These Final

REPUBLIQUE DU CAMEROUN REPUBLIC OF CAMEROON
Paix – Travail – Patrie Peace – Work – Fatherland

2
********** **********
MINISTERE DE MINISTRY OF HIGHER
L’ENSEIGNEMENT SUPERIEUR EDUCATION
********** **********
UNIVERSITE DE YAOUNDE I THE UNIVERSITY OF YAOUNDE I
********** **********
FACULTE DE MEDECINE ET DES FACULTY OF MEDICINE AND
+ SCIENCES BIOMEDICALES BIOMEDICAL SCIENCES
DEPARTEMENT OF GYNAECOLOGY AND OBSTETRICS
Preeclampsia: prevalence, determinants and

perinatal and maternal outcome at the
Garoua regional and military hospitals.
Thesis written and publicly defended in view of obtaining the degree of Doctor of general medicine by
ADAMOU Habibatou Madina
15M098
Director Co-directors
Pr. DOHBIT Julius Sama
Pr. MBU Enow Robinson
Associate Professor
Professor Departement of Obstetrics and
Departement of Obstetrics and Gynaecology
FMBS, UY1
Gynaecology
Dr NYADA Serge Robert
FMBS, UY1 Lecturer
Departement of Obstetrics and
Gynaecology
FMBS, UY1
Dr EYONG Isaac Mboh
Lecturer
Departement of Obstetrics and
Gynaecology
FHS, UB
Academic year 2021-2022

REPUBLIQUE DU CAMEROUN REPUBLIC OF CAMEROON
Paix – Travail – Patrie Peace – Work – Fatherland
********** **********
2 MINISTERE DE MINISTRY OF HIGHER
L’ENSEIGNEMENT SUPERIEUR EDUCATION
********** **********
UNIVERSITE DE YAOUNDE I THE UNIVERSITY OF YAOUNDE I
********** **********
FACULTE DE MEDECINE ET DES FACULTY OF MEDICINE AND
SCIENCES BIOMEDICALES BIOMEDICAL SCIENCES
DEPARTEMENT OF GYNAECOLOGY AND OBSTETRICS
Preeclampsia: prevalence, determinants and

perinatal and maternal outcome at the
Garoua regional and military hospitals.
Thesis written and publicly defended in view of obtaining the degree of Doctor of general medicine by
ADAMOU Habibatou Madina
15M098
DATE :
Jury Research Team
President of the jury
Director
Pr FOMULU JN
Pr. MBU Robinson Enow
Reporter
Co-directors
Pr. MBU Robinson Enow
Pr. DOHBIT Julius Sama
Members
Dr NYADA Serge Robert
Dr JEMEA Bonaventure
Dr EYONG Isaac Mboh
Academic year 2021-2022

Preeclampsia: prevalence, determinants and perinatal and maternal outcome
at the Garoua regional and military hospitals.
TABLE OF CONTENTS
Dedication...............................................................................................................................................iii
Acknowledgment....................................................................................................................................IV
The Administrative And Teaching Staff Of The Faculty Of Medicine And Biomedical Sciences (Fmbs)
Yaounde I For The 2021/2022 Academic Year........................................................................................V
Physician’s Oath.................................................................................................................................XVII
List Of Figures:.................................................................................................................................XVIII
List Of Tables:.....................................................................................................................................XIX
List Of Abbreviations:..........................................................................................................................XX
Abstract................................................................................................................................................XXI
Resume...............................................................................................................................................XXII
Chapter 1: Introduction.............................................................................................................................1
1.1. Background........................................................................................................................................2
1.2. Justification........................................................................................................................................3
1.3. Research Questions............................................................................................................................3
1.4. Research Hypothesis..........................................................................................................................3
1.5. Objectives..........................................................................................................................................4
1.6. Definition Of Operating Terms.........................................................................................................4
Chapter 2: Literature Review....................................................................................................................5
2.1 Introduction........................................................................................................................................6
2.2. Preeclampsia......................................................................................................................................7
2.2.1. Definition........................................................................................................................................7
2.2.2. Epidemiology..................................................................................................................................7
2.2.3. Classification Of Preeclampsia.......................................................................................................8
2.2.4. Anatomy Of The Placenta(13)........................................................................................................8
2.2.5. Physiology Of Pregnancy (14).....................................................................................................10
2.2.6. Pathophysiology (15)....................................................................................................................12
2.2.7. Risk Factors (16)..........................................................................................................................14
2.2.8. Diagnosis Of Preeclampsia (12)...................................................................................................16
2.2.8.4. Prediction Of Preeclampsia.......................................................................................................17
2.2.9. Management Of Pre-Eclampsia.(12)............................................................................................18
2.2.9.1. Goal...........................................................................................................................................18
2.2.9.2. Means.........................................................................................................................................18
2.2.9.3. Delivery.....................................................................................................................................20
2.2.9.4. Prevention..................................................................................................................................21
i
2.2.10. Complications Of Pre-Eclampsia.(17)........................................................................................22
2.3. Recent Publications.........................................................................................................................25
Chapter 3: Methodology.........................................................................................................................34
3.Materials And Methods.......................................................................................................................35
3.1. Type Of Study.................................................................................................................................35
3.2. Site Of Study...................................................................................................................................35
3.3. Duration Of Study...........................................................................................................................35
3.4. Study Population..............................................................................................................................35
3.5. Sample Size Estimation...................................................................................................................36
3.6. Procedure.........................................................................................................................................37
3.7. Data Management............................................................................................................................37
3.8. Material For Data Collection And Write Up...................................................................................38
3.9. Personnel Used................................................................................................................................38
3.10. Ethical Considerations:..................................................................................................................38
Chapter 4: Results...................................................................................................................................40
4.1. Presentation Of The Study Population............................................................................................40
4.2. The Prevalence Of Preeclampsia.....................................................................................................41
4.3. Sociodemographic Characteristics Of Study Population.................................................................41
4.4. Obstetrics And Medical Characteristics Of Study Population........................................................43
4.5. Risk Factors Associated To Preeclampsia.......................................................................................45
4.6. Clinical And Biological Characteristics Of Patients With Preeclampsia........................................46
4.7. Evolution.........................................................................................................................................49
4.8. Complications Of Preeclampsia......................................................................................................50
Chapter 5: Discussion.............................................................................................................................53
5.1. Prevalence Of Preeclampsia............................................................................................................53
5.2. Sociodemographic Characteristics Of Patients With Preeclampsia................................................53
5.3. Risk Factors Associated With Preeclampsia:..................................................................................54
5.4. Maternal And Foetal Outcome Of Preeclampsia.............................................................................54
5.5. Limitations To The Study:...............................................................................................................56
Chapter 6: Conclusion............................................................................................................................58
Chapter 7: Recommendations.................................................................................................................60
References...............................................................................................................................................62
Appendix................................................................................................................................................66
ii
DEDICATION
I dedicate this work to my parents: my dad, Mr ADAMOU Baba Abba and my

mom, DJENABOU Sali.
iii
ACKNOWLEDGMENT
All praise is due to GOD, the especially merciful, the entirely merciful for all the blessings
and favors he bestowed upon me. It was neither my will nor my hardwork nor my intelligence
but his mercy, without him nothing is possible.
This work could not have been done without the participation and support of some people to
whom I would like to present my gratitude.
 Pr MBU Enow Robinson; for his availability, corrections, encouragement, guidance in
the course of this work.
 Pr DOHBIT SAMA Julius; for his availability, sacrifice and efforts in orientating me
through out this work.
 Dr EYONG and Dr NYADA; for the support, corrections, encouragement, availability
throughout this work.
 To the Dean of the FMSB and to all the entire staff of FMSB, thanks for the hard work
and commitment in training and supporting me.
 To all the members of the Jury for accepting to examine and evaluate this piece of
work.
 To all the women who accepted to participate in this study research.
 To all the directors, chief nurses and all the medical personnel of the hospitals.
 To my parents, Mr and Mrs ADAMOU, my pillars, my support system, my
motivation. Thanks for the endless love, encouragement, moral and financial support,
patience, without which I would not have achieved this piece of work.
 To my siblings (Dr Aminatou, Fadimatou Hanane, Mohamadou BB Star, Aissatou
Chatam, Souaibou Rais, Aboubakar Iyawa Asmaou, Aissatou Arfa, Hadjaratou
Tilmiza,) and all my family members who contributed one way or the other for the
fulfilment of this work.
 To my friends that became sisters; Amina Nguilandi, Sadou Aicha Yasmine, Sidiki
Ramatou, Hadidjatou Madinatou, Fatimatouz’ Zaraou, Hawa Aboubakar, Asmaou
Daouda, Rekya Mamat for the wonderful seven years spent together.
 To my internship group members (Abissegue Gisele, Alake Hycintha, Abrow Samuel,
Adjessa Abega, Aboubakar Razzaq, Abanda Dross Ulrich, Binwe Janvier).
 To all my classmates and collegues of the 47th promotion I love you guys.
 To all my juniors of the 48th promotion.
 To our elder brother Dr Abdoulwahab and Dr Alamine for always being there and
answering when ever we needed your help.
 To my neighbours and collegues; Tchedele Hilary, Hadidjatou Maoloudou.
 A special thank to Ahmadou Garba for always being there for me.
iv
 To all those who contributed to this work in one way or the other.
THE ADMINISTRATIVE AND TEACHING STAFF OF THE FACULTY

OF MEDICINE AND BIOMEDICAL SCIENCES (FMBS) YAOUNDE I
FOR THE 2021/2022 ACADEMIC YEAR
1. ADMINISTRATIVE STAFF
Dean : Pr ZE MINKANDE Jacqueline
Vice- Dean in charge of academic Affairs: Pr NTSAMA ESSOMBA Claudine Mireille
Vice-Dean in charge of Students’ record, follow-up and statistics: Pr MAH Evelyn
MUNGYEH
Vice- Dean in charge of Co-operation and Research: Pr NGO UM Esther Juliette épse
MEKA
Chief of Service in charge of Statistics and Student’s Affairs: Dr NSEME ETOUCKEY
Eric
Director of Administrative and Financial Affairs: M. MEKA Gaston
General Coordinator of Specialization Cycle: Pr ONGOLO ZOGO Pierre
Chief of service, Finance: M. MPACKO NGOSSO Charles Romuald
Chief of service, General Administration and Personnel: Pr SAMBA Odette NGANO ép.
TCHOUAWOU
Chief of service, Certificates/Diplomas: Mrs ASSAKO Anne DOOBA
Chief of service, Education and Statistics: Mrs HAWA OUMAROU
Deputy Head of Education and Statistics: Mrs FAGNI MBOUOMBO AMINA épouse
ONANA
Chief of service, Equipment and Maintenance: M. NNA Etienne Prosper
Interim Chief Librarian: Mme FROUISSOU née MAME Marie-Claire
Stores accountant: M. MOUMEMIE NJOUNDIYIMOUN MAZOU
2. PROGRAM AND SPECIALTY TRAINING COORDINATORS

Coordinator of Dentistry: Pr BENGONDO MESSANGA Charles
Coordinator of Pharmacy: Pr NTSAMA ESSOMBA Claudine
Coordinator of Intern: Pr ONGOLO ZOGO Pierre
Coordinator, Specialization in Histopathology/Morbid Anatomy: Pr ESSAME OYONO
Jean Louis
v
Coordinator, Specialization in Anaesthesiology and Intensive care: Pr ZE MINKANDE
Jacqueline
Coordinator, Specialization in General Surgery: Pr NGO NONGA Bernadette
Coordinator, Specialization in Obstetrics and Gynaecology: Pr MBU ENOW Robinson
Coordinator, Specialization in Internal Medicine: Pr NGANDEU Madeleine
Coordinator, Specialization in Paediatrics: Pr MAH Evelyn MUNGYEH
Coordinator, Specialization in Molecular Biology: Pr KAMGA FOUAMNO Henri Lucien
Coordinator, Specialization in Radiology and Medical Imagery: Pr NKO’O AMVENE
Samuel
Coordinator, Specialization in Public Health: Pr TAKOUGANG Innocent
CESSI Pedagogic Manager : Pr ANKOUANE ANDOULO Firmin
HONORABLE DIRECTORS OF THE YAOUNDE UNIVERSITY CENTRE FOR

HEALTH SCIENCES
Pr MONEKOSSO Gottlieb (1969-1978)
Pr EBEN MOUSSI Emmanuel (1978-1983)
Pr NGU LIFANJI Jacob (1983-1985)
Pr CARTERET Pierre (1985-1993)
HONORABLE DEANS OF FACULTY OF MEDICINE AND BIOMEDICAL

SCIENCES
Pr SOSSO Maurice Aurélien (1993-1999)
Pr NDUMBE Peter (1999-2006)
Pr TETANYE EKOE Bonaventure (2006-2012)
Pr EBANA MVOGO Côme (2012-2015)
3. TEACHING STAFF
N° NAME RANK FIELD
DEPARTMENT OF SURGERY AND SPECIALTIES
01 SOSSO Maurice Aurélien (HD) P General Surgery
02 DJIENTCHEU Vincent de Paul P Surgery : Neurosurgery
03 ESSOMBA Arthur (Interim HD ) P General Surgery
04 MOUAFO TAMBO Faustin P Paediatric Surgery
vi
05 NGO NONGA Bernadette P General Surgery

06 NGOWE NGOWE Marcellin P General Surgery
07 ZE MINKANDE Jacqueline P Anaesthesiology- Intensive care
08 BAHEBECK Jean AP Orthopaedic Surgery
09 BEYIHA Gérard AP Anaesthesiology- Intensive care
10 ESIENE Agnès AP Anaesthesiology- Intensive care
11 EYENGA Victor Claude AP Surgery : Neurosurgery
12 FARIKOU Ibrahima AP Orthopaedic Surgery
13 GUIFO Marc Leroy AP General Surgery
14 HANDY EONE Daniel AP Orthopaedic Surgery
15 OWONO ETOUNDI Paul AP Anaesthesiology- Intensive care
16 BANG GUY Aristide SL General Surgery
BENGONO BENGONO Roddy
17 SL Anaesthesiology- Intensive care
Stéphan
18 JEMEA Bonaventure SL Anaesthesiology- Intensive care
19 NGO YAMBEN Marie Ange SL Orthopaedic Surgery
20 AHANDA ASSIGA SL General Surgery
21 AMENGLE Albert Ludovic SL Anaesthesiology- Intensive care
22 BWELE Georges L General Surgery
23 TSIAGADIGI Jean Gustave L Orthopaedic Surgery
24 BELLO FIGUIM L Surgery : Neurosurgery
BIKONO ATANGANA Ernestine
25 L Surgery : Neurosurgery
Renée
BIWOLE BIWOLE Daniel Claude
26 L General Surgery
Patrick
27 EPOUPA NGALLE Frantz Guy L Urology
28 FOLA KOPONG Olivier L General Surgery
29 FONKOUE Loïc L Orthopaedic Surgery
30 FOUDA Jean Cédrick L Urology
IROUME Cristella Raïssa BIFOUNA
31 L Anaesthesiology- Intensive care
épouse NTYO’O NKOUMOU
vii
32 KONA NGONDO François Stéphane L Anaesthesiology- Intensive care
33 MBOUCHE Landry Oriole L Urology
MEKEME MEKEME Junior
34 L Urology
Barthelemy
35 MOHAMADOU GUEMSE Emmanuel L Orthopaedic Surgery
36 MULUEM Olivier Kennedy L Orthopaedic Surgery
37 NWAHA MAKON Axel Stéphane L Urology
38 NDIKONTAR KWINJI Raymond L Anaesthesiology- Intensive care
NGOUATNA DJEUMAKOU Serge
39 L Anaesthesiology- Intensive care
Rawlings
40 NYANIT BOB Dorcas L Paediatric Surgery
41 OUMAROU HAMAN NASSOUROU L Surgery : Neurosurgery
42 SAVOM Eric Patrick L General Surgery
DEPARTMENT OF INTERNAL MEDICINE AND SPECIALTIES

