A Prospective Study of Maternal and Perinatal Outcomes in Eclampsia in a Tertiary Care Centre

Abstract

Background: The term eclampsia is derived from a Greek word, meaning like a flash of lightening. The onset of convulsions in a woman with pre-eclampsia that cannot be attributed to other causes is termed eclampsia. It is a major cause of maternal and fetal mortality and morbidity in our country. The management of eclampsia is still challenging to the obstetrician, requiring the greatest skill, judgement, and patience. Methods and Materials: Our study is an observational and prospective study of 58 cases admitted with eclampsia in Mahatma Gandhi Institute of Medical Sciences (MGIMS), Sewagram. The study was extended from January 2020 to December 2021. The inclusion criteria were all the cases of eclampsia (antepartum and postpartum), primigravida and multigravida, duration of gestation>20 weeks. Patients with convulsion during pregnancy or in puerperal period attributed to epilepsy or other causes were excluded from the study. Results: In our study majority of cases (58.6 %) belong to the younger age group /= 37 weeks). 55.2% had antepartum eclampsia, 36.2% postpartum and 8.6% had intrapartum eclampsia. Most common complication observed was need of blood or blood products transfusion (35 %), Hemolysis, Elevated Liver Enzymes Low Platelets (HELLP) syndrome (21%), prolonged Intensive Care Unit (ICU) admission (19%) followed by abruption, Disseminated Intravascular Coagulation (DIC), Acute Kidney Injury (AKI), Posterior Reversible Encephalopathy Syndrome (PRES), hypertensive retinopathy, pulmonary edema. Majority of patients (57%) underwent cesarean section, most common indication being poor bishop’s score with deteriorating maternal condition (54.5%). Out of 58 cases, 84.4% were live births and 15.6% were still born. 63.2% of all live births were small for gestational age, 44.8% had Neonatal Intensive Care Unit (NICU), and 8% had early neonatal death. Conclusion: Early pregnancy registration, good antenatal care and counselling about warning symptoms, early identification of pre-eclampsia and its complications, and timely intervention can reduce the incidence of eclampsia. Early identification of high-risk cases at primary healthcare facilities including severe pre-eclampsia, impending eclampsia and eclampsia and immediate referral to tertiary care centre equipped with multidisciplinary team, ICU and NICU facilities, might reduce fetal morbidities like prematurity, neonatal intensive care unit admission etc. and maternal morbidities like prolonged hospitalisation, AKI, DIC , pulmonary edema, multi organ dysfunction syndrome etc. and mortality.