19
 Mamah JE,
Department of Obstetrics and Gynaecology, Federal Teaching
Hospital, Abakaliki, Ebonyi State, Southeast Nigeria.
E‑mail: johnbosco.mamah.pg78545@unn.edu.ng
This is an open access journal, and arcles are distributed under the terms of the Creave
Commons Aribuon‑NonCommercial‑ShareAlike 4.0 License, which allows others to remix,
tweak, and build upon the work non‑commercially, as long as appropriate credit is given and
the new creaons are licensed under the idencal terms.
For reprints contact: reprints@medknow.com
How to cite this article: Onoh RC, Mamah JE, Umeokonkwo CD,
Onwe EO, Ezeonu PO, Okafor L. Severe preeclampsia and eclampsia:
A 6‑year review at the Federal Teaching Hospital, Abakaliki,
Southeast Nigeria. Trop J Obstet Gynaecol 2019;36:418‑23.
Received: 18‑05‑2019 Revised: 23‑08‑2019 Accepted: 07‑11‑2019
Published Online: 22‑01‑2020
[Downloaded free from http://www.tjogonline.com on Wednesday, January 22, 2020, IP: 62.203.45.105]

Onoh, et al.: Severe preeclampsia and eclampsia in Abakaliki, Nigeria
419
Tropical Journal of Obstetrics and Gynaecology / Volume 36 / Issue 3 / September‑December 2019
pathophysiology.[2,3] Preeclampsia is a multisystemic disease
characterized by gestational hypertension and significant
proteinuria from the second half of pregnancy in a previously
normotensive and aproteinuric woman.[4-8] Eclampsia, on
the other hand, is an extreme spectrum of preeclampsia, it
is defined as new onset of generalized tonic-clonic seizure
during pregnancy or puerperium in a patient with features
of preeclampsia.[8-11]
Worldwide, preeclampsia is estimated to complicate about
2–10% of pregnancies, this incidence is estimated to be
seven times higher in developing countries (2.8% of live
births) compared to developed countries where it constitutes
0.4% of live births.[5,10] It accounts for over 63,000 maternal
deaths annually with about 98% of such deaths occurring in
developing countries.[6,7] Studies done in Nigeria report an
incidence of between 2 and 16%[5] but in Abakaliki, Ajah et al.
found an incidence of 1.75% at the defunct Federal Medical
Centre, Abakaliki.[8]
The high maternal mortality and fetal wastages associated
with preeclampsia and eclampsia remain a huge public
health issue.[12] Poor health systems, lack of trained staff,
poor quality of care, low levels of education, patriarchal
culture and poverty are some of the factors contributing
to the vulnerability of pregnant women to the major
complications of preeclampsia-eclampsia.[8,12,13] This study
was conceived to explore the prevalence, trends, patient
characteristics, and pregnancy outcomes of patients managed
for preeclampsia-eclampsia since the inception of FETHA in
January 2012.
Materials and Methods
Ebonyi State is one of the five states in the Southeast
geopolitical zone of Nigeria. It was created in 1996
from the largely rural areas of the preexisting Enugu and
Abia States with Abakaliki as its headquarters. It has an
estimated population of 4.3 million people and occupies
a landmass of 6400 km2, sharing boundaries in the West
with Enugu State, Abia State in the Eastern border, Cross
River in the South, and Benue State in the North. The
vegetation characteristic of the area is the tropical rain
forest with an average annual rainfall of 1600 mm and
an average atmospheric temperature of 36°C. Igbo is the
predominant ethnic group in Ebonyi state and majority
practice Christianity.
Study setting
The Federal Teaching Hospital Abakaliki (FETHA) is a federal
government-owned tertiary health institution established
in December 2011 when the federal government acquired
then Ebonyi State University Teaching Hospital Abakaliki and
merged it with the former Federal Medical Centre, Abakaliki.