43 NJOYA OUDOU (HD) P Internal medicine/Gastrroenterology
44 AFANE ZE Emmanuel P Internal medicine /Pneumology
45 ASHUNTANTANG Gloria Enow P Internal medicine /Nephrology
46 KAZE FOLEFACK François P Internal medicine /Nephrology
47 KINGUE Samuel P Internal medicine /Cardiology
48 KUATE TEGUEU Calixte P Internal medicine /Neurology
49 MBANYA Jean Claude P Internal medicine /Endocrinology
50 NDJITOYAP NDAM Elie Claude P Internal medicine / Gastrroenterology
51 NDOM Paul P Internal medicine /Oncology
52 NJAMNSHI Alfred K. P Internal medicine /Neurology
53 NOUEDOUI Christophe P Internal medicine /Endocrinology
54 SINGWE Madeleine épse NGANDEU P Internal medicine /Rhumatology
55 SOBNGWI Eugène P Internal medicine /Endocrinology
56 PEFURA YONE Eric Walter P Internal medicine /Pneumology
57 ANKOUANE ANDOULO AP Internal medicine /Gastroenterology
58 BISSEK Anne Cécile AP Internal medicine /Dermatology
59 HAMADOU BA AP Internal medicine /Cardiology
60 KOUOTOU Emmanuel Armand AP Internal medicine /Dermatology
viii
61 MENANGA Alain Patrick AP Internal medicine /Cardiology
62 FOUDA MENYE Hermine Danielle SL Internal medicine Nephrology
63 KOWO Mathurin Pierre SL Internal medicine /Gastroenterology
64 NDONGO AMOUGOU Sylvie SL Internal medicine /Cardiology
65 BOOMBHI Jérôme SL Internal medicine /Cardiology
KUATE née MFEUKEU KWA Liliane
66 SL Internal medicine /Cardiology
Claudine
67 NGANOU Chris Nadège SL Internal medicine /Cardiology
68 KAMGA OLEN Jean Pierre Olivier SL Internal medicine /Psychiatry
69 NTONE ENYIME Félicien SL Internal medicine /Psychiatry
70 ANABA MELINGUI Victor Yves L Internal medicine /Rhumatology
71 ATENGUENA OBALEMBA Etienne L Internal medicine /Medical Oncology
72 DEHAYEM YEFOU Mesmin L Internal medicine /Endocrinology
ESSON MAPOKO Berthe Sabine
73 L Internal medicine /Medical Oncology
épouse PAAMBOG
74 FOJO TALONGONG Baudelaire L Internal medicine /Rhumatology
75 MAÏMOUNA MAHAMAT L Internal medicine /Nephrology
76 MASSONGO MASSONGO L Internal medicine /Pneumology
77 MBONDA CHIMI Paul-Cédric L Internal medicine /Neurology
MENDANE MEKOBE Francine épouse
78 L Internal medicine /Endocrinology
EKOBENA
79 MINTOM MEDJO Pierre Didier L Internal medicine /Cardiology
80 NDJITOYAP NDAM Antonin Wilson L Internal medicine /Gastroenterology
NDOBO épouse KOE Juliette Valérie
81 L Internal medicine /Cardiology
Danielle
82 NGAH KOMO Elisabeth L Internal medicine /Pneumology
83 NGARKA Léonard L Internal medicine /Neurology
84 NKORO OMBEDE Grâce Anita L Internal medicine /Dermatology
NTSAMA ESSOMBA Marie Josiane
85 L Internal medicine /Geriatrics
épouse EBODE
NZANA Victorine Bandolo épouse
86 L Internal medicine /Nephrology
FORKWA M.
ix
87 OLEMBE MAGA Hélène Josiane L Internal medicine /Psychiatry
Internal medicine /Interventional
88 OWONO NGABEDE Amalia Ariane L
Cardiology
DEPARTMENT OF MEDICAL IMAGERY AND RADIOLOGY

80 ZEH Odile Fernande (HD) P Radiology/ Medical Imagery
90 MOUELLE SONE P Radiotherapy
91 NKO'O AMVENE Samuel P Radiology/ Medical Imagery
92 GUEGANG GOUJOU. E. P Medical Imagery /Neuroradiology
93 MOIFO Boniface P Radiology/ Medical Imagery
94 ONGOLO ZOGO Pierre AP Radiology/ Medical Imagery
95 SAMBA Odette NGANO AP Biophysics/ Medical Physics
MBEDE Maggy épouse ENDEGUE
96 SL Radiology/ Medical Imagery
MANGA
97 MEKA’H MAPENYA Ruth-Rosine L Radiotherapy
Radiology/ Medical Imagery Nuclear
98 NWATSOCK Joseph Francis L
Medicine
99 SEME ENGOUMOU Ambroise Merci L Radiology/ Medical Imagery
DEPARTMENT OF OBSTETRICS AND GYNAECOLOGY
100 KASIA Jean Marie (HD) P Obstetrics and Gynaecology
101 BELLEY PRISO Eugène P Obstetrics and Gynaecology
102 FOUMANE Pascal P Obstetrics and Gynaecology
103 MBOUDOU Émile P Obstetrics and Gynaecology
104 MBU ENOW Robinson P Obstetrics and Gynaecology
105 NKWABONG Elie P Obstetrics and Gynaecology
106 TEBEU Pierre Marie p Obstetrics and Gynaecology
107 DOHBIT Julius SAMA AP Obstetrics and Gynaecology
108 FOUEDJIO Jeanne H. AP Obstetrics and Gynaecology
109 KEMFANG NGOWA J.D. AP Obstetrics and Gynaecology
110 MVE KOH Valère Salomon AP Obstetrics and Gynaecology
111 NGO UM Esther Juliette épse MEKA AP Obstetrics and Gynaecology
112 NOA NDOUA Claude Cyrille AP Obstetrics and Gynaecology
x
113 BELINGA Etienne SL Obstetrics and Gynaecology

114 ESSIBEN Félix SL Obstetrics and Gynaecology
115 EBONG Cliford EBONTANE L Obstetrics and Gynaecology
116 MBOUA BATOUM Véronique Sophie L Obstetrics and Gynaecology
MENDOUA Michèle Florence épouse
117 L Obstetrics and Gynaecology
NKODO
118 METOGO NTSAMA Junie Annick L Obstetrics and Gynaecology
119 NSAHLAI Christiane JIVIR FOMU L Obstetrics and Gynaecology
120 NYADA Serge Robert L Obstetrics and Gynaecology
121 TOMPEEN Isidore L Obstetrics and Gynaecology
DEPARTMENT OF OPHTALMOLOGY, ENT AND STOMATOLOGY
122 DJOMOU François (HD) AP ENT
123 BELLA Assumpta Lucienne P Ophtalmology
124 EBANA MVOGO Côme P Ophtalmology
125 NDJOLO Alexis P ENT
126 NJOCK Richard P ENT
127 OMGBWA EBALE André P Ophtalmology
128 BILLONG Yannick AP Ophtalmology
129 DOHVOMA Andin Viola AP Ophtalmology
130 EBANA MVOGO Stève Robert AP Ophtalmology
131 ÉPÉE Émilienne AP Ophtalmology
132 KAGMENI Gilles AP Ophtalmology
133 KOKI Godefroy AP Ophtalmology
134 MINDJA EKO David SL ENT/Maxillo-Facial Surgery
135 NGABA Olive SL ENT
AKONO ZOUA épouse ETEME Marie
136 L Ophtalmology
Evodie
137 ANDJOCK NKOUO Yves Christian L ENT
138 ASMAOU BOUBA Dalil L ENT
139 ATANGA Léonel Christophe L ENT-CFS
140 BOLA SIAFA Antoine L ENT
xi
141 MEVA’A BIOUELE Roger Christian L ENT-CFS
142 MOSSUS Yannick L ENT-CFS
MVILONGO TSIMI épouse
143 L Ophtalmology
BENGONO Caroline
144 NANFACK NGOUNE Chantal L Ophtalmology
NGO NYEKI Adèle-Rose épouse
145 L ENT-CFS
MOUAHA-BELL
146 NOMO Arlette Francine L Ophtalmology
DEPARTMENT OF PEDIATRICS
147 MONEBENIMP Francisca (HD) P Pediatrics
148 KOKI NDOMBO Paul P Pediatrics
149 ABENA OBAMA Marie Thérèse P Pediatrics
150 CHIABI Andreas P Pediatrics
151 CHELO David P Pediatrics
152 NGUEFACK Séraphin P Pediatrics
153 MBASSI AWA AP Pediatrics
154 MAH Evelyn AP Pediatrics
155 NGO UM KINJEL Suzanne épse SAP AP Pediatrics
NGUEFACK épouse DONGMO
156 AP Pediatrics
Félicitée
157 ONGOTSOYI Angèle H. AP Pediatrics
KALLA Ginette Claude épse MBOPI
158 SL Pediatrics
KEOU
159 NOUBI N. épouse KAMGAING M. SL Pediatrics
160 EPEE épouse NGOUE Jeannette L Pediatrics
161 KAGO TAGUE Daniel Armand L Pediatrics
162 MEGUIEZE Claude-Audrey L Pediatrics
163 MEKONE NKWELE Isabelle L Pediatrics
164 TONY NENGOM Jocelyn L Pediatrics
DEPARTMENT OF MICROBIOLOGY, PARASITOLOGY, HEMATOLOGY AND
INFECTIOUS DISEASES
165 MBOPI KEOU François-Xavier(HD) P Bacteriology/ Virology
xii
166 ADIOGO Dieudonné P Microbiology/Virology
167 GONSU née KAMGA Hortense P Bacteriology
168 LUMA Henry P Bacteriology/ Virology
169 MBANYA Dora P Hematology
170 TAYOU TAGNY Claude P Microbiology/Hematology
171 NKOA Thérèse AP Microbiology/Hematology
172 OKOMO ASSOUMOU Marie C. AP Bacteriology/ Virology
173 TOUKAM Michel AP Microbiology
174 CHETCHA CHEMEGNI Bernard AP Microbiology/Hematology
175 KINGE Thomson Njie SL Infectious Diseases
176 LYONGA Emilia ENJEMA SL Medical Microbiology
NDOUMBA NKENGUE Annick épse
177 SL Hematology
MINTYA
178 VOUNDI VOUNDI Esther SL Virology
179 BEYELA Frédérique L Infectious Diseases
180 BOUM II YAP L Microbiology
181 ESSOMBA Réné Ghislain L Immunology and Infectious Diseases
182 MEDI SIKE Christiane Ingrid L Clinical Biology
183 NGANDO Laure épouse MOUDOUTE L Parasitology
184 NGOGANG Marie Paule L Clinical Biology
DEPARTMENT OF PUBLIC HEALTH
185 KAMGNO Joseph(HD) P Public Health /Epidemiology
186 ESSI Marie Josée P Public Health /Medical Anthropology
Medical Information Technology/
187 BEDIANG Georges Wylfred AP
Public Health
188 NGUEFACK TSAGUE AP Public Health /Biostatistic
189 TAKOUGANG Innocent AP Public Health
190 TANYA née NGUTI K. A. AP Nutrition
191 BILLONG Serges Clotaire SL Public Health
192 KEMBE ASSAH Félix SL Epidemiology
193 KWEDI JIPPE Anne Sylvie SL Epidemiology
194 NJOUMEMI ZAKARIAOU SL Public Health /Health Economics
xiii
195 ABBA-KABIR HAAMIT-M L Pharmacist
196 AMANI ADIDJA L Public Health
197 EYEBE EYEBE Serge Bertrand L Public Health /Epidemiology
Public Health /Nutritional
198 MBA MAADJHOU Berjauline Camille L
Epidemiology
MOSSUS Tatiana née ETOUNOU
199 L Health promotion expert
AKONO
DEPARTMENT OF MORPHOLOGIC-ANATOMOPATHOLOGIC SCIENCES

200 SANDO Zacharie(HD) P Pathology
201 ESSAME OYONO P Pathology
202 FEWOU Amadou P Pathology
203 MENDIMI NKODO Joseph AP Pathology
204 AKABA Désiré SL Human Anatomy
205 BISSOU MAHOP SL Sport Medicine
206 KABEYENE OKONO Angèle SL Histology/Embryology
207 NSEME Eric SL Legal Medicine
208 NGONGANG Gilbert FranK Olivier L Legal Medicine
MENDOUGA MENYE Coralie Reine
209 L Pathology
Bertine épse KOUOTOU
DEPARTMENT OF BIOCHEMISTRY
NDONGO EMBOLA épse
210 P Molecular Biology
TORIMIRO Judith(HD)
211 PIEME Constant Anatole P Biochemistry
212 AMA MOOR Vicky Joceline AP Clinical Biology/Biochemistry
213 EUSTACE BONGHAN BERINYUY SL Biochemisty
214 GUEWO FOKENG Magellan L Biochemisty
MBONO SAMBA ELOUMBA Esther
215 L Biochemisty
Astrid
DEPARTMENT OF PHYSIOLOGY
216 ETOUNDI NGOA Laurent P Physiology
xiv
Serges(HD)
217 ASSOMO NDEMBA Peguy Brice AP Physiology
218 AZABJI KENFACK Marcel SL Physiology
219 DZUDIE TAMDJA Anastase SL Physiology
220 EBELL’A DALLE Ernest Remy Hervé L Human Physiology
DEPARTMENT OF PHARMACOLOGY AND TRADITIONAL MEDICINE
NGONO MBALLA Rose ABONDO
221 SL African Pharmaco-therapeutics
(HD)
222 NDIKUM Valentine SL Pharmacology
223 ONDOUA NGUELE Marc Olivier L Pharmacology
DEPARTMENT OF ORAL, MAXILLO-FACIAL AND PARODONTOLOGY
BENGONDO MESSANGA
224 P Stomatology
Charles(HD)
225 NOKAM TAGUEMNE M.E. SL Dental Medicine
226 BITHA BEYIDI Thècle Rose Claire L Maxillo-Facial Surgery
227 GAMGNE GUIADEM C.M L Dental Surgery
228 EDOUMA BOHIMBO Jacques Gérard L Stomatology and Surgery
LOWE NANTCHOUANG Jacqueline
229 L Paediatric Odontology
Michèle épouse ABISSEGUE
230 Jules Julien NDJOH L Dental Surgery
231 MBEDE NGA MVONDO Rose L Odontostomatology
MENGONG épouse MONEBOULOU
232 L Paediatric Odontology
Hortense
233 NIBEYE Yannick Carine Brice L Bacteriology
DEPARTMENT OF PHARMACOGNOSY AND PHARMACEUTICAL CHEMISTRY
NTSAMA ESSOMBA Claudine Pharmacognosy / Pharmaceutical
234 P
(HD) Chemistry
235 NGAMENI Bathélémy P Phytochemistry/ Organic Chemistry
236 NGOUPAYO Joseph P Phytochemistry /Pharmacognosy
237 GUEDJE Nicole Marie AP Ethnopharmacology/ Plant Biology
238 BAYAGA Hervé Narcisse L Pharmacy
DEPARTMENT OF PHARMACOTOXICOLOGY AND PHARMACOCINETIC
xv
239 FOKUNANG Charles P Molecular Biology
240 MPONDO MPONDO Emmanuel P Pharmacy
241 TEMBE Estella épse FOKUNANG AP Clinical Pharmacology
242 TABI OMGBA SL Pharmacy
NENE AHIDJO épouse NJITUNG
243 L Neuropharmacology
TEM
DEPARTMENT OF PHARMACY GALENIC AND PHARMACEUTICAL LEGISLATION
244 NNANGA NGA Emmanuel (HD) P Galenic Pharmacy
MBOLE Jeanne Mauricette épse Quality Management, Quality Control
245 SL
MVONDO M. of Health Products and Food
246 SOPPO LOBE Charlotte Vanessa SL Quality Control of Drugs
MINYEM NGOMBI Aude Périne
247 L Pharmaceutical Reglementation
épouse AFUH
248 NYANGONO NDONGO Martin L Pharmacy
HD= Head of Department;

