Introduction: Pregnancy-induced arterial hypertension (systolic blood pressure greater than or equal to 140 mmhg and/or diastolic blood pressure greater than 90 mmhg) appearing after the 20th week of amenorrhoea. The occurrence of disorders that can strongly engage the vital prognosis of the mother and/or the fetus or the newborn when associated with certain pathologies such as the case of diabetes, arterial hypertension. In this study, we evaluate the role of renal failure among the maternal complications of gestational arterial hypertension, in order to reduce the rate of renal aggression during pregnancy.

Material and Methods: This was a prospective descriptive study carried out in the regional hospital of Kankan. The study was carried out on all pregnant women, parturients or women following childbirth with a resting blood pressure greater than or equal to 140/90 mmhg, who agreed to answer our questions without distinction of age or origin, whatever the clinical picture. Data were collected on individual survey forms. The study variables were quantitative and qualitative. Data entry and analysis were carried out using software (Word, Excel) and Epi info version (7.1.0) 2014. Our results were presented in the form of text and tables.

Results: Out of a total of 1500 patients seen during the study period, we recorded 70 hypertensive pregnant women, a frequency of 4.66%. The mean age of the patients was 24 years, with extremes of 15 and 44 years and a standard deviation of 7 years. Systolic blood pressure was greater than 160 mmhg in 46 cases, or 65.71%, and diastolic blood pressure was greater than 110 mmhg in 45 cases, or 64.29%. The most frequent complications of arterial hypertension during pregnancy were classified according to high proportions, with acute renal failure in 4th place in 6 cases, a frequency of 8.57%.

Conclusion: Arterial hypertension is a condition that should not be underestimated. The frequency of hospital admissions varies according to the study. In our study, the frequency was 4.66%, with young patients being the most represented, and maternal complications were dominated by eclampsia in 34 cases (48.57%), with acute renal failure in 4th place in 6 cases (8.57%). A study on a larger population of pregnant women could help identify hypertension during pregnancy, in order to reduce the impact of hypertension and complications in pregnant women.

• Renal failure
• Maternal complications
• Hypertension
• Pregnancy
• Kankan

Camara MLT, Bangoura S, Traore A, Tolno A, Barry KB, et al. (2024) Renal Insufficiency among the Hypertensive Disorders in Pregnancy at Kankan Regional Hospital. J Clin Nephrol Res 11(2): 1123.

Pregnancy-induced arterial hypertension (systolic blood pressure greater than or equal to 140 mmhg and/or diastolic blood pressure greater than 90 mmhg) occurring after the 20th week of amenorrhoea [1]. It is estimated that 95% of pregnancies are at ‘low risk’ of maternal and/or fetal pathology. The onset of disorders that can seriously affect the vital prognosis of the mother and/or the fetus or the newborn when associated with certain pathologies, such as diabetes or arterial hypertension. Arterial hypertension in pregnant women is a condition that should not be underestimated. The incidence of hypertension during pregnancy is similar in most Western countries, with 9.3% in France, 10.8% in the United Kingdom and 10-15% in the United States. Given the maternal and fetal complications it causes, and the complexity of its management, it is the third leading cause of maternal mortality (after hemorrhage and infection) and the leading cause of perinatal mortality. There are many manifestations and implications of hypertension during pregnancy, each of which is linked to a particular management and prognosis for the mother and fetus [2].

In the African literature, the frequency of hypertension associated with pregnancy varies from country to country. In Tunisia, the frequency of hypertension associated with pregnancy was 8.2% [3], in Niger 8.9% [4], in Guinea and at the

Donka University Hospital 17.05% [5].

A study carried out in Bamako in 2020 found maternal complications dominated by eclampsia in 19.0% of our patients, Retroplacental hemorrhage in 10.0% of our patients and 1 case of Acute lung edema (0.3%) [5].

Previous studies on maternal complications of gestational hypertension have found an overall incidence of gestational hypertension, but renal complications are rarely evaluated. In this study we evaluate the place of renal failure among the maternal complications of gestational hypertension, with a view to reducing the rate of renal aggression during pregnancy.