FETHA is located within the center of the state capital. It
provides tertiary level obstetric care and trains postgraduate
medical specialists. It receives referral from the general
hospitals, mission hospitals, and primary health centers, as
well as privately owned hospitals and clinics. It also receives
referral from neighboring states.
Study population/design
This was a retrospective study involving all the cases of
preeclampsia and eclampsia managed at the Federal teaching
hospital Abakaliki between the 1st of January 2012 and
December 31st 2017.
Denition of terms
Hypertension is defined as blood pressure recorded on at
least two occasions 4 h apart measuring ≥140/90 mmHg or
a single recording of 160/110 mmHg or more.[5]
A urine dipstick test of 2+ of proteinuria or more
pluses without evidence of urinary tract infection was
considered significant proteinuria for the diagnosis of severe
preeclampsia while new-onset grand mal seizures in a patient
with preeclampsia were considered eclampsia.
Data collection
Information on the total number of patients who delivered
their baby during the period was retrieved from the obstetric
registers in the labor ward, postnatal ward, antenatal ward,
accident and emergency, and the theatre. The case notes of
the patients who were diagnosed as having preeclampsia
and eclampsia were retrieved from the records department.
Using a pro forma, information on sociodemographic
characteristics, booking status, gestational age on
delivery, risk factors identified, complications (premature
delivery, eclampsia, abruptio placentae, perinatal death,
and maternal deaths) were extracted. Diagnosis, blood
pressures, and urinalysis results on admission, neonatal
APGAR scores, birth weights, and neonatal complications
were also documented.
Data analysis
Data were sorted and analyzed using Epi Info
(Atlanta, USA) version 7. The descriptive analysis of the
patients’ sociodemographic characteristics was presented in
tables as frequency, proportions, and means. Severe disease
was defined as a case with systolic BP of ≥160 mmHg
and diastolic of ≥110 mmHg. The relationship between
severe disease and sociodemographic and other clinical
characteristics was evaluated using Chi-squared test at 5%
level of significance.
[Downloaded free from http://www.tjogonline.com on Wednesday, January 22, 2020, IP: 62.203.45.105]

Onoh, et al.: Severe preeclampsia and eclampsia in Abakaliki, Nigeria
420 Tropical Journal of Obstetrics and Gynaecology / Volume 36 / Issue 3 / September‑December 2019
Ethical approval
Ethical approval was obtained from the research and ethics
committee of FETHA.
Results
During the period under review, a total of 14,181 deliveries
were recorded. Of these numbers, 568 women were managed
for preeclampsia and eclampsia thereby giving a period
prevalence of 4.0%. Preeclampsia was 487 (3.4%) while
Eclampsia was 81 (0.6%). The annual prevalence showed a
range of 2.9–5.2% with a peak of 5.2% in 2017 [Table 1]. Only
254 patients’ case notes out of 568 (44.7%) had complete
information and were used for data analysis.
The mean age of the patients was 27.3 ± 5.6 years. The
modal age group was 25–29 years (93, 36.6%). The majority
of the patients were rural dwellers 130(51.4%), had secondary
level of education 107 (42.1%). Seventeen (6.7%) of the
patients had no formal education. Only 93 (36.6%) of the
patients were booked in our facility while the rest either didn’t
get any antenatal care or registered elsewhere [Table 2].
Among the risk factors, primigravida 81 (31.9%), previous
history of hypertension 37 (14.6%), and family history of
hypertension 23 (9.1%) were the common ones [Table 3].
More women were delivered by cesarean section 124 (48.8%).
The mean gestational age at delivery was 35 weeks. The
mean birth weight was 2.4 ± 0.8 kg [Table 4]. Abruptio
placenta was the commonest maternal complication while
a low APGAR score at 5 min was the most common fetal
complication [Table 5]. Maternal and perinatal deaths were
recorded in 0.8% and 29.5%, respectively.