P= Professor;
AP= Associate Professor;
SL = Senior Lecturer;
L = Lecturer
xvi
PHYSICIAN’S OATH
Declaration of Geneva adopted by the Geneva Assembly of the World Medical Association in
Geneva, Switzerland, September 1948 and amended by the 22nd World Medical Assembly,
Sydney, Australia (August 1968).
I will solemnly pledge myself to consecrate my life to the service of

humanity
I will give my teachers the respect and gratitude which is their due
I will practise my profession with conscience and dignity
The health of my patients will be my first consideration
I will respect secrets confided in me, even after the patient has died
I will maintain by all the means in my power the honour and noble
traditions of the medical profession
My colleagues will be my brothers
xvii
I will not permit considerations of religion, nationality, race, party
politics or social standing to intervene between my duty and my
List of Figures:
Figure 1: The faces of the placenta. Source: ( Université médicale francophone.)................9
Figure 2: Internal morphology of the placenta Source: (getrevision.co.uk, s.d.).............10
Figure 3: Two-stage model of the pathophysiology of preeclampsia.................................12
Figure 4: Pathophysiology of preeclampsia Source: (Sciencedirect.com, s.d.)..............13
Figure 6: Chat flow of our study population..........................................................................40
Figure 7: Distribution of cases according to type of delivery in % (n=57).............................48
Figure 8: Distribution of cases in terms of evolution (n=57).................................................49
xviii
List of Tables:
Table i: Common Risk factors of Pre-eclampsia......................................................................14
Table ii: Recent Publications on prevalence of pre-eclampsia and risk factors.......................33
Table iii: distribution of cases and controls with respect to demographic characteristics......41
Table iv: follow up of current pregnacy..................................................................................43
Table v: obstetrics and medical past histories........................................................................44
Table vi: distribution of cases and controls according to family past history..........................44
Table vii: multiple logistic regression of risk factors associated with preeclampsia................45
Table viii: clinical and biological signs of patients with preeclampsia.....................................46
Table ix: distribution of cases in terms of types of preeclampsia............................................47
Table x: term at delivery......................................................................................................... 47
Table xi: maternal complications of preeclampsia..................................................................50
Table xii: perinatal complications............................................................................................50
Table xiii: multiple logistic regression of perinatal complications of preeclampsia................51
xix
LIST OF ABBREVIATIONS:
WHO World Health Organization
BMI Body Mass Index
BP Blood Pressure
PE Preeclampsia
HELLP Hemolysis Elevated Liver Enzymes, Low Platelets
ACOG American College of Obstetrics and Gynaecology
HTN Hypertension
OPA Acute Pulmonary Oedema
ROT OesteoTendinous Reflexes
LDH Lactate Dehydrogenase
DIC Disseminated Intravascular Coagulation
IUGR Intra Uterine Growth Restriction
IUFD Intra Uterine Fetal Death
VEGF Vascular Endothelial Growth Factors
NOS Nitric Oxide Synthase
NO Nitric Oxide
DBP Diastolic Blood Pressure
SBP Systolic Blood Pressure
MAP Mean Arterial Pressure
FMBS Faculty of Medicine and Biomedical Sciences
UY1 University of Yaounde 1
GRH Garoua Regional Hospital
GMH Garoua Military Hospital
RPH Retro placental hematoma
HDP Hypertensive disease of pregnancy
FHS Faculty of Health Science
UB University of Buea
xx
ABSTRACT
Background: Pre-eclampsia is a multisystemic disorder of pregnancy associated with new-
onset hypertension, which occurs most often after 20 weeks of gestation with the presence of
proteinuria and/or signs or symptoms indicative of target organ injury. Pre-eclampsia
complicates 2-8% of pregnancies globally, and in Africa and Asia, 9% of maternal deaths are
attributed to pre-eclampsia.
In Cameroon, hypertensive disease is a pathological entity common in pregnancy, with a
variety of clinical presentations. Pre-eclampsia is the most common variety of hypertensive
diseases in pregnancy. Lack of epidemiological data in our locality (given that the majority of
studies have been carried out at central and littoral regions) motivates this study in the Garoua
Regional and Military hospitals in oder to determine the prevalence, identify the risk factors
and outcome of pregnancies with preeclampsia.
Method: An unmatched case control study was conducted in the Garoua Regional and
Military hospitals between February and April 2022. All women with preeclampsia within the
study period were identified in the delivery wards, and women with no preeclampsia were
used as controls using a 1:3 ratio. A pretested and structured questionnaire was used for data
collection. The data were entered into SPSS version 20 statistical package for further analysis.
Chi-square test was used to compare categorical variables between cases and controls and
multivariate logistic regression analyses were done to identify the determinants of pre-
eclampsia.
Results: We had a total of 1325 women, and 87 had preeclampsia. The overall prevalence of
preeclampsia in our study population was 6,6%. A total of 228 women met our inclusion
criteria: 57 in the case group and 171 in the control group. multiple pregnancy (AOR=6,816),
new paternity (AOR=17,979), number of ANC <4 (AOR=6,475), history of hypertension in
previous pregnancy (AOR=13,391), family history of hypertension on pregnancy
(AOR=49,292) and family history of chronic hypertension (AOR=34,031) were found to be
risk factors of preeclampsia. Maternal complications included; eclampsia, abruption placenta
(RPH), acute pulmonary edema, acute renal failure and maternal death while perinatal
complications were; preterm birth, low birth weight <2500g and stillbirth.
Conclusion: The prevalence of preeclampsia was high. The risk factors and outcome of
pregnancies with preeclampsia were identified. To promptly diagnose and treat preeclampsia,
health workers should sensitize and give special attention to women with risk factors.
Key words: Preeclampsia, prevalence, determinants, outcome.
xxi
RESUME
Contexte : La pré-éclampsie est un trouble de la grossesse associée à une hypertension
d'apparition récente, qui survient le plus souvent après 20 semaines de gestation avec la
présence d'une protéinurie et/ou, en son absence, des signes ou des symptômes indiquant une
lésion d'organe cible. La pré-éclampsie complique 2 à 8% des grossesses dans le monde et en
Afrique et en Asie, 9% des décès maternels sont attribués à la pré-éclampsie.
Au Cameroun, la maladie hypertensive est une entité pathologique fréquente pendant la
grossesse, avec une variété de présentations cliniques. La pré-éclampsie est la variété la plus
fréquente de la maladie hypertensive pendant la grossesse. Le manque de données
épidémiologiques dans notre localité (étant donné que la majorité des études ont été réalisées
dans les régions du centre et du litorale) a motivé cette étude dans les hôpitaux régional et
militaire de Garoua a fin de déterminer la prévalence, identifier les facteurs de risque et les
complications de la pré-éclampsie.
Méthode : Une étude cas-témoins non appariée a été menée dans les hôpitaux regional et
militaire de Garoua entre Février et Avril 2022. Toutes les femmes ayant une prééclampsie en
salle d’accouchements et celles n’ayant pas de prééclampsie pendant la période d'étude ont été
retenu comme cas et temoins respectivement dans le ratio 1 : 3. Un questionnaire pré-testé et
structuré a été utilisé pour la collecte des données. Les données ont été saisies et analysées
grace au logiciel statistique SPSS version 20. Le test du chi carré a été utilisé pour comparer
les variables entre les cas et les témoins et la régression logistique multivariée à été utilisé
pour identifier les déterminants de la pré-éclampsie.
Résultats : Nous avons eu un total de 1325 femmes, dont 87 avaient une prééclampsie. La
prévalence globale de la prééclampsie dans notre population d'étude était de 6,6 %. Un total
de 228 femmes répondait à nos critères d'inclusion : 57 dans le groupe des cas et 171 dans le
groupe témoin. Les facteurs de risque de prééclampsie étaient les suivants : grossesse multiple
(AOR=6,816), nouvelle paternité (AOR=17,979), nombre de CPN <4 (AOR=6,475),
antécédents d'hypertension lors de la grossesse précédente (AOR=13,391), antécédents
familiaux d'hypertension lors de la grossesse (AOR=49,292) et antécédents familiaux
d'hypertension chronique (AOR=34,031). Les complications maternelles comprenaient
l'éclampsie, le décollement du placenta, l'œdème pulmonaire aigu, l'insuffisance rénale aiguë
et le décès maternel, tandis que les complications périnatales étaient les suivantes : naissance
prématurée, poids de naissance < 2 500 g et mortinatalité.
Conclusion : La prévalence de la prééclampsie était élevée. Les facteurs de risque et les

résultats des grossesses avec prééclampsie ont été identifiés. Pour diagnostiquer et traiter
rapidement la prééclampsie, les agents de santé devraient sensibiliser et accorder une attention
particulière aux femmes présentant des facteurs de risque.
Mots clés : Prééclampsie, prévalence, déterminants, devenirs.
xxii
CHAPTER 1: INTRODUCTION
1
CHAPTER 1: INTRODUCTION
1.1. BACKGROUND
Hypertensive disorders in pregnancy represent a frequent medical complication in pregnancy
and complicates 5-10% of all pregnancies. They are one of the leading causes of morbidity,
long term disability and death during pregnancy and postpartum and accounts for
approximately 14% of all maternal deaths worldwide(1). Hypertensive disorders of pregnancy
include: chronic hypertension; gestational hypertension; pre-eclampsia with or without severe
features; eclampsia and chronic hypertension with superimposed pre-eclampsia/eclampsia(2).
Pre-eclampsia is a multisystemic disorder of pregnancy associated with new-onset
hypertension, which occurs most often after 20weeks of gestation with the presence of
proteinuria and/or signs or symptoms indicative of target organ injury(3). Pre-eclampsia
complicates 2-8% of pregnancies globally and in Africa and Asia, 9% of maternal deaths are
attributed to pre-eclampsia(4).
The World Health Organisation (WHO) estimates the incidence of pre-eclampsia to be seven
times higher in developing countries (28%) compared to developed countries (4%)(5). In
France, pre-eclampsia complicates 2.0% of pregnancies and women with preexisting
hypertension are at high risk to develop preeclampsia during pregnancy(6). In the U.S, the
prevalence of preeclampsia has increased over the past three decades, affecting 2.4% of
pregnancies in 1980 to 3.8% in 2010. This increase in incidence seems, in part, due to recent
trends of delaying pregnancies to a later age and the increased rate of obesity and
cardiovascular risk factors among pregnant women(7). A study carried out showed an overall
prevalence of preeclampsia in Sweden and China, 2.9 and 2.3%, respectively. In Sweden, a
significantly higher risk of mild and severe preeclampsia was associated with nulliparity,
history of diabetes, and gestational diabetes. In China there was no significant association
with parity, and diabetes was the only associated risk factor of severe preeclampsia(8). The
prevalence of pre-eclampsia is 14.4% in Bangladesh(9).
In Sub-Saharan Africa alone, pre-eclampsia remains a major public health problem as the
reported prevalence of pre-eclampsia ranges from 1.8 to 16.7% and contributes to high rates
of maternal mortality(2). The prevalence of pre-eclampsia among pregnant women in Dessie,
Ethiopa was found to be 8.4%, women having family history of hypertension, chronic
hypertension, age greater than or equal 35years, family history of diabetes mellitus and being
2
unmarried were found to be associated with pre-eclampsia(10). Studies carried out in Benin
city and Sokoto in Nigeria showed a prevalence of 5,6% and 6% respectively(5).
In Cameroon, Hypertensive disease is a pathological entity common in pregnancy, with a
variety of clinical presentations. Pre-eclampsia is the most common variety of this condition.
A study carried out, 2009 in the Yaounde Gynaeco-Obstetric and Pediatric Hospital showed
that preeclampsia was the most frequent hypertensive disease in 77.88% of the patients,
representing 4.97% of deliveries(11).
1.2. JUSTIFICATION
Hypertensive diseases are common causes of maternal and perinatal morbidity and
mortality in our milieu, and preeclampsia is the most frequent type of HDP and is the major
cause of hypertension in pregnancy. The increase rate in mortality and morbidity related to
pre-eclampsia (complications, both maternal and perinatal, occur mainly in preeclampsia and
eclampsia, especially in the superimposed forms, and this preferably in severe cases of the
disease. Maternal complications are mainly placenta abruptio, while maternal mortality is
mainly related to the occurrence of eclampsia, while perinatal mortality is associated with the
severity of the hypertensive disease, the main fetal complication being prematurity.) and lack
of epidemiological data in our locality (given that the majority of studies have been carried
out at central and litoral regions) motivated this study in the Garoua Regional and Military
Hospitals in order to have baseline data and also to improve the diagnosis, management and
prevention of preeclampsia.
1.3. RESEARCH QUESTIONS
1. What is the prevalence of preeclampsia at the Garoua regional and military hospitals?
2. What are the associated risk factors?
3. What are the perinatal and maternal outcome of preeclampsia?
1.4. RESEARCH HYPOTHESIS
Preeclampsia is most likely to be the leading complication of pregnancy at the Garoua

regional and military hospitals.
3
1.5. OBJECTIVES
1.5.1. General Objective:
Evaluate the prevalence of preeclampsia, its determinants and perinatal-maternal outcome at

the Garoua regional and military hospitals.
1.5.2. Specific objectives:
1. Describe the sociodemographic characteristics of patients

with preeclampsia at the regional and military hospitals.
2. Determine the Prevalence of preeclampsia in the two hospitals.
3. Identify the risk factors associated with preeclampsia.
4. Identify maternal and perinatal outcome of preeclampsia.
5. Compare maternal and perinatal outcome with women without preeclampsia.
1.6. DEFINITION OF OPERATING TERMS
1) Prevalence:
It is the total number of cases of disease existing in a giving population at a given
period of time, both old and new cases.
2) Determinants:
They generally include the causes (including agents), risk factors (including (old and
new) exposure to sources) and modes of transmission.
3) Preeclampsia:
It’s defined as a condition presented with SBP greater than or equals to 140mmHg and
or DBP greater than or equal to 90mmHg and/or signs of organ damage after
20week’s of gestation.
Or a rise in SBP of atleast 30mmHg or DBP of atleast 15mmHg associated with
proteinuria of atleast 300mg
4
5
CHAPTER 2: LITERATURE REVIEW
6
CHAPTER 2: LITERATURE REVIEW
2.1 INTRODUCTION
2.1.1. Definitions
Hypertension in pregnancy: Hypertension (HTN) in pregnancy is defined as: Systolic blood

