Maternal and Neonatal outcome in eclampsia in a tertiary care hospital in India

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Maternal and Neonatal outcome in eclampsia in a tertiary care hospital in India

Journal Title: Journal of Medical Science And clinical Research - Year 2017, Vol 5, Issue 6

Abstract

Aims and Objectives: (1) To study the risk of eclampsia in relation to several maternal characteristics and exposures including socio-demographic and obstetrics characteristics, community and health facility support and to study maternal and neonatal outcome in eclampsia. (2) To study the association of eclampsia with Socio-demographic factors, antenatal care, obstetric factors and severity of disease, maternal and fetal outcome. Study Design: This was a case control study of 110 cases of pregnant women admitted to the Obstetric ward with a diagnosis of eclampsia (Cases). The control group comprised of women admitted during the same time who did not have pre-eclampsia or eclampsia. Materials and Methods: The study was carried out in the department of Obstetrics and Gynecologist at a tertiary care health institute. The study was a case control study of 110 cases of pregnant women having eclampsia. 110 pregnant women admitted during the same period who did not have eclampsia or preeclampsia were enrolled as control group. Study was approved by the ethical committee of the institute. Informed consent was taken. Demographic data and detailed history was noted. General and systemic examination was done. Type of delivery was noted. Patients were monitored during labor and evaluated in terms of convulsion delivery interval, hours of labor and mode of delivery and indication for cesarean section. Risk of eclampsia in relation to several defined maternal characteristic was studied along with the maternal and fetal outcome in studies cases. The data was analyzed by Epi INFO version 7.1. Qualitative data was expressed in percentages. Quantitative data was expressed in Mean +/- Standard deviation and Ranges were specified. Chi square / Fisher’s exact test were used to observe the difference between proportions. Odds ratio were calculated at appropriate associations. P < 0.05 was considered significant. Results: The analysis of educational status amongst the cases and control group revealed statistically significant difference (P=0.01). The number of skilled patients was more in control group than in cases and the difference was statistically significant (P=0.03). Eclampsia was seen more prevalent in cases coming from rural areas and having higher BMI values (P=0.01). Incidence of eclampsia was found to be more in unbooked cases, primigravida, women with gestational age more than 37 weeks and in those who had less than 3 ANC visits(P=0.01). Difference was statistically insignificant when the factors like singleton or multiple pregnancy and birth interval were analyzed. Majority of the patients (87.27) had convulsions in antepartum period and most of them experienced less than 5 episodes of convulsions. Most of the patients had convulsions before reaching hospital. 57.2% patients reached health care facility within 2hours of seizures and 80.91% patients had a Glasgow coma scale of more than 10 at the time of admission. Systolic blood pressure of majority of the patients was between 140-160 mm of Hg and diastolic blood pressure was between 90-110 mm of Hg. 34.5% patients had 3+ albuminuria and 68.1% patients had brisk reflexes at the time of admission. There was no statistically significant difference in mode of delivery in controls and cases. Majority of the patients were delivered within 24 hrs of seizures. The most common complications seen in the patients with eclampsia were found to be postpartum hemorrhage (11.8%) followed by pulmonary edema (9%) and Acute renal failure (9%). The analysis of mortality patterns revealed that the most common cause of maternal mortality in studied cases was acute renal failure (5.4%) followed by pulmonary edema (4.5%) and Postpartum hemmorhage, septicemia and ARDS. The analysis of fetal outcome revealed that most of the babies were low birth weight (<2.5 kg) and birth weight was normal only in 32.14% babies. There was no statistically significant difference of APGAR scores in babies of cases and control groups. The cases had a statistically significant higher incidence of number of low birth weight babies, Incidence of IUGR, preterm deliveries, stillbirths and neonatal mortality. Lastly poor perinatal outcome was associated most commonly with factors such as IUGR, prematurity and low birth weight. Conclusion: Eclampsia is a serious risk to maternal health and fetal viability and is one of the important factors responsible for maternal and neonatal mortality and morbidity. Regular antenatal visits and controlling BMI in mothers can reduce incidence of eclampsia. Early intervention can reduce maternal and fetal complications. Prematurity, growth restriction and low birth weight are neonatal complications which can be seen in babies born to mothers with eclampsia

Authors and Affiliations

Dr Shalini Fuse

Keywords

EP ID EP521867
DOI -
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