There was no statistically significant association between
sociodemographic characteristics and severe preeclampsia
and eclampsia, P value >0.05 [Table 6]. There was a
significant association between severe preeclampsia/
eclampsia and the development of pulmonary edema and
stroke, P value <0.05 [Table 7].
Discussion
Preeclampsia and eclampsia remain a threat to maternal
and fetal health with the greatest burden borne by
developing countries.[14] This problem is made worse by the
mysterious nature of its etiology and strategies to prevent
its occurrence.[4-6] Reports from a recent multicenter study
identified preeclampsia and eclampsia as the leading cause
of maternal mortality and a major cause of fetal wastage in
Nigeria, overtaking obstetric hemorrhages and sepsis.[15] This
underscores the need for urgent interventions to reverse this
emerging trend.
The prevalence of preeclampsia from this study was 3.6%
while eclampsia was 0.6%. The prevalence of preeclampsia
from the present study is higher than a prevalence of
0.99% earlier reported by Ajah et al. in Abakaliki, while the
prevalence of 0.6% which we found for eclampsia is close
to 0.76% reported by Ajah.[8] It appears a lower incidence of
preeclampsia about 6 years earlier reported by Ajah et al. was
because the study was conducted in one of the institutions
Table 1: Trends of preeclampsia/eclampsia
Year of delivery Total deliveries Preeclampsia/eclampsia Percent (%)
2012 2418 84 3.5
2013 2761 79 2.9
2014 2173 94 4.3
2015 2299 103 4.5
2016 2379 96 4.0
2017 2151 112 5.2
Tot al 14,18 1 568 4.0
Table 2: Sociodemographic characteristics of patients
Variable Frequency Proportion
Age
15‑19 13 5.1
20‑24 65 25.6
25‑29 93 36.6
30‑34 53 20.9
35‑39 23 9.0
=>40 7 2.8
Mean age 27.3±5.6
Place of residence
Rural 130 51.4
Urban 123 48.6
Education
None 17 6.7
Primary 71 28.0
Secondary 107 42.1
Tertiary 59 23.2
Respondent’s occupation
Artisan 13 5.1
Civil Servant 56 22.0
Farmer 43 16.9
Trader 69 27.2
Unemployed 68 26.8
Others 5 2.0
Parity
Nulliparous 81 32.0
Multipara 140 55.3
Grand multipara 32 12.7
Mean 2.0
Booking status
Booked 93 36.6
Unbooked 161 63.4
[Downloaded free from http://www.tjogonline.com on Wednesday, January 22, 2020, IP: 62.203.45.105]

Onoh, et al.: Severe preeclampsia and eclampsia in Abakaliki, Nigeria
421
Tropical Journal of Obstetrics and Gynaecology / Volume 36 / Issue 3 / September‑December 2019
that formed the present Federal Teaching Hospital, Abakaliki.
Certainly the defunct hospital had less patient load. Our
finding compares with 3.3% reported in Enugu[16] but more
than 1.2% reported in Calabar,[9] and less than 4.2% reported
from Ethiopia.[17] While Enugu compares with Abakaliki in
terms of socioeconomic and cultural characteristics, Calabar
is more developed, a situation that might explain the lower
incidence. In this study, we found a progressive rise in the
annual incidence of preeclampsia with the least incidence
recorded in 2013, 2.9% and the highest incidence of 5.2%
was recorded in 2017. This could be due to increased
awareness and improved health-seeking behavior. This is
evident from Ajah’s study reported earlier[8] where 83.1%
of their patients were unbooked, 70% had none or at most
primary education compared with 36.6% booking rate in our
study and 93.3% literacy rate in this study. We also found that
48.6% of patients in this study were urban dwellers unlike
12.6% reported by Ajah and 10.5% reported in Okolobiri.[18]
Preeclampsia and eclampsia were high among primigravidae
in this study, 32.0%, Ajah reported 59.4%[8] while 49.3% was
reported in Enugu[16] and 44.1% was found in Calabar.[9] This
is not surprising because preeclampsia is theorized to be a
disease of primigravidae,[19] but this may not always be the
rule as found in this study. Other notable risk factors in the
patients were advanced maternal age, family, and previous
histories of hypertension and multiple pregnancies. Similar
associations were reported in other studies.[18,17]
Despite advances in the understanding of this disease and
the introduction of novel therapies in the management of
preeclampsia, delivery remains the only cure thereby making
it a major cause of iatrogenic prematurity, accounting for
15% of all premature births and approximately one out of
five very low birth weight babies.[11] More often than not,
pregnancy termination is the case in severe preeclampsia and
eclampsia because the risk of continuing such pregnancy far
outweighs any potential or real benefit of continuing it, due
to the progressive nature of this disease. In this study, 60.2%
of the babies were delivered preterm.