pressure greater than or equal to 140 mmHg and/or diastolic blood pressure greater than or
equal to 90 mmHg in two occasions at least 4-6 hours apart after fifth month of gestation for
pregnancy induced hypertension or before 20 weeks of gestation for chronic hypertension.
Hypertensive disorders of pregnancy (HDP) refer to categories of conditions characterized
by elevated blood pressure and classified as chronic hypertension, preeclampsia superimposed
on chronic hypertension, gestational hypertension, preeclampsia.
2.1.2. Classification of hypertensive disease in pregnancy(12)
 Chronic hypertension (Type II). Chronic hypertension is high blood pressure that
was present before pregnancy or that occurs before 20 weeks of pregnancy. But
because high blood pressure usually doesn't have symptoms, it might be hard to
determine when it began.
 Chronic hypertension with superimposed preeclampsia (Type III). This condition
occurs in women with chronic hypertension before pregnancy who develop worsening
high blood pressure and protein in the urine or other blood pressure related
complications during pregnancy.
 Gestational hypertension (Type IV). Women with gestational hypertension have
high blood pressure that develops after 20 weeks of pregnancy. There is no excess
protein in the urine or other signs of organ damage. Some women with gestational
hypertension eventually develop preeclampsia.
 Preeclampsia (Type I). Preeclampsia occurs when hypertension develops after 20
weeks of pregnancy and is associated with signs of damage to other organ systems,
including the kidneys, liver, blood or brain. Untreated preeclampsia can lead to serious
(even fatal) complications for mother and baby, including development of seizures
(eclampsia). Previously, preeclampsia was diagnosed only if a pregnant woman had
7
high blood pressure and protein in her urine. Experts now know that it's possible to
have preeclampsia without having protein in the urine.
2.2. PREECLAMPSIA
2.2.1. Definition
Preeclampsia is increased blood pressure >140/90mmHg after 20weeks of gestation with or

without the presence of proteinuria and/or signs of organ failure.
2.2.2. Epidemiology
Worldwide, preeclampsia and related conditions are among the leading causes of maternal
mortality. It is estimated to complicate 2–8% of all pregnancies. While maternal death due to
preeclampsia is less common in developed countries, preeclampsia-related maternal morbidity
is high and remains a major contributor to intensive care unit admissions during pregnancy.
Pre-eclampsia complicates 2-8% of pregnancies globally and in Africa and Asia, 9% of
maternal deaths are attributed to pre-eclampsia(4).
The World Health Organisation (WHO) estimates the incidence of pre-eclampsia to be seven
times higher in developing countries (28%) compared to developed countries (4%)(5). In
France, pre-eclampsia complicated 2.0% of pregnancies(6). In the U.S, the prevalence of
preeclampsia has increased over the past three decades, affecting 2.4% of pregnancies in 1980
to 3.8% in 2010(7). A study carried out showed an overall prevalence of preeclampsia in
Sweden and China, 2.9 and 2.3%, respectively(8).
In Sub-Saharan Africa alone, the prevalence of pre-eclampsia ranges from 1.8 to 16.7% and
contributes to high rates of maternal mortality(2). The prevalence of pre-eclampsia among
pregnant women in Dessie, Ethiopa was found to be 8.4%(10). Studies carried out in Benin
city and Sokoto in Nigeria showed a prevalence of 5,6% and 6% respectively(5).
In Cameroon, Hypertensive disease is a pathological entity common in pregnancy, with a
variety of clinical presentations. Pre-eclampsia is the most common variety of this condition.
A study carried out, 2009 in the Yaounde Gynaeco-Obstetric and Pediatric Hospital showed
that preeclampsia was the most frequent hypertensive disease in 77.88% of the patients,
representing 4.97% of deliveries(11).
8
2.2.3. Classification of preeclampsia

Once the diagnosis of preeclampsia has been established, its severity must be specified and
the additional examinations necessary for etiological diagnosis must be carried out. Several
types of preeclampsia can be distinguished according to severity.
a) Mild pre-eclampsia: It is a HTA with 90-99mmHg for the diastolic pressure and 140-
149mmHg for the systolic pressure associated with a proteinuria to 1 g/24hours
b) Severe pre-eclampsia: It is defining:
Either, by a severe form of HTA associating to varying degrees, a severe HTA with blood
pressure figures: ≥160mmHg for PAS and/or ≥110mmHg for PAD, often unstable and
resistant to medical treatment.
It may be a rapidly evolving nephrotic syndrome: massive proteinuria, massive edema,
sudden weight gain (several kilograms in a few days), oliguria; One or more functional signs:
violent headaches, visual disturbances (phosphenes, tinnitus), sharp osteotendinous reflexes
(ROT), epigastric pain in bar.
Or by the occurrence of complications:
- Maternal: eclampsia, HRP, OAP, stroke, HELLP syndrome.
- Fetal: intrauterine growth retardation, prematurity, acute or chronic fetal suffering, in utero
death associated with hypertension.
In conclusion, we note that none of the classifications is simple, however we have opted for
the ACOG classification.
2.2.4. Anatomy of the placenta(13)
The placenta at term appears as a disk 18 to 20 cm in diameter, 4 to 5 cm thick in the center, 4

to 6 mm thick at the edges, its weight at term is about 500g.It has: a fetal side and a maternal
side
9
Fetal side Maternal side
Figure 1: The faces of the placenta. Source: ( Université médicale francophone.)
Its structure is made up of the placenta itself, with the basal plate, the chorionic plate and
between the two, the intervillous chamber and the chorionic villi.
- The basal plate is attached to the uterine wall. It is essentially formed, from the
intervillous chamber to the basal deciduous plate, by the residual elements of the syncytio-
trophoblast and cytotrophoblast, often covered by a fibrinoid layer.
- The intervillous chamber and the chorionic villi which start from the chorionic plate.
Some villi go from one plate to the other, these are the clamp villi, others remain free in the
intervillous chamber. Each villi pedicle and its arborization constitute a functional vascular
unit: the fetal cotyledon.
10
Figure 2: Internal morphology of the placenta Source: (getrevision.co.uk, s.d.)
2.2.5. Physiology of pregnancy (14)

During normal pregnancy there are two trophoblastic invasions of the spiral arteries.
- The first occurs between the 8th and 12th week of gestation and results in the creation of a
trophoblastic shell and an intravascular plug which completely obstructs the decidual
capillaries of the spiral arteries, thus protecting the egg from maternal blood.
- The second invasion occurs between the 13th and 18th week and results in the progressive
disappearance of the endothelial cells, the smooth muscle cells of the media and the internal
elastic layer. This is replaced by fibrin, which makes these vessels lose their contractile
character. After 16 weeks, the trophoblast cells invade and destroy the elastic and smooth
muscle layer of the wall of the spiral arteries. This process is completed by 4 months of age
results in a low-resistance arteriolar system and allows a high flow rate in the intervillous
chamber.
All these phenomena transform the spiral vessels into low-pressure, high-flow vessels
ensuring placental and fetal vascularization. On the general level, several physiological
modifications have been noted.
11
2.2.5.1. Cardiovascular function:
- cardiac output is increased during the first 10 weeks by 30% or 1.5 L/min. This
increase is maintained until term when the flow rate is around 6 L/min. The heart rate
is slightly increased, from 15 to 20 beats/min.
- Blood pressure drops by 20% or 5mmHg in the first half of pregnancy to gradually
return to the earlier values of pregnancy towards term.
- Peripheral resistance decreases. This decrease is more important than the increase in
cardiac output in early pregnancy.
2.2.5.2. Renal function:

- As the kidney becomes a beneficiary, it adapts to the cardiac output. Thus, the renal
balance increases from 500 ml/min to 700-800 ml/min during pregnancy, resulting in
an increase in glomerular filtration. This allows the elimination of uric acid, creatinine
and urea. This results in a decrease in blood levels of these substances.
- The increase in maternal extracellular fluids is about 30% in favor of the plasma
sector.
- This increase is responsible for a drop in the hematocrit level which is not anemia but
hemodilution. The remainder of the extracellular fluid is distributed to the interstitial
spaces, resulting in clinical infiltration of the tissues, which may generate frank
oedema, which remains physiological.
12
2.2.6. Pathophysiology (15)
In preeclampsia, there is a 2-stage disorder:
Figure 3: Two-stage model of the pathophysiology of preeclampsia.
Stage 1: The second invasion does not occur or occurs completely. The insufficiency of this
process maintains a high resistance in the terminal part of the spiral arterioles, as evidenced
by velocimetric studies, and results in a decrease in uterine flow in the intervillous chamber.
This results in poor perfusion of the placenta, which sees its own circulation segregated,
leading in the long run to ischemic lesions in the territory of the uterine aduct and placenta.
Stage 2: The necrotic cells, arrested in the lungs, release their thromboplastins into the
systemic circulation. These can induce intravascular coagulation, which in turn will determine
the specific nephropathy. In addition, ischemia of the decidua and villi leads to a release of
uterine issorian as well as a deficit in the secretion of prostaglandins, the consequences of
which will be vasoconstriction, which has a very marked effect on blood pressure. This
abnormality of placentation is present before the 20 th weeks gestational, thus preceding the
first manifestations of hypertension and proteinuria.
13
Figure 4: Pathophysiology of preeclampsia Source: (Sciencedirect.com, s.d.)
14
2.2.7. Risk factors (16)
The epidemiology of preeclampsia reflects a wide range of risk factors as well as the
complexity and heterogeneity of the disease. Risk factors can be classified into pregnancy-
specific characteristics and maternal preexisting features.
Table i: Common Risk factors of Pre-eclampsia
Category Risk Factors

Pregnancy-specific factors - Nulliparity
- Partner-related factors (new paternity,
limited sperm exposure [e.g.,
barrier contraception])
- Multifetal gestation
- Hydatidiform mole
Preexisting maternal conditions - Older age
- Race
- Higher body mass index
- Pregestational diabetes
- Chronic hypertension
- Renal disease
- Antiphospholipid antibody syndrome
- Connective tissue disorder (e.g.,
systemic lupus erythematosus)
- Family or personal history of
preeclampsia
- Lack of smoking
There are certain risk factors directly related to preeclampsia. These are Pregnancy-specific
features and Maternal characteristics.
15
- Pregnancy-specific features
In terms of parity, nulliparity is a strong risk factor that almost triples the risk of preeclampsia
(odds ratio 2.91, 95% confidence interval [95%CI] 1.28–6.61), according to a systematic
review of controlled studies. It is estimated that two-thirds of all cases occur in first
pregnancies that progress beyond the first trimester.
New paternity also increases the risk of preeclampsia in a subsequent pregnancy. The
association between primiparity and preeclampsia suggests an immunological mechanism,
such that later pregnancies are protected against those paternal antigens. Supporting this
concept, previous pregnancy loss, increased duration of sexual activity prior to pregnancy, or
prolonged prepregnancy cohabitation confer a lower risk of preeclampsia. Conversely, the
risk of preeclampsia is increased with the use of barrier contraceptives, with new paternity,
and with donor sperm insemination.
Also, excess placental volume, as occurs with hydatidiform moles and multifetal gestation, is
also associated with the development of preeclampsia. The disease process may occur earlier
in the pregnancy and have more severe manifestations in such cases. The risk increases
progressively with each additional fetus.
- Maternal characteristics
Extremes of childbearing age have been associated with preeclampsia. However, once
adjustments for parity are made in the younger age group (since most first pregnancies occur
at a younger age), the association between younger age and preeclampsia is lost. Multiple
studies demonstrate a higher incidence of preeclampsia among older women, independent of
parity; however, many of these do not control for preexisting medical conditions. After
controlling for baseline differences, women who were 40 years of age or older had almost
twice the risk of developing preeclampsia (risk ratios of 1.68 [95%CI 1.23–2.29] among
primiparas and 1.96 [95%CI 1.34–2.87] among multiparas).
The association between African-American race and preeclampsia has been confounded
by the higher prevalence of chronic hypertension, often undiagnosed, in this group. While
some studies demonstrate a higher risk of preeclampsia among African-American women,
larger prospective studies that rigorously definepreeclampsia and controlled for other risk
factors did not find a significant association between preeclampsia andAfrican-American race.
More severe forms of preeclampsia may be associated with maternal non-white race.
16
Many of the maternal risk factors for preeclampsia are similar to those for cardiovascular
disease. Preexisting hypertension, diabetes, obesity, and vascular disorders (renal disease,
autoimmune conditions) are all associated with preeclampsia. Risk is correlated with the
severity of the underlying disorder. Women with underlying chronic hypertension have a 10-
25% risk of developing preeclampsia
compared with the general population of pregnant women. This risk is increased to 31% in
women with a longer duration of hypertension (at least 4 years) or more severe hypertension
at baseline.39With pregestational diabetes, the overall risk of developing preeclampsia is
approximately 21%. However, the risk is 11–12% with diabetes of less than 10 years’
duration, which increases to 36–54% among women with longer-standing diabetes associated
with microvascular disease. The risk of preeclampsia is estimated at 20–25% in pregnant
women with mild renal disease (serum creatinine of <1.5 mg/dL) but increasesto greater than
50% in pregnant women with severe renal disease. Preeclampsia also occurs more frequently
among pregnant women with autoimmune conditions such as systemic lupus erythematosus
and antiphospholipid antibody syndrome
Elevated body mass index (BMI) is also associated with preeclampsia. Given the obesity
epidemic in the United States and around the world, this is one of the largest attributable and
potentially modifiable risk factors for preeclampsia. This will be discussed in further detail
below.
A family history of preeclampsia nearly triples the risk of preeclampsia.
Cigarette smoking during pregnancy is associated with a reduced risk of
preeclampsia,43–45 possibly due to modulation of angiogenic factors.
2.2.8. Diagnosis of Preeclampsia (12)
2.2.8.1. Minimum criteria

- BP at least 140/90 mm Hg after 20 weeks’ gestation
- Proteinuria 300mg/24 hours or at least 1+ dipstick
2.2.8.2. Increased certainty of preeclampsia

- BP at least 160/110 mm Hg.
- Proteinuria 2.0g/24 hours or at least 2+ dipstick
- Serum creatinine > 1.2 mg/dl unless known to be previously elevated
17
- Platelets < 100 000/micro litre
- Microangiopathic haemolysis- increased Lactate dehydrogenase
- Elevated serum transaminase levels- Aspartate aminotransferase or Alanine
aminotransferase
- Persistent headache or cerebral or visual disturbance
- Persistent epigastric pain
2.2.8.3. Signs of severity of pre-eclampsia

Pre-eclampsia is said to have a poor prognosis when the following factors are present
- Epigastric pain, nausea, vomiting, persistent headache, osteotendinous hyperreflexia, visual
disturbances (imminent eclampsia).
- Proteinuria > 3.5 g/24 h or 3 crosses
- Uricemia > 60 mg/l
- creatinine level > 12 mg/l
- Oliguria with diuresis < 20 ml/h
- HELLP Syndrome
2.2.8.4. Prediction of preeclampsia
- Attempts have been made to identify markers of faulty placentation. Impaired

placental perfusion, endothelial cell activation and dysfunction, and activation of
coagulation as in the pathophysiology. For the most these have resulted in testing
strategies with poor sensitivity and with poor positive predictive value for
preeclampsia. Currently. There is no screening test that are valid, reliable and
economical.
- The list of predictive factors evaluated during last decades is legion. Which is by no
means all inclusive. These are tests related to: Placental perfusion/vascular resistance,
foetal-placental unit/endocrine function, renal dysfunction, endothelial
dysfunction/oxidant stress and others (antithrombin-III, genetic markers etc.)
18
2.2.9. Management of pre-eclampsia.(12)
2.2.9.1. Goal
- To normalize blood pressure

- To avoid the occurrence of maternal complications.
- Decrease neonatal morbidity.
2.2.9.2. Means
2.2.9.2.1. Non-medicinal means
- Hospitalization and monitoring.

