One of the main causes of illness, permanent impairment, and mortality during pregnancy and after delivery are Hypertensive disorders in pregnancy which account for 14% of all maternal fatalities globally[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. Pre-eclampsia is thought to affect 4% of the world's population[2]. Pre-eclampsia can occur up to 16% more frequently in sub-Saharan Africans[3]. Pre-eclampsia is thought to be responsible for about 300,000 maternal fatalities in low- and middle-income nations[4]. Pre-eclampsia is reportedly linked to a 5.84/1000 birth rate perinatal mortality rate in Nigeria[5]. Locally, eclampsia is linked to a 30% death rate and 11% case fatality rate in Tanzania[6]. Pre-eclampsia is categorized as being with or without severe features[7]. Pre-eclampsia with severe features can be diagnosed with specific criteria. This includes new-onset severe range blood pressures systolic blood pressure ≥ 160 mmHg or diastolic BP ≥ 110 mmHg with or without proteinuria. Specific laboratory findings are also present with severe features including thrombocytopenia (platelet count less than 100,000 × 109/L), impaired liver function as indicated by abnormally elevated blood concentrations of liver enzymes (to twice the upper limit normal concentration), and severe persistent right upper quadrant or epigastric pain unresponsive to medication and not accounted for by alternative diagnoses, renal insufficiency (serum creatinine concentration more than 1.1 mg/dL or a doubling of the serum creatinine concentration in the absence of other renal disease) pulmonary edema, new-onset headache unresponsive to medication and not accounted for by alternative diagnoses, or visual disturbances[7, 8]. This type of classification is not plausible in a lot of cases in our settings because of the availability of equipment for the specific investigations and the ability of the patients to afford the costs of all the investigations due to low social economic status. Practically the health care providers usually rely on the elevation of the blood pressure, the urine analysis results and clinical findings to make a diagnosis of pre-eclampsia with severe features[12].
1.2 PROBLEM STATEMENT:
Severe pre-eclampsia is defined as systolic blood pressure of 160 mm Hg or more, or diastolic blood pressure of 110 mm Hg or more on two occasions at least 4 hours apart (unless antihypertensive therapy is initiated before this time), Thrombocytopenia (platelet count less than 100 ,000× 109/L), Impaired liver function that is not accounted for by alternative diagnoses and as indicated by abnormally elevated blood concentrations of liver enzymes (to more than twice the upper limit normal concentrations), or by severe persistent right upper quadrant or epigastric pain unresponsive to medications, Renal insufficiency (serum creatinine concentration more than 1.1 mg/dL or a doubling of the serum creatinine concentration in the absence of other renal disease), Pulmonary edema, New-onset headache unresponsive to medication and not accounted for by alternative diagnoses and Visual disturbances[9]. Severe pre-eclampsia is still a significant public health issue in Sub-Saharan Africa, where it contributes to high rates of maternal and perinatal morbidity and mortality[10, 11]. Despite advancements in our understanding of the risk factors and treatment options for this illness, information is still lacking regarding the severity and early newborn outcomes of severe pre-eclampsia in Tanzania, particularly in BMC. Hence this study aims to describe the prevalence and the early neonatal outcomes of severe pre-eclampsia among women who delivered at BMC.
1.3 RATIONALE OF THE STUDY
The findings of this study will provide a local understanding about the magnitude and the early neonatal outcomes associated with severe pre-eclampsia among pregnant women who delivered at BMC. Which is crucial for the clinical management of pre-conception and pregnant women to enable development of strategies and interventions to prevent complications attributed to severe pre-eclampsia.
1.4 RESEARCH QUESTION
What is the prevalence of Severe Pre-eclampsia and its associated early neonatal outcomes of severe pre-eclampsia among pregnant women who delivered at Bugando Medical Centre?
1.5 RESEARCH OBJECTIVES
1.5.1 Broad objectives
To determine the prevalence of severe pre-eclampsia and the associated early neonatal outcomes among pregnant women who delivered at Bugando Medical Centre.
1.5.2 Specific Objectives:
1. To determine the prevalence of severe pre-eclampsia among pregnant women who delivered at Bugando medical Centre. 2. To determine the early neonatal outcomes of severe pre-eclampsia among pregnant women who delivered at Bugando Medical Centre.