Low birth weight as a result of preterm delivery and
intrauterine growth restrictions are known complications
of severe preeclampsia. The average birth weight from this
study was 2.4 ± 0.8 kg. Also, these patients present before
the onset of labor with an unfavorable cervix thereby making
them candidates for emergency cesarean sections with
Table 3: Risk factors observed in the cases
Variable Frequency Proportion
Family history of diabetes mellitus
Yes 5 2.0
No 249 98.0
Family history of hypertension
Yes 23 9.1
No 231 90.9
Diabetes
Yes 1 0.4
No 253 99.6
Molar pregnancy
Yes 2 0.8
No 252 99.2
Multiple gestations
Yes 18 7.1
No 236 92.9
Nulliparity
Yes 81 31.9
No 173 68.1
Previous history of hypertension
Yes 37 14.6
No 217 85.4
Renal disease
Yes 2 0.8
No 252 99.2
Advanced maternal age
Yes 12 4.7
No 242 95.3
Table 4: Mode of delivery and neonatal outcome
Variable Frequency Percentage
Mode of Delivery
Cesarean section 124 48.8
Instrumental delivery 12 4.7
Spontaneous vaginal delivery 118 46.5
Gestational age at delivery (Weeks)
<34 79 31.1
34‑36 74 29.1
≥37 101 39.8
First Min APGAR score
<4 49 23.3
4‑6 41 19.5
=>7 120 57.2
Second Min APGAR score
<4 39 18.6
4‑6 18 8.6
=>7 153 72.8
Asphyxiated
Yes 75 35.7
No 135 64.3
Fetal outcome
Alive 179 70.5
Dead 75 29.5
Birth weight (Kg)
<2.5 122 48.0
2.5‑3.5 111 43.7
3.6‑3.9 8 3.2
=>4 13 5.1
Mean birth weight±SD 2.4±0.8
[Downloaded free from http://www.tjogonline.com on Wednesday, January 22, 2020, IP: 62.203.45.105]

Onoh, et al.: Severe preeclampsia and eclampsia in Abakaliki, Nigeria
422 Tropical Journal of Obstetrics and Gynaecology / Volume 36 / Issue 3 / September‑December 2019
its own unique complications. In this study, more women
were delivered by cesarean section 48.8% compared to
46.5% who had vaginal delivery. The rest (4.7%) had assisted
vaginal delivery with vacuum or forceps. These findings
are supported by the management principle of stabilizing
women with severe preeclampsia and delivering by the
most expeditious route.[8] The 48.0% low birth weight and
48.8% of women who had caesarean section in this study are
close to 51.69% and 44.9%, respectively reported by Ajah.[8]
The incidence of cesarean section in this study is similar to
findings reported in Okolobiri,[18] Ibadan,[20] and Ethiopia[21]
but lower than 71.2% reported in Calabar[9], and 65.9% in
Ghana[22] while the incidence of low birth weight is less than
58.2%, 58.54%, and 71.43% respectively reported in Enugu,[16]
Tanzania,[23] and India[24] but more than 17.74% in Calabar[9]
and 28.9% in Zimbabwe.[2]
The commonest complication found among patients in this study
was abruptio placentae 11.5%. Maternal mortality was recorded in
0.8% of the population and 29.5% of babies were lost to perinatal
death. Severe preeclampsia and eclampsia are recognized causes
of maternal and fetal morbidity and mortality.[2-8] It is even worse
when intervention is offered late as was observed in this study
where the patients presented late after patronizing healing
homes and religious centers. This was not helped by the low
socioeconomic status of women in this environment,[8] thereby
making hospital presentation a last resort after significant
damage had been done. Morbid aversion for cesarean section
was also a major reason for delayed presentation to the hospital