This is a prospective descriptive study. Our study was conducted in the regional hospital of Kankan, the second largest city in the Republic of Guinea. The Kankan regional hospital is a public institution, and the study took place in the maternity ward, which is dedicated to care, training and research.

All pregnant women or women following childbirth with a blood pressure ≥ 140/90 mmhg were used in our study. For data collection, we used : prenatal consultation diaries, consultation and hospitalization registers, medical records, operative report register, vaccination register.

This is a prospective descriptive study which was carried out over a period of six [6], months from 1st May to 31st October 2023. We targeted all pregnant women and patients seen in the department during the study period. The study finally focused on all pregnant women, parturients or women following childbirth with a resting blood pressure greater than or equal to 140/90 mmhg.

We used the formula for calculating sample size and obtained a minimum sample equal to 70 patients. All pregnant women, parturients and women following childbirth who agreed to answer our questions, regardless of age, origin or clinical picture. Data were collected on individual survey forms. The quantitative study variables were: frequency, maternal age, blood pressure, biological tests (creatinine, blood urea, uricemia, proteinuria, Blood count, platelets, transaminases, bilirubins), the qualitative variables were : type of arterial hypertension and period of discovery, maternal complications. Each variable was defined to describe the measurement modalities.

• Frequency: to determine the proportion of hypertensive pregnant women in relation to the total number of women hospitalized in the department during the study period.
• Maternal age: the different ages were grouped into regular 5-year age brackets.

Types of hypertension: pre-eclampsia, chronic hypertension, added pre-eclampsia, transient gravidic hypertension.

• Maternal complications :
• Pre-eclampsia: hypertension, proteinuria appearing after the 20th week of amenorrhoea.
• Eclampsia: tonic-clonic convulsion during pregnancy or in the postpartum period.
• Retro-placental haematoma : black discharge.
• Acute renal failure: creatinine greater than 90 µmol/L with oliguria or preserved diuresis.
• Hellp syndrome: haemolysis, elevated transaminases, thrombocytopenia.

Biological tests: to define the biological modalities relating to one of the complications.

Data entry and analysis were performed using software (Word, Excel) and Epi info version (7.1.0) 2014. Our results were presented in the form of text and tables, commented on, discussed and compared with current data in the literature.

Epidemiological data

• Overall incidence of hypertension in pregnant women. Out of a total of 1,500 patients seen during the study period, we recorded 70 hypertensive pregnant women, representing a frequency of 4.66%.
• Maternal age: We divided our patients into 5-year age brackets. Out of a total of 70 patients, the 15-19 age bracket was the most representative, with 23 cases, a proportion of 32.85%; the mean age of the patients was 24 years, with extremes of 15 and 44 years and a standard deviation of 7 years [Table 1].

Table 1 : Pregnant women with hypertension by maternal age.

Clinical data

Among the 70 hypertensive pregnant women, systolic blood pressure was greater than 160 mmhg in 46 cases (65.71%) and diastolic blood pressure was greater than 110 mmhg in 45 cases (64.29%) [Table 2].

Table 2: Distribution of hypertensive pregnant women according to blood pressure levels

Pregnant women with hypertension were distributed according to the type of hypertension and the period of discovery. Most of them had pre-eclampsia (30 cases) and were discovered after 20 weeks’ amenorrhea [Table 3].

Table 3: Distribution of hypertensive pregnant women by type of hypertension and period of discovery

The most frequent complications of hypertension during pregnancy were classified according to high proportions, with acute renal failure in 4th place, with 6 cases, representing a frequency of 8.57% [Table 4].

Table 4: Distribution of hypertensive pregnant women according to maternal complications

Epidemiological data

The aim of this study was to determine the place occupied by acute renal failure among the complications of arterial hypertension during pregnancy. The answer to this question must involve determining the number of hypertensive pregnant women in our context. In our study, there were 70 cases of hypertensive pregnancy, which is 4.66%.

This proportion is not negligible, especially in the context of a regional site where medical specialities are rare, and this rarity may have consequences for maternal morbidity and mortality. Our results are questionable in relation to the literature. Doumbia Bourama in 2020 in Bamako reported that during the study period 5800 pregnant women and patients consulted the department, 290 of whom had pregnancy-associated hypertension, a frequency of 5.0% [5]. Touré I.A et al in 1997 in Niger recorded 70 hypertensive women out of 784 participants examined, a prevalence of 8.9% [4].