- Rest in left lateral decubitus, normo sodium diet.
2.2.9.2.2. Medication
Medication includes antihypertensive drugs and adjuvant treatments (anticonvulsants,

infusion solution).
2.2.9.2.2.1. Indications
All cases of severe pre-eclampsia/eclampsia require hospitalization in a specialized setting.

Hygienic and dietary measures should be adopted, such as resting in a left lateral position.
This improves uteroplacental perfusion. The diet should be normo-sodic because salt
deprivation worsens the hypovolemia of preeclampsia.
Therapeutic approaches begin with a clinical assessment of the mother and fetus, i.e., a
complete clinical examination.
2.2.9.2.2.2. Management of hypertension.
The management of hypertension is essential to stabilize the maternal condition. It is based on

the use of molecules administered intravenously, the objective being a diastolic blood
19
pressure (DBP) between 90 and 105 mmHg and a mean arterial pressure (MAP) between 105
and 125 mmHg in order to maintain sufficient visceral perfusion.
The antihypertensive agents that can be used are:
- calcium channel blockers (Nicardipine and Nifedipine);
- alpha-beta blockers (Labetalol);
- peripheral vasodilators (Dihydralazine);
- central antihypertensives (Alpha-methyl dopa and Clonidine).
2.2.9.2.2.3. Fluid Balance.
Vascular filling is not systematic during severe pre-eclampsia, but it is indicated in the event
of a sudden fall in blood pressure following antihypertensive drugs, in the presence of
oliguria, and before epidural anaesthesia. It should be used sparingly because of the life-
threatening risk of pulmonary edema. Often the choice of solution is crystalloids, but the use
of albumin depends on the protidemia. The effectiveness of expansion will be judged by
blood pressure, heart rate, pulse oximetry, and resumption of diuresis.
2.2.9.2.2.4. Prevention and treatment of convulsion.
Magnesium sulfate (MgS04) is the gold standard in the management of eclampsia. It is

indicated when the prodromal stages of eclampsia appear, subject to the contraindications
(renal insufficiency, neuromuscular disease). It should only be administered in a specialized
environment equipped with resuscitation equipment and under close supervision.
During treatment, signs of overdose should be detected by frequently assessing the state of
consciousness, the presence of osteotendinous reflexes (ROT), respiratory rate and diuresis.
Alternatively, benzodiazepines may be used.
2.2.9.2.2.5. Nursing care.
Strict maternal-fetal monitoring is essential because of the rapid evolution of the disease.
They focus on the evaluation of weight, oedema, diuresis, BP, and the state of consciousness,
as well as the evolution of the signs of gravity.
20
Fetal monitoring includes assessment of fetal mouvement and fetal heart sounds. Clinical data
are supported by paraclinical examinations (blood biology, obstetrical ultrasound, fetal heart
rate recording).
2.2.9.3. Delivery.
2.2.9.3.1. Modalities of delivery:

- Conservative or expectant attitude:
Prolongation of the pregnancy before 34 weeks' gestation is justified provided that there is
rigorous maternal-fetal monitoring with sufficient technical resources. Despite the maternal
exposure to the occurrence of complications, this approach is beneficial for the fetus in terms
of term and viability.
- Interventionist attitude:
The decision of the team (obstetrician, resuscitator, pediatrician) is dictated by several
elements: gestational age, hypotrophy, pulmonary maturity, parental desire, corticosteroid
therapy performed or not, history and age of the patient.
The definition of criteria for fetal extraction is very difficult, but a few are proposed:
- severe preeclampsia beyond 34 weeks' gestation
- severe preeclampsia before 24 weeks' gestation
between 24 and 34 days, the indications are : Uncontrolled hypertension, eclampsia, PAO,
PRH, thrombocytopenia less than 50,000/mm3, subcapsular hematoma of the liver, after
initiation of corticosteroid therapy for prolongation of pregnancy, rapidly worsening renal
failure and/or persistent oliguria (diuresis less than 400 ml/24 hours) despite appropriate
vascular filling, prodromal eclampsia (headache or visual disturbances), persistent epigastric
pain, progressive HELLP syndrome; repeated decelerations of the fetal heart rate, short-term
variability less than 3 ms, IUGR beyond 32 days' gestation, umbilical artery diastole reversed
beyond 32 days' gestation, oligohydramnios.
- Pathways to delivery:
These depend on the maternal-fetal status.
The upper route is indicated if the maternal-fetal condition is unstable requiring specific
measures such as respiratory distress, hemorrhage, presence of neurological signs, eclampsia
21
or subcapsular hematoma of the liver, fetal hypoxia, unsatisfactory biophysical score, cardiac
rhythm abnormalities. Labor can be induced or present spontaneously, so vaginal delivery is
acceptable under conditions of cephalic presentation, advanced term with rigorous maternal-
fetal surveillance and favorable Bishop score.
2.2.9.4. Prevention.
2.2.9.4.1. Primary prevention
It’s by definition only possible in diseases in which the cause is well identified, which is not
the case in pre-eclampsia, despite the very significant progress in knowledge of the
physiopathological mechanisms involved in the development of this disease. Prevention
consists of avoiding the development of the disease. Certain measures could be beneficial,
such as interventions on modifiable risk factors (reduction of obesity, stress, inter-pregnancy
interval, etc.) and corrections of pathophysiological changes. Calcium supplementation is
recommended during pregnancy (1.5 to 2.0g of elemental calcium per day) for all pregnant
women, especially for those at high risk, younger, and with inadequate intakes. A low dose of
acetylsalicylic acid (aspirin 75 mg to 150 mg) to be started before 20 days' gestation is
indicated in certain specific situations such as the existence of anticardiolipin antibodies or a
circulating anticoagulant, treatment with subcutaneous heparin associated with aspirin seems
to allow better results, and antihypertensive treatment should be instituted if the hypertension
is severe. On the other hand, supplementation with vitamins D, C and E and restriction of salt
intake during pregnancy are not useful.
2.2.9.4.2. Secondary prevention
It’s based on early detection of the disease before clinical symptoms appear: this involves
monitoring of hypertension and proteinuria in all pregnant women during prenatal
consultations.
2.2.9.4.3. Tertiary prevention
It’s the timely management of the disease to prevent aggravation and complications. It
focuses on the four interventions based on antihypertensive treatment, anticonvulsant therapy,
careful monitoring of the patient and planned delivery.
22
2.2.10. Complications of pre-eclampsia.(17)
2.2.10.1. Maternal complications
They can occur antepartum, perpartum and even postpartum.
 Eclampsia
This is a serious complication of pre-eclampsia, most often preceded by visual disturbances,

headache, digestive disturbances, and acute ROTs. Classically, it is characterized by
generalized tonic-clonic convulsive seizures, or immediately by disturbances of
consciousness, blindness or coma.
 HELLP syndrom
The HELLP syndrome (Hemolysis Elevated Liver Enzymes, Low Platelets) reflects the
maternal hepatic damage encountered during preeclampsia in health or postpartum. It
associates acute intravascular hemolysis with the presence of schizocytes, anemia, elevated
LDH, low haptoglobin, thrombocytopenia and hepatic cytolysis with elevated transaminases.
Nausea and vomiting are the most common clinical signs. Because of the severity of the
prognosis for death, it is imperative to look for signs supported by paraclinical data in any
preeclamptic patient.
 Subscapular hematoma of the liver
Subscapular hematoma of the liver is a rare complication of severe preeclampsia and HELLP
syndrome, extremely serious, leading to hepatic rupture with maternal-fetal mortality.
 Retro placental hematoma (RPH)
Premature detachment of a normally inserted placenta is highly variable in size, resulting in a

hematoma which in turn interrupt’s part or all of the uteroplacental circulation. It is life-
threatening for the mother and fetus and constitutes a therapeutic emergency: fetal death in
23
utero occurs when the detachment is greater than 50%, and the mother is exposed to
hemorrhage and disorders of hemostasis. Clinically, a retroplacental hematoma is evoked by
sudden, intense abdominal pain, associated or not with moderate blackish metrorrhagia. The
uterus is hypertonic, "wooden belly", painful to palpation with cutaneous hypersensitivity,
there is an increase in uterine height, fetal movements are absent or diminished.
 Acute renal failure
Acute renal failure occurs during severe preeclampsia. The histological abnormalities consist
of acute tubular necrosis and/or intravascular thrombi associated with endothelio-glomerular
lesions that are characteristic of the lesions of nephropathy of pregnancy. Recovery of renal
function is complete except in the case of cortical necrosis.
 Disseminated intravascular coagulation
In severe preeclampsia, there is a pathological activation of hemostasis in addition to the

hypercoagulability of pregnancy. Initially, there is compensated gravidic hypercoagulability,
reflected by an abnormal increase in the level of thrombin-antithrombin complexes. DIC is
initially reflected by clinical signs of microthrombocytosis in the feto-placental unit (IUGR,
MFIU) and/or in the maternal body (renal failure, HELLP syndrome, eclampsia). Thus, the
markers of microthrombosis are elevation of fibrinogen degradation products above 20 mg/L
and D-dimer above 1200ng/ml. Then, DIC becomes hemorrhagic, with the collapse of
coagulation factors, as well as the appearance of soluble complexes, plasmin-anti-plasmin
complexes, fibrinogen degradation products and D-dimers, sometimes with a shortening of
the euglobulin lysis time. Clinically, it may be manifested by hemorrhagic manifestations or
shock.
 Acute pulmonary edema (APO)
Pulmonary edema occurs mainly in the immediate postpartum period. It is an acute

pulmonary edema of overload, most common in the context of renal failure, significant fluid
retention and/or underlying cardiac disease. Clinically, it is manifested by dyspnea and
crackles on pulmonary auscultation.
 Cerebrovascular accident
24
Cerebrovascular accident is a leading cause of maternal mortality in women with
preeclampsia, with the majority of deaths caused by intracerebral hemorrhage.it occurs most
often in the antepartum and postpartum period.
2.2.10.2. Perinatal complications
Pre-eclampsia causes placental insufficiency with inadequate nutrition and oxygenation of the
placenta, and the associated fetal complications are intrauterine growth retardation and fetal
death in utero (in rare cases). As the only curative treatment is induction of labor, EP is a
common factor in prematurity.
 Prematurity
The occurrence of a birth before 37 completed weeks of gestation is present in Canada with
an incidence rate of 7.9%. The complications associated with prematurity are respiratory
distress syndrome, apnea, neonatal jaundice, hypoglycemia and prolonged hospitalization,
pneumonia, in children under five years of age.
 Fetal hypotrophy
Fetal hypotrophy or intrauterine growth retardation (IUGR) is defined as a birth weight below
the 10th percentile of normalized weight for sex and gestational age. In addition to causing a
spectrum of perinatal complications such as iatrogenic prematurity, fetal distress, and
induction of cesarean delivery, IUGR is responsible for approximately 40% of
IUGR.Neonates surviving after a diagnosis of fetal hypotrophy have an increased risk of
neonatal morbidity including necrotizing enterocolitis, thrombocytopenia and renal failure.
 Death in utero
Stillbirth is defined as the birth of a dead fetus with a gestational age greater than or equal to
20 weeks’ gestation, or with a birth weight greater than 500 g. The most common cause of
IUGR is placental abruption.
25
The Manning score reflects the fetal well-being on five criteria: the quantity of amniotic fluid,
fetal respiratory movements, active fetal movements and the reactive aspect of the fetal heart
rate on a tracing obtained with a cardiotocograph.
The Doppler examinations allow the measurement of indexes and in particular the Pourcelot
index, a resistance index obtained by the formula: Resistance index= (peak systolic - peak
diastolic) / peak systolic.
2.3. RECENT PUBLICATIONS
AUTHORS TITLE METHODOLOGY RESULTS

1)MWASHAMBA Prevalence and A hospital based This study included a
M. MACHANA & risk factors analytical cross-sectional total of 400 participants
ANGELINA A. associated with study design was used. with a 100% response
JOHO(18) severe pre- Purposive sampling was rate. Participants ranged
eclampsia utilized for the selection from 17 to 45 years of
among of hospitals. age with mean age of
postpartum Proportionate sampling 28.75 (± 6.296). The
women in was used for selection of prevalence of severe pre-
Zanzibar. A representatives from each eclampsia among post-
cross-sectional hospital and study was partum women was
study conducted by an 26.3% (n=105). After
interviewer who adjusting for the possible
administered a confounders factors
questionnaire with close associated with sever
ended questions and pre-eclampsia were
chart review for data maternal age group of
gathering. SPSS 15-20 years (AOR
version23 was used for 13.839, 95% C-I 1.037-
data analysis and 14.210), pregnancy from
descriptive and multiple new partner\ husband
logistic regression was ( POR 7.561, 95% CI
performed for control of 3.883-14.724), family
confounders. history of high blood
pressure (AOR 6.446 ;
CI 3217-12.971),
Diabetes prior to
26
conception (AOR
55.827, 95% C I 5.061-
615.868), having high
blood pressure on a
previous pregnancy
(AOR 18.582, 95% C.I
4.617-81.564), paternal
age above 45 (AOR
2.401, 95% C.I 1.044-
5.519) and multifetal
gestation (AOR 9.62% ;
95% C.I 2-01 -28.84).
2) Yang and al(8) Preeclampsia This cross-sectional The 555446 Swedish

Prevalence Risk study compared pregnancies and 79243
factors and deliveries from the Chinese pregnancies had
pregnancy Swedish National mean (50) material age
outcomes in Medical Birth Register of 30.9(5.3) and
Sweden and (2007-2012) and the 28.6(4.6) years,
china. china labor and Delivery respectively. The overall
survey (2015-2017). The prevalence of
Swedish Medical Birth preeclampsia was similar
Register records in Sweden and China,
maternal, pregnancy and 16068(2.9%) and
neonatal, information for 1803(2.3%) respectively,
nearly all deliveries in but with 5222 cases
Sweden. The China labor (30.5%) considered
and delivery survey was severe in Sweden and
conducted throughout 1228 cases (68.1%)
china and these data were considered severe in
reweighed to enable China. Obesity (defined
national comparisons- as BMI >= 28 china and
participants included BMI >= 30 in Sweden)
555446 deliveries from was a stronger risk factor
Sweden and 79243 in China compared with
deliveries from China Sweden (China odds
Data management and ratio [OR], 5.12:95%
analysis was conducted C.I, 3.82-6.85 Sweden:
27
from November 2018 to OR, 3.49:95% C.I, 3.31-