among these women, even when they realized the urgent need
for it.[25] Fear of cost and the perception of cesarean section
as a reproductive failure are known to perpetuate this poor
health-seeking behavior.[25,26] Similar complications to ours were
reported in other studies.[2,4,16,17,26]
There was no statistically significant association between
maternal sociodemographic characteristics and severe
preeclampsia and eclampsia. Stroke and pulmonary edema
were complications that had a significant association with
severe preeclampsia and eclampsia, P < 0.05. The reason for
this association was not immediately clear but more often
than not, the patients were noted to have been overloaded
by injudicious fluid administration at the referring facility
or may not have received any intervention to control their
blood pressure prior to presentation in our facility. These are
recipe for major complications as was observed in this study.
Conclusion
In conclusion, the prevalence of preeclampsia and eclampsia
was high with an annual increase from 2012 till it peaked
in 2017. The fetomaternal morbidity and mortality also
showed a similar trend. Sadly, late hospital presentation
with severe disease and compromised health status was a
common finding in this study. This makes a strong case for
awareness creation on the dangers of preeclampsia, dispelling
misconceptions surrounding early hospital presentation
and increased training of manpower in the rural areas so
as to be able to recognize this disease and make a timely
referral. It is important to equip neonatal care units since
iatrogenic preterm deliveries are almost always inevitable in
the management of severe preeclampsia. Also, the place of
universal antenatal coverage cannot be over-stressed if we
Table 5: Maternal complications
Variable Frequency Percentage
Abruptio placentae
Yes 30 11.8
No 224 88.2
HELLP syndrome
Yes 5 2.0
No 249 98.0
Maternal death
Yes 2 0.8
No 252 99.2
Renal failure
Yes 6 2.4
No 248 97.6
Pulmonary edema
Yes 5 2.0
No 259 98.0
HELLP: hemolysis, elevated liver enzyme levels, and low platelet levels
Table 6: Sociodemographic and clinical factors associated with
severe disease
Variable Severe disease Unadjusted
odds ratio
95% CI P
Yes (%) No (%)
Place of residence
Rural 106 (81.5) 24 (18.5) 1.2 0.67‑2.30 0.478
Urban 96 (78.1) 27 (21.9) Ref
Parity
Nulliparous 59 (76.6) 18 (23.4) 1.0 0.35‑2.58 0.929
Multiparous 112 (83.6) 22 (16.4) 1.5 0.57‑3.87 0.419
Grand multiparous 24 (77.4) 7 (22.6) Ref
Education
Primary or less 74 (84.1) 14 (15.9) 1.5 0.77‑2.99 0.227
Secondary or more 129 (77.7) 37 (22.3) Ref
Marital Status
In a union 180 (79.3) 47 (20.7) 0.7 0.22‑2.02 0.470
Not in a union 23 (85.2) 4 (14.8) Ref
Booking Status
Unbooked 133 (83.6) 28 (17.4) 1.6 0.84‑2.91 0.159
Booked 70 (74.3) 23 (24.7) Ref
GA at delivery
<34 64 (81.0) 15 (19.0) Ref
34‑36 62 (83.8) 12 (16.2) 1.2 0.53‑2.79 0.654
=>3 7 77 (76.2) 24 (23.8) 0.8 0.36‑1.5 5 0.441
[Downloaded free from http://www.tjogonline.com on Wednesday, January 22, 2020, IP: 62.203.45.105]

Onoh, et al.: Severe preeclampsia and eclampsia in Abakaliki, Nigeria
423
Tropical Journal of Obstetrics and Gynaecology / Volume 36 / Issue 3 / September‑December 2019
are to attain sustainable development goals as it pertains to
maternal and child health.