Tidiane Traoré et al at the Nianankoro Fomba hospital in Ségou in 2021 found a frequency of hypertension in pregnant women of 8.01% (283 patients out of 3533 pregnant women) [6]. Houda et al in 2022 in Algeria reported that among 742 patients hospitalized in the obstetrics unit of the University Hospital theTlemcen during the period (03 April to 02 May), only 46 pregnant patients were hypertensive, with a frequency of 6% which is low compared with the overall frequency of pregnancies [7].  Our results are similar to those in the current literature.

We divided our patients into 5-year age brackets. Out of a total of 70 patients, the 15-19 age bracket was the most representative with 23 cases, a proportion of 32.85% ; the mean age of the patients was 24 years with extremes of 15 and 44 years and a standard deviation of 7 years.

Traoré Tidiani et al in Ségou in 2020 found that the mean age of patients was 20.65 years, with extremes of 14 and 44 years. The 14 to 19 age group was the most affected, with a frequency of 60.2% [8].

Clinical data

In our study, systolic blood pressure was greater than 160 mmhg in 46 cases, 65.71%, and diastolic blood pressure was greater than 110 mmhg in 45 cases, 64.29%. Traoré Tidiani et al., in Ségou in 2020 found that systolic blood pressure was greater than 150 mmhg in 93 cases (52.8%) and diastolic blood pressure was between 90 and 100 mmhg in 107 cases (60.8%) [8]. Our results are similar to those reported in the scientific literature. The most frequent complications of arterial hypertension during pregnancy were classified according to their high proportions, with acute renal failure in 4th place in 6 cases, a frequency of 8.57%.

Traoré Tidiani et al in Ségou in 2020 found that infectious complications (endometritis and parietal suppuration) were the most frequent maternal complications, accounting for 53.4% of cases. Other complications included acute renal failure in 20% of cases, retroplacental haematoma in 13.3% of cases and delivery hemorrhage in 13.3% [8]. Yassine Smith et al in Morocco in 2021, had reported concerning maternal complications, they were dominated by ?retroplacental haematoma (45%), followed by severe pre-eclampsia, which constituted 24% and then ?eclampsia 13%, HELLP syndrome 6% and finally ?acute renal failure representing 4% [1].

Our results are superimposable in terms of the maternal complications encountered, although there are remarkable differences in terms of frequency, which could be explained by the difference in sample sizes, but also by the study settings. Our results have internal validity based on the practical modalities of the variables measured on the one hand, and on the comparison of the results obtained with data from the scientific literature on the other. However, the presence of a bias in relation to the hospital study setting influences the external validity of our study, but the results are usable in our local context. In perspective, this study can be carried out on a large population to reduce the negative impact of hypertension during pregnancy in order to reduce maternal morbidity and mortality and ensure adequate management of hypertension during pregnancy.

Arterial hypertension is a condition that should not be underestimated. The frequency of hospital admissions varies according to the study, the context and the study site; the frequency in our study was 4.66%, young patients were the most represented, maternal complications were dominated by eclampsia in 34 cases (48.57%), with acute renal failure in 4th place in 6 cases (8.57%). These complications are at the root of maternal morbidity. A study of a larger population of pregnant women could enable arterial hypertension to be identified during pregnancy, in order to reduce the impact of arterial hypertension and complications in pregnant women.

To my masters, Professor KABA Mohamed Lamine and Professor Bah Alpha Oumar, your love of a job well done, your availability and your skills have encouraged me to produce scientific articles. Please find here the expression of my deep gratitude.

My co-authors: Dr Bangoura Soriba, Dr Traoré Aly, thank you for your commitment and perseverance from the beginning of the development of the protocol data to the submission of the manuscript with a view to publication of a scientific article. Allow me to thank you for your scientific rigor.

Thank you to the readers of this journal who agreed to critically review this manuscript in order to improve the level of scientific continuity. Please find here the expression of my deep gratitude.

The confidentiality of the information collected was guaranteed: patients were informed beforehand and their informed consent was obtained.

The study is limited by the fact that, as it is a hospital study, the data could not be extended to the entire population.

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