August 2020 and revised 3.67 nulliparity had a
in February to March much stronger
2021. association with severe
preeclampsia in Sweden
compared with China
(Sweden: OR 3.91:95%
C.I, 3.65-4.18; China:
OR 1.65:95% C.I 1.20-
2.25). The overall
stillbirth rate for
singleton in China was
more than 3- fold higher
than in Sweden (865|
77512[1.1%] vs
1753/547219[0.3%]
P<0.0001 and 10-fold
higher among women
with preeclampsia
(66/1652[4.6%] vs
160/14499[0.4%]
P<0.001)
28
3) Ananya Dutto Prevalence of A cross-sectional study was A total of 111
Mou and al(9) preeclampsia designed and conducted during pregnant women
and the the period from October 2019 to participated in the
associated risk October 2020. All the relevant study from the
factors among analyses were performed at the Sylhet region. The
pregnant women Department of Biochemistry and age range of the
in Bangladesh Molecular Biology, Shahjalal subjects was 17 to
University of Science and 37 years, with a
Technology, Sylhet, mean of 26.4 ±
Bangladesh. The study 4.9 years. Overall,
participants were enrolled from the mean of systolic
the Gynae and Obstetrics unit of (SBP), diastolic
Sylhet Osmani Medical College, (DBP), and pulse
Sylhet Diabetic Hospital, and pressure (PP) were
another private hospital in the 122.2 ± 19.9 mmHg,
Sylhet city area. About 220 79.8 ± 13.6 mmHg,
pregnant women, who visited and 42.4 ±
these hospitals for their regular 12.0 mmHg,
checkups, were invited to respectively, for the
participate in the study. Among study cohort.
them, 111 women (29 rural and Among the study
82 urban) were agreed to participants, 22.9%
participate. Their had hypertension
anthropometric, socio- prior to pregnancy
demographic, individual as well and 19.1% were
as family history of diabetes and diabetic, whereas
hypertension and lifestyle 43.7% of the study
information were noted in a subjects had a
standard questionnaire form. family history of
Information regarding hypertension, 38.4%
preexisting hypertension and the had a family history
necessity of antihypertensive of diabetes and 7%
medications were either had a family history
obtained from the participant's of hypertensive
self-report or from their medical disorders in
documents. The anthropometric pregnancy
measurements were made with
the assistance of trained medical The overall
personnel following the standard prevalence of
procedure described elsewhere. preeclampsia was
Briefly, the systolic blood 14% among the
pressure (SBP) and diastolic study subjects. 9.9%
blood pressure (DBP) were of the pregnancies
measured using an automated were found to have
blood pressure recorder (Omron preeclampsia after
M10, Japan) while they were 20 weeks of
seated in a comfortable position gestation without
after at least 10 min of rest. The prior history of
weight was recorded to the hypertension,
29
nearest 0.1 kg (kg) with the
subject standing on the weighing whereas, the
machine (Beurer BF 700, prevalence of
Germany) without shoes and preeclampsia that
wearing light clothing. Inclusion superimposed on
criteria: pregnant women of any chronic
trimester were included as study hypertension was
participants. Exclusion criteria: found to be 5.4%.
participants suffering from
preexisting kidney disease or We also assessed
urinary tract infection, the relationships
preexisting liver disease, and between socio-
preexisting thyroid disorder demographic
were excluded from the study. factors, obstetrical
During exclusion of the data, and the
participants, we considered the prevalence of
subject's self-reported evidence preeclampsia. In
and/or medical records of their univariate analysis,
preexisting diseases. the requirement of
antihypertensive
medications, less
intake of fruits and
vegetables, and not
visiting a doctor
during pregnancy
(antenatal care)
were found to be
significantly
associated with the
prevalence of
preeclampsia. After
adjusting for these
significant
independent factors
using multiple
regression analysis,
the requirement of
antihypertensive
medications and
lack of antenatal
care during
pregnancy were
found as
independent
predictors for
preeclampsia.
Respondents who
were required to
take
30
antihypertensive
medications either
occasionally or
regularly were more
likely to be
preeclamptic than
those who did not
(AOR 5.45, 95% CI
[1.09, 27.31]).
Women who never
consulted any
doctor during their
pregnancy period
had about 6.8 times
higher odds of being
preeclamptic than
women who did
occasionally or
regularly (AOR
6.83, 95% CI [1.00,
46.48])
4) Gizachew Preeclampsia A hospital-based cross-sectional The prevalence of

Assefa and associated study was conducted in Dessie preeclampsia among
Tessema, factors among referral hospital between August pregnant women in
Abebe Tekeste pregnant women and September 2013. All Dessie referral
and Tadesse attending pregnant women who had hospital was found
Awoke antenatal care in antenatal visit at Dessie referral to be 8.4%. Women
Ayele(10) Dessie referral hospital were included for the having family
hospital, study. A total of 490 pregnant history of
Northeast women were enrolled in the hypertension
Ethiopia: a study. Pretested and structured [Adjusted Odds
hospital-based questionnaire via face-to-face Ratio (AOR) = 7.19
study interview technique was used (95% CI 3.24–
for data collection. The data 15.2)], chronic
were entered into EPI info hypertension [AOR
version 3.5.3 statistical software = 4.3 (95% CI 1.33–
and exported to SPSS version 20 13.9)], age
statistical package for further ≥35 years [AOR =
analysis. Descriptive statistics 4.5 (95% CI 1.56–
were used to explore the data in 12.8)], family
relation to relevant variables. history of diabetes
Binary logistic regression mellitus [AOR = 2.4
analysis was employed. Odds (95% CI 1.09–5.6)]
ratio with 95% confidence and being unmarried
intervals (CI) was computed to [AOR = 3.03 (95%
identify factors associated with CI 1.12 – 8.2)] were
31
Preeclampsia. found to be
associated with
preeclampsia.
5) Olivier Pancha A Study on Background: In sub-Saharan In total, 160

Mbouemboue, Factors Related Africa, hypertensive disorders in pregnant women
Diallo Cellou, to Hypertensive pregnancy remain a major call were examined
Marcel Tangyi Disorders in for concern owing to their during the period of
Tamanji, Pregnancy in increasing incidence, gravity study, among which
Chantal Ngaoundere and associated complications. In 75 recorded a high
Blakga, Armel (Adamawa Cameroon, the epidemiological blood pressure thus
Herve Nwabo Region, reality of hypertensive disorders fulfilling our
Kamdje, Cameroon) in pregnancy remains unknown inclusion criteria.
acques Olivier in the majority of regions. Age (P=0.013),
Ngoufack, Objective: This study aimed to previous twin
Andre identify the determinants of pregnancy
Youmbi(19) hypertensive disorders among (P=0.013) and
pregnant women in a hospital preeclampsia
milieu in Ngaoundere town. (P=0.013) were
Methods: A cross-sectional found to be
study was carried out at the significantly
Ngaoundere Regional Hospital, predictive of
the reference hospital facility of chronic
the Adamawa Region of hypertension.
Cameroon from May to June Religion (P=0.004)
2014 and multiparity
(P=0.001) were
identified as
significant
independent
predictive risk
factors of
preeclampsia,
History of
preeclampsia
(P=0.025) was
identified as
predictive risk
32
factor for
superimposed
preeclampsia.
Conclusion:
Independent
predisposing factors
associated with
hypertensive
disorders in
pregnancy in our
milieu, which
include advanced
age, the notion of
preeclampsia and
history of twin
pregnancy for
chronic
hypertension, parity
and religion for
preeclampsia, and
history of
preeclampsia for
superimposed
preeclampsia.
6) Nkem Ernest Prevalence and A cross sectional study The prevalence of
Njukang and Risk Factors of conducted between April-July HDP was 14.5%; of
al(20) Hypertensive 2018 in Mezam Division. which 3.4% chronic
Disorders in Consecutive sampling was used HTN (CH), 31.8%
Pregnancy: Case to recruit 1210 pregnant women. gestational HTN
of Mezam Descriptive statistics, chi-square (GH), 48.3%
Division, NWR (χ2) test and multivariate preeclampsia (PE),
Cameroon logistic regression were used for 5.7% PE
analysis. superimpose on CH
and 10.8% severe
PE. Risk factors of
CH were Family
history HTN
[Adjusted Odd
Ratio (AOR),
95%Confidence
Interval (CI): 3.70
(1.7-11.6)], stress
[2.80 (1.1-10.9)]
and
overweight/obese
[2.6 (1.3-6.7)]. For
GH,
Single/separated
[2.7 (1.5-4.7)],
33
family history [4.4
(1.5-13.1)], alcohol
[2.8 (1.1-5.4)] and
previous history of
HDP [4.9 (1.5-
10.2)] were
significant. For PE,
overweight/obese
[2.7 (1.4-7.1)],
previous history of
HDP [3.5 (1.6-7.1)],
smoking [5.1 (1.3-
9.3)], mode of
delivery (CS) [3.2
(1.4-6.3)], age at
first pregnancy (≥35
years) [7.4 (1.9-
28.4)], blood group
(AB) [3.3 (1.3-5.9)],
gestational age (>
40 weeks) [3.1 (1.3-
5.9)] and birth
spacing (> 108
months) [4.8 (1.3-
61.1)] were
significant.
Table ii: Recent Publications on prevalence of pre-eclampsia and risk

factors
34
CHAPTER 3: METHODOLOGY
35
3.MATERIALS AND METHODS
3.1. TYPE OF STUDY

This was an unmatched case control study.
3.2. SITE OF STUDY

Our study was carried out in 2 major hospitals in Garoua, more precisely: the Garoua
Regional and Military Hospitals.
The Garoua Regional Hospital is located in Garoua, the capital of the north
region of Cameroon, more precisely in the health district of Garoua 1. It is a reference health
facility created in 1937 and specializes in all domains especially, in mother and child health
care. It’s gynecology/obstetrics department has a capacity of 30 inpatient beds, 3 delivery
tables, 2 operating theatres with 1 laparoscopy column. The service carries out an average of
2500 deliveries per annum with a staff of 3 specialists, 2 general doctors, about 12 midwives
and nurses, level 4 and 5 medical students and nurse students. Also, GRH is the first
referential site of “chèque santé” in the north region which makes it accessible for all.
The Garoua Military Hospital is also located in Garoua, Cameroon. It is the
reference hospital in Garoua 2 in terms of expertise and patient management. The service of
obstetrics and gynecology has a solid staff of 02 specialists, 6 midwives and nurses. The
patient turnout is high with approximately 300 Consultations per month where 70 percent are
antenatal consultations.
No resent studies have been found in the 2 hospitals so our study will be used as a baseline for
future studies.
3.3. DURATION OF STUDY

The study was within 8 months, from November 2021 to June 2022. Data collection took
place from of February to April 2022. Data management and writing of full thesis was from
01 May 2022 to June 2022.
36
3.4. STUDY POPULATION
The source population for the study was all women attending delivery services at the GRH
and GMH. The study population was the selected pregnant women attending delivery services
in both hospitals.
3.4.1. Inclusion criteria

For the women to be included in this study, they conformed to the following inclusion
criteria:
Cases: Women in the post partum with diagnosis of preeclampsia before delivery.
Controls: Controls were women without preeclampsia who gave birth till 48th hour post
partum in one of the 2 hospitals.
All cases and controls were seen by obstetrician in the hospitals.
3.4.2. Exclusion criteria

Women with known hypertension and renal disease were excluded from the study. Women
with serious medical conditions and who couldn’t give consent were also excluded from the
study.
3.5. Sample size estimation
3.5.1. Type of sampling:

We performed a consecutive and non-probabilistic sampling. For each case of preeclampsia,
about 3 women who followed her in delivery and had no hypertension were retained as the
controls.
3.5.2. Sample size:

Our minimal sample size was calculated using the Schlesselmen formula.
n≥
( 1+ ) p(1− p)(Zₐ+ Z ₂ ᵦ)²
1
c
(P₁−P₀)²
P₀ = % of controls exposed = 0.25 (25%)
P₁ = % of cases exposed = 0.5 (50%)
c= number of controls per cases
Zᵦ = power = 1.28
37
P ₀+ P₁ 0.25+0.5
Zₐ =level of significance = 1.96 P= = = 0.375
2 2
n ≥ ¿ ¿ = 53
After application of the formula, we got a minimal sample size of 53, cases= 53 and controls
= 159 (ratio 1:3).
3.6. Procedure
3.6.1. Administratives Procedure

Before carrying out the study, we sought for ethical clearance from the Ethics and Research
Committees of the Faculty of Medecine and Biomedical Sciences of the University of
Yaounde 1 and Garoua Regional and Military hospital.
3.6.2. Data collection Procedure
Once the research protocol was completed, we submitted it to the FMBS ethics committee for
approval. The demand for authorization to recruit was filled and submited at the GRH and
GMH prior to the start of our investigation. Once authorizations were obtained, we began our
recruitement in the 2 hospitals. We viewed women in the delivery and post partum units once
they gave their approval. Women were interviewed for past histories and hospital records
were noted. Then, using our inclusion criteria, we selected patients for the study and classified
them two groups: cases and controls.
We then calculated the prevalence. This was done by reviewing the registers
of each maternity and noting every woman who gave birth within the study period. They were
grouped into preeclamptic and non preeclamptic. The prevalence was then calculated by
dividing number of women with preeclampsia by the total number of deliveries registered and
multiplying by 100. Risk factors and outcomes in both groups were identified, noted and then
compared to determine the odds ratio. The following variables were analyzed.
Maternal variables included:

- Sociodemographic variables; age, marital status, level of education, occupation,
residence, religion.
- Obstetrics and medical variables; gravidity, parity, multiple pregnancy, new paternity,
gestational age, numof ANC, past history of hypertension on prior pregnancy, family
history of hypertension, family history of hypertension on pregnancy.
38
- Clinical variables; types of preeclampsia, path of delivery, eclampsia, abruption
placenta, HELLP syndrome, acute pulmonary edema, acute renale failure,
cerebrovascular accident, maternal death, preterm birth, low birth weight, still birth,
neonatal asphyxia.
3.7. Data Management
Data were entered into SPSS version 22 for analysis. Descriptive statistics were used to
characterize the sample, and numerical data was presented as frequency, proportion, or
percentages. The quantitative variables were expressed in terms of means and standard
deviation. The results were summarized using tables.
Pearson chi ² was used to examine the statistical association between the dependent variable
and independent variables. Variables with a p value of ≤0.2 in the bi variable analysis were
entered into a multivariable logistic regression to isolate an independent effect of the
predictors. Finally, multivariable logistic regression analysis was carried out to evaluate the
combined effect of several factors associated with preeclampsia after adjusting for
confounding variables. Adjusted odds ratios (AOR) with 95% CI were used to express the
magnitude of the effect of each category on the determinants of preeclampsia and outcomes
relative to the reference category. p value <0.05 was used to determine the level of statistical
significance.
3.8. MATERIALS FOR DATA COLLECTION AND WRITE UP

 Laptop computer
 USB flash disk of 32GB
 Reams of papers
 Telephone
 Ball point pen and pencils
 Software for data analysis
3.9. PERSONNEL USED

 Medical students/Nurses/medical doctors working at the above-mentioned hospitals.
39
3.10. Ethical considerations:
We carried out our study under strict respect of research principles which were; ethical
clearance obtained from the Ethical Committee of the Faculty of Medicine and Biomedical
Sciences of the University of Yaoundé I, research authorisation from the different hospital
administratives, anonymous questionnaires used so that the identity of participants was kept
private, personal details of participants of the study were kept with strict confidentiality. Data
obtained was used strictly for the study. All information collected will be used for the sole
purpose of this study.
CHAPTER 4 : RESULTS
40
CHAPTER 4: RESULTS
4.1. Presentation of the study population

A total of 1325 women delivered at the GRH and GMH during our study period among whom
87 of them were diagnosed with preeclampsia. Nineteen of the patients were not eligible for
our study and 21 refused to participte in the study, leaving us with 57 cases and 171 controls
(1:3) as illustrated in the figure below.
Total source population :