Limitation
A major limitation of this study Was with retrieving patient
case notes. In most cases, the case notes had incomplete
documentation especially in the early years following the
merger of Ebonyi State University Teaching Hospital and
the Federal Teaching Hospital, Abakaliki to form the Federal
teaching hospital, Abakaliki. This makes a strong case for
computerization of the health information department of
hospitals in the West African subregion.
Financial support and sponsorship
Nil.
Conicts of interest
There are no conflicts of interest.
References
1. Abubakar A, Abdullahi RA, Jibril HZ, Dauda MN, Poopola MA.
Maternal ethnicity and severity of pre-eclampsia in Northern Nigeria.
Asian J Med Sci 2009;1:104-7.
2. Ngwenya S. Severe preeclampsia and eclampsia: Incidence,
complications and perinatal outcomes at a low-resource setting,
Mpilo Central Hospital, Bulawayo, Zimbabwe. Int J Women Health
2017;9:353-7.
3. von Dadelszen P, Magee LA, Devarakonda RM, Hamilton T,
Ainsworth LM, Yin R, et al. The prediction of adverse maternal outcomes
in preeclampsia. J Obstet Gynaecol Can 2004;26:871-9.
4. Chuppana R, Madhavi AP, Sharon PS, Priya SS, Shehnaz S. A study
of maternal deaths from preeclampsia and eclampsia in a tertiary care
centre. IAIM 2018;5:6-10.
5. Osungbade KO, Olusimbo KI. Public health perspectives of preeclampsia
in developing countries: Implications for health system strengthening.
J Pregnancy. doi: 10.1155/2011/481095.
6. Waugh JS, Smith MC. Hypertensive disorder. In: Edmonds K, editor.
Dewhurst’s Text book of Obstetrics and Gynecology. 8th ed. New Jersey:
Wiley- Black well; 2012. p. 101-10.
7. World Health Organization: Trends in Maternal Mortality: 1990 to
2008. Geneva: WHO; 2010. Available from http://whq/Ibdo c. who.
Int/Publications/2010/97892-41500265.
8. Ajah LO, Ozonu NC, Ezeonu PO, Lawani LO, Obuna JA, Onwe EO.
The feto-maternal outcome of preeclampsia with severe features
and eclampsia in Abakaliki, Southeast Nigeria. J Clin Diag Res
2016;10:QC18-21.
9. Kooffrey ME, Ekott M, Ekpoudom DO. The prevalence of
preeclampsia among pregnant women in the University of Calabar
Teaching Hospital, Calabar. Saudi J Health Sci 2014;3:133-6.
10. Thapa K, Jha R. Magnesium sulphate: A life saving drug. J Nepal Med
Assoc 2008;47:104-8.
11. Shennan A. Hypertensive disorders. In: Edmonds DK, editor. Dewhurst’s
Text Book of Obstetrics and Gyecology. 7th ed. New Jersey: Wiley- Black
well; 2007. p. 227-35.
12. Population council of America. Ending eclampsia: A systematic review
of the treatment and management of preeclampsia and eclampsia. USAID
document; 2010.
13. Tebeu P, Halle G, Ngowa JD, Domgue JF, Ourtching C, Mboudou E.
Outcome of pregnancy in preeclampsia at the regional hospital
Maroua- Cameroon. Int J Reprod Med Gynecol 2017;3:34-9.
14. Mustapha R, Ahmed S, Gupta A, Venuto R. A comprehensive review of
hypertension in pregnancy. J Pregnancy 2012;10:91-109.
