Abstract

Background: Preeclampsia is a hypertensive disorder of pregnancy that significantly contributes to maternal and neonatal morbidity and mortality, particularly in low-resource settings. The condition is associated with serious complications including preterm birth, intrauterine growth restriction, and maternal death. This study aimed to determine the prevalence, associated risk factors, and obstetric outcomes of preeclampsia among pregnant women at the Kumba Regional Hospital.

Methods: A retrospective study was conducted from January to May 2025 involving the review of medical records of pregnant women admitted to Kumba Regional Hospital Annex from January 2020 to December 2024. A total of 816 antenatal files were reviewed using a structured data extraction sheet. Purposive sampling was used to select the hospital and an Exhaustive sampling was used to select the files. Ethical approval was obtained from the Institutional Review Board of the University of Buea and the South West Regional Delegation of Public Health. Data were entered into EpiData 3.9 and analyzed using SPSS version 28. Chi-square tests and logistic regression were used to identify factors associated with preeclampsia. A p-value ≤ 0.05 was considered statistically significant.

Results: Out of 816 records reviewed, 342 cases of preeclampsia were identified, giving an overall prevalence of 41.9%. Significant sociodemographic factors associated with preeclampsia included age (p ≤ 0.001), residence (p = 0.004), occupation (p < 0.001), and marital status (p = 0.025). Clinical determinants such as proteinuria (p < 0.001), gestational age < 37 weeks (AOR = 5.989), gravidity ≤ 4 (AOR = 6.834), and ANC attendance (p = 0.021) were also significant. Maternal outcomes included edema (37.3%), PPH (1%), and maternal death (1%). Neonatal outcomes included preterm birth (15.7%), low birth weight (13.7%), birth asphyxia (15.7%), neonatal death (3.9%), and stillbirth (3.9%).

Conclusion: The five-year prevalence of preeclampsia at Kumba Regional Hospital is high (41.9%). Both sociodemographic and clinical factors contribute significantly to its occurrence. The condition is associated with adverse maternal and neonatal outcomes. Improved antenatal care and early detection strategies are recommended to mitigate these complications.

CHAPTER ONE

INTRODUCTION

1.1 Background of the Study

Preeclampsia is one of the leading causes of maternal morbidity and mortality in the world [1] Preeclampsia is hypertension that generally occurs after 20 weeks of gestation along with proteinuria [2]. When proteinuria is absent, preeclampsia is diagnosed in association with liver dysfunction, thrombocytopenia, pulmonary edema, new onset of kidney dysfunction, or new-onset of cerebral or visual disturbances [3]. It can cause severe morbidity, chronic disability, and even death of mothers and babies. Moreover, it is linked with an increased risk of cardiovascular diseases and type 2 diabetes in a mother’s later life [4].

Ninety nine percent of the 800 daily maternal deaths occurring worldwide are recorded in developing countries [5]. Hypertensive disorders in pregnancy are the third cause of maternal mortality [5-6].  Pre-eclampsia complicates 0.5-2% of pregnancies in rich countries. In Cameroon, the prevalence of hypertensive disorders in pregnancy is 8.2% while that of pre-eclampsia is between 5.9 and 6.4% [7-9]. In 2009, eclampsia occurred in 9.5 out of 1000 deliveries at the Yaoundé General Hospital [10]. Hypertensive disorders were the third cause of maternal mortality at the Yaoundé central Hospital and the second cause at the Yaoundé General Hospital [11]. These hospitals are the most important health facilities in the country’s capital. A study carried out in the referral Hospital of the most populated region of Cameroon revealed that eclampsia was the cause of 17.5% of maternal deaths [12].

Given that national statistics are not available those figures can be extrapolated to the whole country. An unpublished study conducted at the Yaoundé gynaeco obstetric and pediatric hospital in 2010 revealed that eclamptic seizures occur in 2-3% of pre-eclamptic women without appropriate prophylaxis [13].

In developing countries, women are at 14 times higher risk of dying from obstetric complications compared to developed countries [39]. Pregnancy complications caused around 289,000 deaths of women worldwide in 2013 and 99% of them were from developing countries [39]. Globally, about 12% of mothers die only from preeclampsia [40]. As estimated by WHO, the occurrence of preeclampsia is seven times higher in developing countries compared to developed countries [41]. The prevalence of preeclampsia ranges between 1.8 and 16.7% in developing countries [42].

Several studies have demonstrated that preeclampsia is linked with the failure of the trophoblastic invasion of maternal spiral arteries which leads to higher vascular resistance of uterine arteries and lower uteroplacental blood flow [43-44]. If unmanaged, preeclampsia can prevent the flow of adequate blood and oxygen to the developing fetus, cause maternal liver and kidney damage and sometimes progress to eclampsia, a serious condition involving seizures [45-46]. There is no known cure for preeclampsia other than the delivery of the baby or the placenta. Early diagnosis and close monitoring can help to control preeclampsia during pregnancy. Developed countries have reduced the incidence of eclampsia and associated mortality by nearly 90% through early detection during antenatal care and by increasing access to hospital care for preeclamptic women [47].

1.2 Statement Of The Problem

Preeclampsia is a major cause of maternal and neonatal complications globally, affecting about 2–8% of pregnancies worldwide and up to 7.6% in parts of sub-Saharan Africa, including Cameroon.

Although it contributes to serious outcomes like maternal death, eclampsia, preterm birth, low birth weight, and stillbirth, its burden in Cameroon remains underexplored. Previous studies have highlighted risk factors such as hypertension and late antenatal care, but their impact on outcomes in local settings is not well understood.

This lack of context-specific data limits effective prevention and management strategies, especially in resource-limited hospitals like the Kumba Regional Hospital. Therefore, this study seeks to investigate the prevalence, risk factors, and maternal and neonatal outcomes of preeclampsia in this setting. [14-15]

1.3 Research Questions

1. What is the prevalence of preeclampsia among pregnant women at KRH?
2. What are the factors associated with preeclampsia at KRH?
3. What are the maternal and neonatal outcomes associated with pre-eclampsia among pregnant women at KRH?

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