1325
Case group : 87
Excluded: 19
Refused to participate:21
Total cases retained : 57 Controls : 171
Ratio 1:3 (three women that gave birth after a preeclamptic patient)
Figure 6: flow chart of our study population.
41
4.2. The Prevalence of preeclampsia
During our study period, we had a total of 1325 women, from which 87 had preeclampsia and
12 had gestational hypertension. The prevalence of preeclampsia in our study was 6,6%.
4.3. Sociodemographic characteristics of study population.
Table iii: distribution of cases and controls with respect to demographic

characteristics
Variables Cases N (%) Control N (%) OR (CI 95%) P Values
N=57 N=171
Age (years)
0-19 16(28,1) 11(6,4) 2,377(1,487-3,798) 0,002
20-25 10(17,1) 54(31,6)
26-30 8(14,0) 55(32,2)
31-35 8(14,0) 32(18,7)
>35 15(26,8) 19(11,1) 1,731(1,073-3,792) 0,033
Marital status
Married 55(96,5) 165(96,5) 1,000(0,295-3,393) 0.100
Single 2(3,5) 6(3,5)
Divorced 0 0
Residence
Urban 31(17,9%) 142(82,1%) 0.100
Rural 26(47,3%) 29(52,7%)
Occupation
Housewife 42(73,6) 119(69,6) 0,637
Private sector 5(8,9) 15(8,8)
Public sector 4(7,0) 11(6,4)
Farmer 4(7,0) 21(12,3)
Student 2(3,5) 5(2,9)
Level of education
No level 38(66,7) 66(38,6) 0,733
Primary level 9(15,8) 78(45,6)
Secondary level 8(14,0) 22(12,9)
Higher level 2(3,5) 5(2,9)
Religion
Muslims 36(63,2) 119(69,6) 0,542
Christians 17(29,8) 43(25,1)
42
From a total of 228 participants included in our study (57 cases and 171 controls), the mean
age of cases 26 (SD: ±7,80) years was lower than that of controls 28,29 (SD±5,90) years.
Fifteen (26,3%) of the cases and fifty-four (31,6%) of the controls were in the age group of
20-25 years. Fifty-five (25,0%) of the cases and one hundred sixty-five (75,0%) of the
controls were married. Thirty-one (17,9%) of the cases and one hundred and forty-two
(82,1%) lived in the urban area and the majority of the participants were Muslims (23,4%
cases and 76,6%). Thirty-six (35,3%) of the cases and sixty-six (64,7%); had no level of
education. With regards to occupation, more than the majority forty-six (27,1%) of the cases
and 124 (72,9%) of the controls were unemployed (housewife).
43
4.4. Obstetrics and medical characteristics of study population
Table iv: follow up of current pregnacy
Variables Case N= Controls OR(CI:95%) P values

57 N= 171
n (%) n (%)
Gravidity
Primigravida 23(47,9%) 25(52,1%) 6,029(4,436-8,196) 0,000
multigravida 34(18,9%) 146(81,1% 0,532(0.196-0,867) 0,002

)
Parity (number of delivery)
Nullipara (0) 23(40,4) 27(15,8) 3,487 (1,120-7,528) 0,000
Primipara (1) 3(5,3) 32(18,7) 0,134(0,120-0,431) 0,428
Paucipara (2-4) 15(26,3) 80(46,8) 0,495(0,156-1,042) 0,091
Multipara (≥5) 16(28,0) 32(18,7) 2,295(1,662-4,324) 0,000
Type of Pregnancy
Multiple 8(14,0) 4(2,3) 2,939 (1,837-4,701) 0,001
Single 49(86,0) 167(97,7) 0,431(0,193-0,963)
New paternity 10(83,3%) 2(16,7%) 3,830 (2,678-5,047) 0,000
Gestational age ( weeks)

<37 33(57,9) 10(5,8) 5,916 (3,934-8,895) 0,000
37-42 24(42,1) 161(94,2) 0,267(0,155-0,461) 0,000
>42 0 0
Number of ANC
<4 37(64,9%) 38(66,7%) 3,774 (2,362-6,030) 0,000
≥4 20 133 0,583(0,462-0,735) 0,000
44
Twenty- three (47,9%) of the cases and thirty-seven (15,8%) of the controls were nulliparous,
eight (66,7%) of the cases and 4 (33,3%) of the controls had multiple pregnancies while ten
(83,3%) and two (16,7%) had different fathers from prior pregnancies. Thirty-seven (64,9%)
of the cases and thirty-eight (66,9%) of the controls had less than four ANC consultation.
All these variables are significantly associated with preeclampsia (p values < 0.005).
Table v: obstetrics and medical past histories
Variables Case N= Controls N= OR (CI 95%) P value

57 n(%) 171 n(%)
Prematurity 2(3,5) 3(1,8) 1,622 (0,541-4,861) 0,433
Still birth 3(5,2) 4(2,3) 2,018 (0,495-8,219) 0,412
Miscarriage 4(7,0) 28(16,4) 0,462 (0,180_1,189) 0,078
Hypertension on 11(19,3) 3(1,8) 3,655 (2,513-5,317) <0,000
prior pregnancy
Cardiopathy and 0 0
renal disease
Diabetes mellitus 0 0
Tobacco use 0 0
Alcohol intake 6(10,53%) 17(9,94%) 1.049(0.506-2.171) 0.899
Eleven (19,3%) of the cases and 3 (1.8%) of the controls had past history of hypertension on
their prior pregnancy.
There was no notion of tobacco use and any cardiopathy and renal disease in the study
population. Six (10,53%) of the cases and seventeen (9,94%) of the controls take alcohol.
Hypertension on prior pregnancy was found to be a risk factor of preeclampsia.
Table vi: distribution of cases and controls according to family past history
Variables Case N= Controls N= OR (CI 95%) P value

57 171 n (%)
n (%)
45
Hypertension on 21(36,8) 2(1,2) 5,199(3,767-7,177) 0,000
pregnancy
Chronic 42(73,7) 13(7,6) 8,807(5,313-14,601) 0,000
hypertension
Of the study participants, forty-two (73,7%) of the cases and thirteen (7,6%) of the controls
had chronic hypertension. Twenty-one (36,8%) of the cases and two (1,2%) of the controls
had family history of hypertension on pregnancy. Both are found to be risk factors of
preeclampsia.
4.5. Risk factors associated to preeclampsia
Table vii: multiple logistic regression of risk factors associated with

preeclampsia
Variables Case N= 57 Controls N= AOR (CI 95%) P value

n (%) 171 n (%)
Multiple 8(14,0) 4(2,3) 6,816(1.969-23,596) 0,002

Pregnancy
New paternity 10(83,3%) 2(16,7%) 17,979(3,808-84,893) 0,000

Number of
ANC
<4 37(64,9) 38(22,2) 6,475(3,372-12,435) 0,002
Hypertension on
prior pregnancy
11(19,3) 3(1,8) 13,391(3,586-50,009) 0,000
Family history
HTN on
pregnancy 21(36,8) 2(1,2) 49,292(11,061-219,666) 0,000
Family history
Chronic
hypertension 42(73,7) 13(7,6) 34,031(15,034-77,030) 0.000
46
After multiple regression, multiple pregnancy, new paternity, number of ANC < 4,
hypertension on prior pregnancy, family history of HTN on prior pregnancy, family history
chronic hypertension was found to be risk factors of preeclampsia.
4.6. Clinical and biological characteristics of patients with preeclampsia
Table viii: clinical and biological signs of patients with preeclampsia
Variables Effective(n=57) Frequency (%)

Functional signs
Asymptomatic 10 17,5
Headache 40 70,3
Visual disturbance 18 32,1
Vertigo 12 21,0
Epigastric pain 16 28,5
Nausea/ vomiting 12 20,5
Oligo/ anuria 2 3,5
Dyspnea 0 0
Bleeding 10 17,5
Convulsion 17 30,8
SBP (mmHg)
< 140 10 17,5
47
140-159 25 43,9
>= 160 22 38,6
DBP (mmHg)
<90 12 21,1
90-109 19 33,3
>=110 26 45,6
Urine Dipstick (Proteinuria)
+ 13 22.8
++ 29 50.9
+++ 15 26,3
The main sign represented by more than the majority of the cases was headache (70,3%),
43,5% (25) had a systolic blood pressure between 160-179 mmHg and 38,6%(10), ≥180
mmHg at their admission and 45,6%(26) had arterial diastolic blood pressure ≥ 110 mmHg.
Urine dipstick proteinuria was carried out on all the participants. It was positive for all the
cases, with 50,9% of the cases having more than 2+ (>500mg)
 The rest of the workups was not exploited: urea, creatinine, transaminases,
FBC, TP/TCK, because not all the cases did the exams.
Table ix: distribution of cases in terms of types of preeclampsia
Variables Effective (n=57) Frequency (%)

Type of preeclampsia
Mild 10 17,5
Severe 47 82,4
More than the majority of the cases had severe preeclampsia with a frequency of 82,4%.
4.7. Delivery
Table x: term at delivery
Term at delivery Effective (n=57) Frequency (%)

<37 29 50,9
48
37-42 28 49,1
Most of the cases had less than 37 weeks when gestation.
Vaginal delivery 63.2(n=36)
caesarean section 36.8(n=21)
0 10 20 30 40 50 60 70
Figure 7: Distribution of cases according to type of delivery in % (n=57)
63,2% of the case population gave birth through vaginal delivery.
49
4.7. Evolution
70
60 57.9(n=33)
50
40 38.6(n=22)
30
20
10
3.5(n=2)
0
Good evolution Complications death
Figure 8: Distribution of cases in terms of evolution (n=57)
 Favourable
In our studies, 33 patients only, i.e 57,9% evoluated well under treatment with gradual
normalisation of arterial blood pressure.
 Mortality
We registered 2 deaths during our study with a percentage of 3,5%.
50
 Morbidity
24 patients (38,6%) had complications.
4.9. Complications of Preeclampsia
4.9.1. Maternal complication
Table xi: maternal complications of preeclampsia
Variables Case (n=57) Frequency

(%)
Eclampsia 13 22,8
HELLP Syndrome 0
Retro placental hematoma 6 10,5
Acute pulmonary edema 1 1,7
Acute renal failure 2 3,5
IVDC 0 0
Maternal deaths 2 3,5
The major complication observed was Eclampsia, with a percentage of 22,8% (n=13), we
registered 2 maternal deaths following Eclampsia attack.
No control had the above-mentioned complications.
4.9.2. Perinatal complications
Table xii: perinatal complications
Variables Case N= Controls N= 171 OR (CI 95%) P value

57 n (%) n (%)
Preterm birth 29(50.9%) 5(2,9%) 5,910(4,080-8,555) 0,000
Neonatal 15(26,3%) 29(17%) 1,494(0,916-2,436) 0,121
asphyxia
Birth weight 14(24,6%) 1(0,6%) 4,623(3,427-6,237) 0,000
51
<2500g
Stillbirth 17(29,8%) 2(1.2%) 4,675(3,400-6,428) 0,000
Preterm birth was the main complication of preeclampsia representing (57,9%) followed by
stillbirth (29,8%). Preterm birth, bight weight < 2500g and stillbirth were found to be
associated with preeclampsia.
Table xiii: multiple logistic regression of perinatal complications of

preeclampsia
Variables Case N= Controls N= 171 AOR (CI 95%) P value

57 n (%) n (%)
Preterm birth 33(57,9%) 5(2.9%) 4,801(2,035-6,011) 0,000
Birth Weight 14(24,5%) 1(0,6%) 2,920(1,011-3,356) 0,001

<2500
Stillbirth 17(29,8%) 2(1.2%) 2,247(1,104-3,583) 0,002
After logistic regression, multivariable analysis showed that perinatal complications related
to preeclampsia were preterm birth, birth weight <2500g and stillbirth.
52
CHAPTER 5 : DISCUSSION
53
CHAPTER 5: DISCUSSION
5.1. Prevalence of preeclampsia.

In this study, the prevalence of preeclampsia at the Garoua regional and military hospitals was
6,6%. This finding is significantly higher as compared with studies conducted in different
areas where it was found to be 2.0% in France(6), 3% in Norway(21), 2.9% and 2.3% in
Sweden and China respectively (8). This is because it has been proven that the incidence of
preeclampsia is much more higher in developing countries compared to developed
countries(5). However, this finding was lower compared to studies conducted in different
areas; 14.4% in Bangladesh(9), 16% in Nigeria (22), 8.34% in Ethopia(10) and 7.8% in
Algeria (23). This difference might be due to the fact that there is a difference in geographical
areas, study setting, methodology and a difference in time duration.
Also, this finding was different to studies carried out in Yaounde, Cameroon which found a
prevalence of 4.8%. this can be explained by differences in technical platform and personals.
5.2. Sociodemographic characteristics of patients with Preeclampsia.

The mean age of cases was 27years (SD: ±7,80), this is the same with findings in other areas;
27years (SD=±4.6) in north Ethiopia and 28 years in Douala, Cameroon(25,26). The
frequency of preeclampsia was higher in women with age group < 20years (28%) than the
other age groups. This differs with findings in Egypt and Tehran,Iran that shows that the
frequency of preeclampsia is higher in the age group 26-30years (41%) and 21-30 years
(23,7%) respectively(27,28). This can be explained by the fact that in the locality they are
they are still
54
More than the majority of the cases (66,7%) were illiterate. This is the same as in Jahun,
Nigeria were 93.0% of the case group were illitrate (22). However, this differs from fidings in
North Ethiopia where the majority of the cases (56%) reached secondary education(25). This
can be explained by the difference in mentality of the areas. Also 73,6% of women with
preeclampsia were housewives, this is same with findings in North Ethiopa, Egypt and Jahun,
Nigeria where more than the majority 53,9%, 56% and 87% of preeclamptic women were
housewives.
5.3. risk factors associated with preeclampsia:
Multiple pregnancy, new paternity, number of ANC < 4, hypertension on prior pregnancy,
family history of HTN on pregnancy, family history of chronic hypertension was found to be
risk factors of preeclampsia.
Multiple gestation was strongly associated with preeclampsia after multiple logistic
regression. Women with multiple pregnancies had 7 times higher risks of developing
preeclamsia than women with single pregnancies. This finding is similar with studies done in
Egypt (AOR=7,6), and slightly different from Ethiopia (AOR=8,22) (27,29). This can be
explained by difference in sampling and population size.
In this study, family history of hypertension on prior pregnancy was strongly associated with
preeclampsia development. Women who had a family history of HTN prior to pregnancy had
higher risks of developing preeclampsia than their counterparts (AOR= 49,2). This finding is
similar to study conducted in India (AOR=38.0)(30). In Ethiopia however,women who had a
family history of HTN on prior pregnancy were 5.24 times more likely to develop
preeclampsia than those who had no family history of HTN on prior pregnancy (AOR: 5.24)
(29). This is due to difference study duration and sample size.
Those participants who had a history of hypertension on prior pregnancy had 13 higher risks
of developing preeclampsia than their counterparts (AOR=13,2). This finding is supported by
studies conducted in Ethiopia (AOR: 10.28)(31). This showed that women with a history of
hypertension on their previous pregnancy need to have a focus and could be an acceptable
means of screening for preeclampsia, especially in limited resourced location.
55
5.4. Maternal and foetal outcome of preeclampsia
We report 22.8% of the eclampsia cases that constitute the first maternal complication of our
study. This high rate could be explained by the delay in the management because of the
patients came consulting late. Retroplacental hematoma (RPH) occupies 2nd place with
10.5%, which coincides with the study of Cissé et al (32) and a study carried out at Douala
(26) and is comparable to that of the literature. These complications are high in African
countries and are rare in developed countries. However, it should be noted that in developed
countries eclampsia complicates an average of 1 to 5% pre-eclampsia, an incidence of 25 to
50 per 100,000 births, while RPH complicates 3 to 5% preeclampsia. This differs from the
results and Mboudou et al who present RPH as the main complication (11). This difference
would probably be due to 2 facts in our series. On one hand we had more cases of seizures as
signs of severity and on the other hand the delay in the management complicating pre-
eclampsia. We found 2 cases of maternal deaths following eclampsia attacks: a maternal case
fatality rate of 3.5%. This agrees with the study by Kartout et al which represents eclampsia
as the leading cause of maternal mortality (4 cases / 8), unlike in developed countries where it
represents 0-1.8%(33)
56
5.5. Limitations to the study:
 The first limitation to the study was that the majority of the studies carried out during
the previous years had different methodology (larger study duration, study type
(matched case- control), larger sample size) compared to this study which makes it
difficult to compare results.
 In our study, we saw the patients from when they gave birth till 48 hours post partum,
which made it difficult to look for possible complications after that period.
 Lack of other variables which can be associated with preeclampsia (inter-pregnancy
interval, nutritional status during pregnancy, BMI).
57
CHAPTER 6 : CONCLUSION
58
CHAPTER 6: CONCLUSION
At the end of the study whose aim was to determine the prevalence of preeclampsia, identify
the sociodemographic characteristics of women with preeclampsia, identify risk factors and
maternal and foetal outcomes associated with preeclampsia, the following conclusions were
drawn:
1. The prevalence of preeclampsia was 6,6% in the two hospitals.