15. Oladapo O, Adetoro O, Ekele B, Chama C, Etuk S, Aboyeji A, et al.
When getting there is not enough: A cross-sectional study of 998
maternal deaths and 1451 near misses in public tertiary hospitals
in a low-income country. BJOG, 2015. Available from: www.doi.
org/10.1111/1471-0528.13450.
16. Ugwu EOV, Dim CC, Okonkwo CD, Nwankwo TO. Maternal and
perinatal outcome of severe preeclampsia in Enugu, Nigeria after
introduction of Magnesium sulfate. Niger J Clin Pract 2011;14:418-21.
17. Wagnew M, Muluken D, Worku A, Nyagero J. Trends of
preeclampsia/eclampsia and maternal and neonatal outcomes among
women delivering in Addis ababa selected government hospitals,
Ethiopia: A retrospective cross-sectional study. Pan Afr Med J
2016;25:12-8.
18. Adokiye EA. Factors inuencing the prevalence of preeclampsia-eclampsia
in booked and unbooked patients: 3 years retrospective study in NDUTH,
Okolobiri. World J Med Medical Sci 2015;3:1-14.
19. Cunningham FG, Leveno KJ, Bloom SL, Spong CY, Dashe JS,
Hoffman BL, et al. Hypertensive Disorders. Williams Obstetrics. 24th ed.
USA: McGraw-Hill companies; 2014. p. 728-77.
20. Oladokun A, Okewole AI, Adewale IF, Babarinsa IA. Evaluation of
cases of eclampsia in University college hospital Ibadan over a 10 year
period. West Afr J Med 2000;19;3:92-4.
21. Abate MM, Lakew Z. Eclampsia a 5 year retrospective review of
216 cases managed in 2 teaching hospitals in Addis Ababa. Ethiop Med
J 2006;44:47-52.
22. Obed SA, Aniteye P. Pregnancy following eclampsia: A longitudinal
study at Korle-Bu teaching hospital. Ghana Med J 2007;41:139-43.
23. Ndaboine EM, Kihunrwa A, Rumanyika R, Im HB, Massinde AN.
Maternal and perinatal outcomes among eclamptic patients admitted
to Bugando medical centre, Mwanza, Tanzania. Afr J Reprod Health
2012;16:35-41.
24. Singhal SR, Deepika A, Nanda S. Maternal and perinatal outcome in
severe preeclampsia and eclampsia. J South Asian Federation Obstet
Gynecol 2009;1:25-8.
25. Sunday-Adeoye I, Kalu CA. Pregnant Nigerian womens view of
caesarean section. Niger J Clin Pract 2011;14:276-9.
26. Ezeome IV, Ezugworie JO, Udealor PC. Beliefs, perceptions and
views of pregnant women about caesarean section and reproductive
decision-making in a specialist health facility in Enugu, Southeast
Nigeria. Niger J Clin Pract 2018;21:423-8.
Table 7: Relationship between severe disease and the
development of complications in mothers and their babies
Variable Severe disease Unadjusted
odds ratio
95% CI P
Yes (%) No (%)
Abruptio placentae
Yes 23 (76.7) 7 (23.3) 0.8 0.32‑1.99 0.636
No 180 (80.4) 44 (19.6)
Renal failure
Yes 4 (66.7) 2 (33.3) 0.5 0.09‑2.76 0.412
No 199 (80.2) 49 (19.8)
Stroke/pulmonary edema
Yes 1 (20.0) 4 (80.0) 0.1 0.01‑0.53 <0.001
No 202 (81.1) 47 (18.9)
Neonatal outcome
Dead 61 (81.3) 14 (18.7) 1.1 0.57‑2.25 0.717
Alive 142 (79.3) 37 (2 0.7)
[Downloaded free from http://www.tjogonline.com on Wednesday, January 22, 2020, IP: 62.203.45.105]