Printed in Nigeria HYPERTENSION IN PREGNANCY: PATTERN, ANAESTHETIC CARE AND OUTCOME IN A HOSPITAL IN THE NIGER-DELTA REGION OF NIGERIA

This study set out to determine the pattern, seasonal presentation and the challenges encountered by anesthesiologists in the care of patients with hypertension in pregnancy at caesarean section in a centre short of anaesthetic manpower without an intensive care unit Method A retrospective assessment of anaesthetic records of patients presenting in theatre for caesarean section was done with particular reference to mode of anaesthesia, complication including fetal and maternal outcome in the immediate perioperative period from 2004 to 2008 Results Hypertensive disease in pregnancy constituted 13.1% of caesarean section cases, with peaks of presentation commonly between February and June. The months of September and October also experience lower and less frequent peak incidents in tandem with periods of peak rainfalls in the NigerDelta. This corroborates studies done in other parts of the world including northern and eastern Nigeria. The incidence in The Niger-Delta was remarkably higher than other parts of Nigeria and other rain forest zones. Of these, 50% were eclamptics, 45% had pre-eclamspia while other hypertensive diseases constituted the balance of 5%. 60.6% of these patients had General anaesthesia –relaxant technique, 18.1% had intravenous ketamine (plus hypotensive adjuvant) , 11.7% spinal anaesthesia while others had epidural, combined-spinal epidural (CSE) and local infiltration with sedation. Four intraoperative maternal deaths were experienced, while fetal mortality was 8.6% Conclusion The higher incidence of pre-eclampsia/ eclampsia in the Niger-Delta compared to other parts of the rain forest and the world makes it an issue of significant public health concern in this region. Health education, accessibility to skilled health care services and ease of transportation in this region would reduce the morbidity and mortality associated with this disease. KEYWORDS; Pre-eclampsia, Eclampsia, seasonal variation, caesarean section, mortality, Niger-Delta INTRODUCTION Hypertensive disease complicates 5-7% of all pregnancies, 90% of which is essential hypertension, while chronic hypertension complicates 1-3 percent of all pregnancies. Together with pregnancy induced hypertension, chronic hypertension accounts for 12% of maternal mortality. Hypertensive disorders during pregnancy are a leading cause of maternal death in the United States and Great Britain (Arias 1989,Kaunitzet al 1985) and are important causes of neonatal morbidity and mortality (Chamberlain et al1978,MacGillivray 1983) The cause of these diseases is, however, still unknown. In the Niger-Delta region in Nigeria pregnancy induced hypertension is one of many causes of pregnancy related deaths. Its impact on maternal and perinatal morbidity and mortality has been a subject of previous studies in other parts of Africa. We set out in this review of patients who had caesarean section, to assess the pattern, seasonal variation, trends, impact and how improved anaesthetic perioperative maternal and fetal care affects outcome in our environment. METHODOLOGY This was a Hospital based retrospective study of hypertensive patients presenting for caesarean section and its seasonal variation and comparison with other indications for caesarean section. The burden of increased caesarean section rate increased by pregnancy induced hypertension in this general hospital was assessed in