Prevalence, Clinical Characteristics, Maternal and Perinatal Outcomes of Patients With Recurrent Preeclampsia at Kenyatta National Hospital - a Cross- Sectional Study

Abstract

Introduction: Hypertensive disorders in pregnancy are a significant cause of maternal morbidity and mortality globally. The recurrence rate of preeclampsia ranges from 6% to 25%, with the variability depending on patient characteristics and demographic differences and various comorbidities as risk factors. This study sought to determine the prevalence, clinical characteristics, maternal and perinatal outcomes of patients with recurrent pre-eclampsia at Kenyatta National Hospital (KNH). Methodology: This was a descriptive cross-sectional study conducted at the KNH from 3rd October 2021 to 31st March 2021. Postpartum women with recurrent preeclampsia were interviewed and additional data extracted from files. Sociodemographic, clinical characteristics, maternal and perinatal outcomes of patients with recurrent pre-eclampsia was expressed using percentages, mean (standard deviation) median (interquartile ranges) and proportions respectively. Pearson’s Chi square was used for categorical variables to assess the clinical characteristics associated with adverse fetal and maternal outcomes P values of 0.05 was considered statistically significant. Logistic regression analysis was used to model for factors associated with morbidity. Results Out of 553 patients who had preeclampsia, 343 had new onset preeclampsia and were ineligible, 58 had preeclampsia superimposed on chronic hypertension and 152 patients had recurrent preeclampsia. The prevalence rate was 27 (95%CI: 23.8 - 31.2 Thirty-eight percent had early onset preeclampsia, 53 % had preterm deliveries <37 weeks gestation. Ninety nine percent had at least 1 antenatal visit while 77% had at least 4 visits. Thirty percent were given calcium supplements, and 20% got low dose aspirin for prevention of preeclampsia. Only 9 % had pre-existing comorbidities. There were no adverse maternal outcomes, 32.9% had pregnancy related comorbidities with 15.9% having HELLP syndrome, 3.9 % having postpartum haemorrhage and acute kidney injury respectively. Caesarean section rate was 78%. Fifty three percent had preterm births, 42 % were admitted in the newborn unit, 17 % had foetal growth restriction and 12.5% had Stillbirths. Patients with less than 4 antenatal visits and no prenatal calcium supplement was associated with adverse maternal outcomes. Foetal growth restriction was associated with preterm births. Conclusion Prevalence of recurrent preeclampsia is high 27.5%. The average age of patients is 32 years with a high ANC attendance. However, there is low use of aspirin and calcium for prevention of preeclampsia. There is a high caesarean section rate but no mortality reported. A high proportion of patients had preterm births resulting in newborn unit admissions. We recommend managing such patients in facilities that can conduct caesarean sections, screening for fetal growth restriction and offer newborn care for preterm neonates.