A study on risk factors, maternal and foetal outcome in cases of preeclampsia and eclampsia at a tertiary care hospital of South India

Abstract

INTRODUCTIONHypertension in pregnancy remains still a major health issue for women and their descendants throughout the world but remains a major issue in developing countries rather than developed countries. Globally preeclampsia [PE] and eclampsia are responsible for approximately 14% of maternal deaths with variable incidences in developed and developing countries.1 Eclampsia accounts for 24% of maternal deaths during pregnancy in India according to FOGSI study in India.2 Gestational hypertension affects 5-10% of pregnancies, but is associated with fewer and less severe complications. Eclampsia is defined as the new onset of generalized ABSTRACT Background: Hypertension in pregnancy remains still a major health issue for women and their descendants throughout the world but remains a major issue in developing countries rather than developed countries. Eclampsia accounts for 24% of maternal deaths during pregnancy in India according to FOGSI study in India. Changing trends in pregnancy globally with increased maternal age of conception, assisted reproductive technologies has contributed a significant impact in the risk factors for PE and eclampsia. The present study was aimed to investigate and determine the related risk factors in cases of PE and eclampsia. The maternal and foetal outcomes with major complications of the women with PE and eclampsia were also studied. Methods: A prospective cross sectional study for a period of two years was conducted at a tertiary care hospital among antenatal cases and all cases of PIH were recorded and studied. Cases were managed as per the existing obstetric protocol after clinical examination and investigations. Detailed socio demographic data and history of risk factors were collected and entered into Microsoft excel sheet and analyzed. Maternal and foetal outcome were noted in the cases of the study. Results: The incidence of PE and eclampsia in the study was 43.3% and 10.8%, 25-35 years age group being the most common. PE and eclampsia was associated with BMI>30, parous women with previous history of PE, diabetes mellitus and more in unregistered cases. PE and eclampsia were more in Illiterates and socio economic class 2 &3. The incidence of maternal complications was 32.99% with premature labour being the common and in case of foetal complications prematurity was the commonest with 16 cases. The maternal mortality was very less with only 4.64% in the study. Conclusions: Pregnancy induced hypertension with PE and eclampsia still remains a major problem in developed countries. Good antenatal care with increased awareness and increased antenatal visits may help in reducing the incidence and maternal and foetal complications. Increased incidence among illiterates and low socio economic status group provides the target group to be directed against any medical measures and national health programmes.

Untitled

“…Rate of complications depends upon number of convulsions, duration of convulsion, duration of admission between hospitalization and last fit, proper nursing care treatment, least time for delivery. The incidence of maternal mortality in our study was 5% which is in line with study conducted by Shailja B et al 21 (4.64%). Other studies had reported higher mortality rate of around ten percent.…”

Severe preeclampsia and eclampsia: adverse obstetric outcomes and prognostic factors

“…11 Sailja et al on the other hand found maximum cases of preeclampsia in >35 years age group (46%) and eclampsia in 26-35 years group (20.5%). 5 Similarly, our results of 57.94% preeclampsia cases in nulliparous women is similar to 45.9% reported by Bej et al and 63.3% of nulliparous hypertensive cases reported by Bal et al 4,11 We didn't find either of these age groups or nulliparity to have statistically significant association with increased probability of adverse maternal or fetal outcome. So, although maternal age and parity may help us predict a risk of preeclampsia, they are not significant prognostic markers.…”

“…4 Sailaja reported 2.1% incidence of hypertensive disorders of which 54.1% were preeclampsia and eclampsia. 5 The reported incidence in these studies is much less than the incidence of hypertensive disorders in our study which was 11.85% for hypertensive disorders and 6.18% for severe preeclampsia and eclampsia.…”

Effects of yoga on cardiometabolic risks and fetomaternal outcomes are associated with serum nitric oxide in gestational hypertension: a randomized control trial

“…WHO has estimated the incidence of preeclampsia to be seven times higher in developing countries (2.8% of live births) than in developed countries (0.4%) 3 . In developing countries like India, about 50% of GH leads to preeclampsia, which may culminate in eclampsia if not treated early and effectively 4 . The maternal mortality in eclampsia in India is estimated to be 20–33% 5 .…”