IN PREGNANCY : PATTERN , ANAESTHETIC CARE AND OUTCOME IN A HOSPITAL IN THE NIGER-DELTA REGION OF NIGERIA 1

This study set out to determine the pattern, season al presentation and the challenges encountered by anesthesiologists in the care of patients with hype rtension in pregnancy at caesarean section in a cen tre short of anaesthetic manpower without an intensive car unit Method A retrospective assessment of anaesthetic records o f patients presenting in theatre for caesarean sect ion was done with particular reference to mode of anaes thesia, 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. Th months of September and October also experience lower and less frequent peak incidents i n tandem with periods of peak rainfalls in the Nige rDelta. This corroborates studies done in other part s of he world including northern and eastern Niger ia. The incidence in The Niger-Delta was remarkably hig her than other parts of Nigeria and other rain forest zones. Of these, 50% were eclamptics, 45% ha d pre-eclamspia while other hypertensive diseases constituted the balance of 5%. 60.6% of these patie nts had General anaesthesia –relaxant technique, 18.1% had intravenous ketamine (plus hypotensive ad juv nt) , 11.7% spinal anaesthesia while others had epidural, combined-spinal epidural (CSE) and lo cal infiltration with sedation. Four intraoperative maternal deaths were experienced, while fetal morta lity was 8.6% Conclusion The higher incidence of pre-eclampsia/ eclampsia in the Niger-Delta compared to other parts of the rai n forest and the world makes it an issue of significa nt public health concern in this region. Health education, accessibility to skilled health care ser vic s and ease of transportation in this region wou ld reduce the morbidity and mortality associated with this disease. KEYWORDS; Pre-eclampsia, Eclampsia, seasonal variat ion, caesarean section, mortality, Niger-Delta INTRODUCTION Hypertensive disease complicates 5-7% of all pregna ncies, 90% of which is essential hypertension, whil e 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 (Chamber lain et al1978,MacGillivray 1983) The cause of these diseases is, however, still unknown. In the Niger-Delta region in Nigeria pregnancy indu ced hypertension is one of many causes of pregnancy related deaths. Its impact on maternal and perinata l morbidity and mortality has been a subject of pre vious studies in other parts of Africa. We set out in thi s review of patients who had caesarean section, to assess the pattern, seasonal variation, trends, impact and how improved anaesthetic perioperative maternal and fe tal care affects outcome in our environment. METHODOLOGY This was a Hospital based retrospective study of hy pertensive patients presenting for caesarean sectio n and its seasonal variation and comparison with other indica tions for caesarean section. The burden of increase d caesarean section rate increased by pregnancy induc ed hypertension in this general hospital was assess ed in