Maternal and perinatal outcome in severe preeclampsia and eclampsia

Abstract

INTRODUCTIONHypertension in pregnancy constitutes the most common medical complication occurring in 12-22% of all pregnancies of which pre-eclampsia remains the leading cause that complicates 10% of all pregnancies.1,2 It is defined as new onset of elevated blood pressure and proteinuria (BP>/=140/90 and >/= 0.3gm protein in 24 hours urine specimen) after 20 weeks of gestation in a previously normotensive woman. 3,4 It is considered severe if blood pressure and proteinuria are increased substantially (BP>/=160/110 and >5 gm protein in 24 hours urine specimen) or symptoms of end organ damage like thrombocytopenia, altered liver function, oliguria, cerebral or visual disturbances, pulmonary edema and fetal growth restriction are present. 3,4 Eclampsia is defined as the new onset of generalized tonic clonic seizure in a woman with severe preeclampsia. Seizures most commonly occur in the postnatal period in 44% cases, antenatally in 38% and in the intrapartum period in 18%. 5 It was found that 3-5% of first pregnancies and 1% of subsequent pregnancies are complicated by preeclampsia.1 WHO estimated that approximately 60,000 women die each year from pre-eclampsia world-wide. Pre-eclampsia and eclampsia account for 24% of all ABSTRACTBackground: Pre-eclampsia accounts for the majority of referrals in a tertiary care centre as it stands one of the major causes of maternal and perinatal morbidity and mortality. The objective of this study was to study the maternal and fetal outcome in patients with severe pre-eclampsia and eclampsia in a tertiary centre over a period of one year. Methods: Total 150 women with severe eclampsia and eclampsia after 20 weeks of gestation were included. Women with medical complications like anemia, preexisting hypertension, epilepsy, diabetes, vascular or renal disease, multiple gestation, polyhydramnios were excluded. Patients were managed as per existing protocol after proper history, examination and investigations. Anti-hypertensive of choice was alphamethyl-dopa, labetalol and oral nefidipene. Magnesium sulphate was used as anti convulsant. Results: Out of 150 cases of severe pre-eclampsia and eclampsia, majority (69%) were between 20-30 years of age and 47% were primigravida. We had 75 patients with convulsions on admission and 75 with severe pre-eclampsia of whom 11 had convulsions. Headache was most common complaint. Common mode of delivery was caesarean section in 72 (48%) women, majority in view of failed induction or non-progress. Maternal complications were noted in 59% attributed to renal dysfunction, postpartum hemorrhage, DIC, placental abruption, HELLP, pulmonary edema, pulmonary embolism and renal failure. 4 maternal deaths were recorded. Conclusions: Maternal and perinatal complications are more in patients with eclampsia. The incidence of eclampsia can be reduced by better antenatal care, early recognition and prompt treatment of severe pre-eclampsia.

Maternal-Fetal Outcomes of Pregnancies with Thrombocytopenia-One Center Experience

“…A study by Saxena et al showed that about 48% of such patients had to be subjected to CS. 16 The most common indication for operative intervention in our study was fetal distress, unlike the study by Saxena et al, in which the most common indication for CS was failed induction or non-progress.…”

Perinatal outcomes of severe preeclampsia/eclampsia and associated factors among mothers admitted in Amhara Region referral hospitals, North West Ethiopia, 2018

“…Stillbirth was one of the causes for unfavorable outcomes. 103 (22.6%) of newborns were stillbirths which is a higher finding compared with the studies done in Addis Ababa (8.5%) [ 14 ], Mettu Karl Referral Hospital (10.2%), Ghana (6.8%) [ 20 ] and Haiti (17.8%) [ 17 ] but lower than studies done in Nigeria (34.2%). It shows that stillbirth is still high which may alert policy makes, managers and health care providers to make health care set up better.…”

“…The Government of Ethiopia in line with WHO takes a commitment to reduce perinatal mortalities through multiple high impact interventions at both facility and community levels to remove bottlenecks such as harmful traditional practices, poor infrastructure, shortage of transportation facilities and inadequate care at health facilities that can hamper access to safe motherhood services [ 12 ]. Even though, there were devotion to reduce pregnancy related complications and mortalities, perinatal deaths due to severe preeclampsia/eclampsia is still increasing worldwide [ 7 , 13 , 14 ].…”

“…Studies tried to investigate the trend, magnitude and associated factors of severe preeclampsia and eclampsia throughout the world [ 7 , 14 , 18 – 21 ], but almost all these studies used secondary data and limited to investigate feto-maternal outcomes.…”

Perinatal outcomes of hypertensive disorders in pregnancy at a referral hospital, Southern Ethiopia

“…Moreover the risk of perinatal death from hypertensive disorders in pregnancy is more daunting than the maternal death. For instance, the risk of perinatal death from severe pre-eclampsia is 13% whereas maternal death is less than 1% let-alone the short and long term consequences in surviving new-born [12,13]…”