2. Preeclampsia was more frequent among women with age less than 20 years
and more than 35 years than the other age groups.
3. The risks factors associated with preeclampsia identified were multiple
pregnany, new paternity, history of hypertension on prior pregnancy, family
history of hypertension on prior pregnancy and family history of chronic
hypertension.
4. The main maternal complication was eclampsia, followed by RPH and preterm
birth was the first perinatal complication followed by stillbirth.
59
CHAPTER 7 : RECOMMENDATIONS
60
CHAPTER 7: RECOMMENDATIONS
Based on the findings and conclusions of this study, we therefore propose the following
recommendations.
1. Hospitals:
- To improve the level of care through appropriate and early management of
patients with preeclampsia inorder to reduce complications.
- To sensitize women on the importance of ANC.
2. Patients:
- To begin ANC early so that those with risk factors can be followed up properly
in order to prevent preeclampsia and minimize complications.
3. Resaerchers:
- To carry out more researches in the same areas and nearby areas with a longer
time duration and larger population size so as to get more information in order
to help the government plan its interventions to reduce morbidity and mortality
associated with preeclampsia.
61
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66
APPENDIX
67
APPENDIX
APPENDIX 1: Ethical clairence
68
69
Appendix 2: Research authorization
70
APPENDIX 3: INFORMATION NOTICE FOR PARTICIPANTS
Title of the study: Prevalence and determinants of preeclampsia among pregnant women
at the Garoua regional and military hospitals
Principal Investigator: Adamou Habibatou Madina
Supervisor:
Prof. Mbu Robinson
Obstetrician/Gynecologist, Faculty of Medicine and Biomedical Sciences (FMBS),
The University of Yaoundé I.
Co-supervisor:
Prof. Dohbit
Obstetrician/Gynecologist, Faculty of Medicine and Biomedical Sciences (FMSB),
The University of Yaoundé I.
Introduction:
Adamou Habibatou Madina is a 7th year medical student at the Faculty of Medicine and
Biomedical Sciences (FMBS) at the University of Yaoundé 1. TEL: 699131013
I am carrying out a study to determine the prevalence of preeclampsia and identify its
determinants.
Purpose of the study:
The study has as aims to describe the sociodemographic characteristics of the patients,
determine the prevalence of preeclampsia, identify risk factors of preeclampsia, identify
maternal and foetal outcomes of preeclampsia and then compare the outcome in women with
or without preeclampsia.
Procedure: If you agree to participate in the study, you will be interviewed by the principal
investigator. The interviewer will complete a questionnaire by verbally asking you some
questions.
Your name will be omitted from the questionnaire to always ensure your anonymity. The
interviewer will also access your medical records/file to obtain any additional information.
The information gathered will be stored safely under lock and key by the principal
investigator who will then code and enter it into a password-protected computer database
prior to analysis
71
Benefits:
There is no direct benefit to you by participating in this study.
Risks: There is no associated danger to your health or well-being.
Confidentiality:
Any information you provide will be treated as confidential. Your confidentiality will be
always maintained by omitting your names from the questionnaire and instead, each
questionnaire will be randomly assigned with a study number for purposes of identification in
the study. Only research personnel will have access to your data. The study numbers will be
used during data analysis and report writing of the study and at no point will any detail that
might identify an individual be provided. The information obtained will be used only for the
purpose of the study.
Voluntarism:
Your participation in the study is voluntary. If you choose to decline to participate or
withdraw from participating in the study, you will not be denied any service by the
hospital. You are free to change your mind later and stop participating even if you agreed
earlier.
Contact Information:
If you have any questions about the study, you can contact.
Adamou Habibatou Madina at 699131013, adamuo.habibatou@gmail.com , Faculty of
Medicine and Biomedical Sciences (FMSB), The University of Yaoundé I.
72
APPENDIX 4: Participant consent form
(English version)
Mr. / Mrs. / Ms............................................................................................................
Title: “PREVALENCE AND DETERMINANTS OF PREECLAPSIA AMONG

PREGNANT WOMEN AT THE GAROUA REGIONAL AND MILITARY
HOSPITALS”.
The final year Medical Student, ADAMOU Habibatou Madina, proposed to me to

participate in a study they are carrying out at the Garoua Regional Hospital (GRH) and
Garoua Military Hospital in view of his M.D. Thesis. This study has as main aim to determine
the prevalence of preeclampsia and its risk factors to establish an empirical management
adaptable to our context.
She precise to me that I was free to accept or deny the proposal. I have received and
understood the following information:
 The aim of this study
 The procedure and the tests to be done
 Possible constraints and risks
I accept that my medical records be consulted by the research personnel and used for research
purposes only. My medical record will be discussed with me at the end of the study. My
participation can be interrupted at any time if the principal investigator deems it necessary or
if I wish. All data concerning me will be strictly confidential. Only the research personnel,
and eventually a health authority representative will be given access to my data. The research
protocol for this study has been reviewed and validated by the institutional committee of
research and ethiques of the Faculty of Medicine and Biomedical Sciences. At any time, I can
ask for supplementary information from the student investigator ADAMOU Habibatou
Madina, using the phone numbers: 699131013.
I hereby accept to participate in the study under the aforementioned conditions. A signed copy
of this consent form will be given to me and will serve its purpose in time of need.
Date : ......../........../..............
73
Investigator’s signature Volunteer’s signature
(Version Francaise)
M/Mme/Mlle……………………………………………………………………………………
Titre : « PRÉVALENCE ET DETERMINANTS DE LA PRÉÉCLAMPSIE CHEZ LES
FEMMES ENCEINTES DES HÔPITAUX RÉGIONAUX ET MILITAIRES DE
GAROUA »
L’étudiante ADAMOU Habibatou Madina, étudiante en 7ème année à la FMSB, m’a

proposé de participer à une étude qu’elle réalise à l’Hôpital Regionale et Militaire de Garoua
en vue de la rédaction de son mémoire. Cette étude a pour but principal de determiner la
prevalence de la preeclampsie et ces facteurs de risque pour établir un guide pour le
diagnostic, de prise en charge et prevention pratique à notre milieu.
Elle m’a précisé que je suis libre d’accepter ou de refuser sa proposition. J’ai reçu des
informations concernant :
- Le but de l’étude,
- La procédure et les analyses réalisées,
- Les possibles risques et les contraintes liés à l'étude,
- Les avantages liés à l’étude.
J’accepte que mon dossier médical soit consulté par les membres de l’équipe de
recherche et que les informations y relatives soient utilisées dans le but de la recherche
seulement. Mes résultats me seront restitués après les analyses. Toutes les informations
personnelles seront confidentielles. Seulement les personnels de recherche et éventuellement
le personnel médical auront accès à mes résultats. Le protocole de recherche relatif à cette
étude a été revu et validé par le comité institutionnel d’éthique et de la recherche de la faculté
de médicine et des sciences biomédicales. À tout moment, je pourrai prendre des informations
supplémentaires à l’étudiante ADAMOU Habibatou Madina, utilisant le numéro de
téléphone : 699131013.
J’accepte donc de participer à cette étude sous les termes susmentionnés. Une copie
signée de cette fiche de consentement éclairée me sera remise pour valoir ce que de droit
74
Date ……/……/……….
Signature de l’investigateur Signature du participant
APPENDIX 5 : QUESTIONNAIRE
Date : _ _ /_ _/_ _ _ _ (dd/mm/yyyy)
Serial N⁰: Type: case/control

I. IDENTIFICATION
Number Variables Classes
01 Age
02 Marital status 1.single

2.married
3.divorced
03 Residence 1.urban
2.rural
04 Level of education 1.No formal education
2.Primary education
3.secondary education
4.higher education
05 Occupation
06 Religion 1.christian
2.muslim
3.none
II. FOLLOW UP OF CURRENT PREGNANCY
07 Gravity
75
08 Parity
09 Gestational age
10 Number of antenatal consultations
11 Inter genetical interval
12 Multiple pregnancy 1.yes

2.no
III. PERSONAL PAST HISTORY

1. Obstetrics
13 Prematurity 1.yes
2.no
14 Abortion 1.yes
2.no
15 Stillbirth 1.yes
2.no
16 Miscarriage 1.yes
2.no
17 Ectopic pregnancy 1.yes
2.no
18 Hydatidiform mole 1.yes
2.no
19 gestational hypertension 1.yes
2.no
20 Preeclampsia/Eclampsia 1.yes
2.no
2. Medical
76
21 Chronic Hypertension 1.yes

2.no
22 Obesity 1.yes
2.no
23 Diabetes 1.yes
2.no
24 Renal disease 1.yes
2.no
25 Cardiopathy 1.yes
2.no
3. Environmental
26 Smoking 1.yes
2.no
27 Stress 1.yes
2.no
28 Physical activity 1.yes
2.no
IV. FAMILY PAST HISTORY
29 Preeclampsia/Eclampsia 1.yes
2.no
30 Hypertension disease 1.yes
2.no
31 New Paternity 1.yes
2.no
77
V. CLINICAL PRESENTATION
1. Functional signs
32 Headache 1.yes
2.no
33 Visual disturbance 1.yes
2.no
34 Epigastric pain 1.yes
2.no
35 Nausea/vomiting 1.yes
2.no
36 Oligo/anuria 1.yes
2.no
37 Dyspnea 1.yes
2.no
2. Physical signs
38 Systolic blood pressure
39 Diastolic blood pressure
40 Diuresis (24h)
41 Edema 1.yes
2.no
42 Consciousness 1.yes
2.no
43 Bleeding 1.yes
2.no
44 Convulsion 1.yes
2.no
45 Osteotendinous reflexes 1.yes
2.no
46 Pulmonary edema 1.yes
78
2.no
VI. WORKUPS
 Biological
47 Urine dipstick (Proteinuria)

48 Urea and creatinine levels
49 Transaminase
50 TP/TCA
51 Full blood count
 Obstetrical Ultrasound
53 Obstetrical Ultrasound 1. RPH

2. IUGR
54 Chest X-Ray
VII. OUTCOME
 Delivery
55 Route of delivery 1.down route

2.up route
56 Presentation 1.cephalic
2.others
57 Special gesture
58 Complication
 Neonate
79
59 APGAR
60 Weight
61 Height
62 PC
80

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REPUBLIQUE DU CAMEROUN REPUBLIC OF CAMEROON

Paix – Travail – Patrie Peace – Work – Fatherland

DEPARTEMENT OF GYNAECOLOGY AND OBSTETRICS

Preeclampsia: prevalence, determinants and

Academic year 2021-2022

DEPARTEMENT OF GYNAECOLOGY AND OBSTETRICS

Preeclampsia: prevalence, determinants and

Academic year 2021-2022

I dedicate this work to my parents: my dad, Mr ADAMOU Baba Abba and my

THE ADMINISTRATIVE AND TEACHING STAFF OF THE FACULTY

2. PROGRAM AND SPECIALTY TRAINING COORDINATORS

HONORABLE DIRECTORS OF THE YAOUNDE UNIVERSITY CENTRE FOR

HONORABLE DEANS OF FACULTY OF MEDICINE AND BIOMEDICAL

05 NGO NONGA Bernadette P General Surgery

DEPARTMENT OF INTERNAL MEDICINE AND SPECIALTIES

DEPARTMENT OF MEDICAL IMAGERY AND RADIOLOGY

113 BELINGA Etienne SL Obstetrics and Gynaecology

DEPARTMENT OF MORPHOLOGIC-ANATOMOPATHOLOGIC SCIENCES

HD= Head of Department;

I will solemnly pledge myself to consecrate my life to the service of

I will practise my profession with conscience and dignity

The health of my patients will be my first consideration

My colleagues will be my brothers

Figure 1: The faces of the placenta. Source: ( Université médicale francophone.)................9

Figure 2: Internal morphology of the placenta Source: (getrevision.co.uk, s.d.).............10

Figure 3: Two-stage model of the pathophysiology of preeclampsia.................................12

Figure 4: Pathophysiology of preeclampsia Source: (Sciencedirect.com, s.d.)..............13

Figure 6: Chat flow of our study population..........................................................................40

Figure 7: Distribution of cases according to type of delivery in % (n=57).............................48

Figure 8: Distribution of cases in terms of evolution (n=57).................................................49

Table i: Common Risk factors of Pre-eclampsia......................................................................14

Table ii: Recent Publications on prevalence of pre-eclampsia and risk factors.......................33

Table iv: follow up of current pregnacy..................................................................................43

Table v: obstetrics and medical past histories........................................................................44

Table viii: clinical and biological signs of patients with preeclampsia.....................................46

Table ix: distribution of cases in terms of types of preeclampsia............................................47

Table x: term at delivery......................................................................................................... 47

Table xi: maternal complications of preeclampsia..................................................................50

Table xii: perinatal complications............................................................................................50

Table xiii: multiple logistic regression of perinatal complications of preeclampsia................51

Conclusion : La prévalence de la prééclampsie était élevée. Les facteurs de risque et les

Mots clés : Prééclampsie, prévalence, déterminants, devenirs.

1.3. RESEARCH QUESTIONS

1.4. RESEARCH HYPOTHESIS

Preeclampsia is most likely to be the leading complication of pregnancy at the Garoua

1.5.1. General Objective:

Evaluate the prevalence of preeclampsia, its determinants and perinatal-maternal outcome at

1.5.2. Specific objectives:

1. Describe the sociodemographic characteristics of patients

1.6. DEFINITION OF OPERATING TERMS

CHAPTER 2: LITERATURE REVIEW

CHAPTER 2: LITERATURE REVIEW

Hypertension in pregnancy: Hypertension (HTN) in pregnancy is defined as: Systolic blood

2.1.2. Classification of hypertensive disease in pregnancy(12)

Preeclampsia is increased blood pressure >140/90mmHg after 20weeks of gestation with or

2.2.3. Classification of preeclampsia

2.2.4. Anatomy of the placenta(13)

The placenta at term appears as a disk 18 to 20 cm in diameter, 4 to 5 cm thick in the center, 4