Antepartum Eclampsia Research Articles

ASSESSMENT OF CAUSES OF MATERNAL DEATH IN 1 YEAR AT A TERTIARY CENTER OF CENTRAL INDIA

Background: According to the definition of maternal mortality, it is the “death of a woman while pregnant or within 42 days following termination of pregnancy, irrespective of the site and duration of pregnancy, from any cause connected to or aggravated by the pregnancy or its management but not by accidental or incidental cause.” Studying maternal mortality and factors contributing to maternal deaths at Bundelkhand Medical College for 1 year from January 2021 to December 2021 to identify causes that can be avoided and use the knowledge, thereby produced to lower maternal mortality. Methods: A retrospective cross-sectional study of all maternal deaths from January to December 2021. The causes of death and the time between admission and death for each maternal death were thoroughly examined. Results: The Maternal mortality ratio in the present study was found to be 357.7/100,000 live births for the year 2021. Antepartum eclampsia was found most prevalent cause of maternal mortality in 39% cases. Other causes were pregnancy induced hypertension, severe anemia, retained placenta, hepatitis with multi organ failure, septic shock, and ruptured uterus. Conclusion: Maternal mortality is indicator of health-care services of a nation. Better awareness and early referral can help in reducing maternal mortality significantly.

Perinatal outcome of babies born to mothers with antepartum eclampsia: A study from tertiary care hospital of Central India

Background: Eclampsia is a major cause of perinatal mortality. There is a need for studies that will correlate maternal factors and perinatal outcome, which will provide potential strategies to improve fetal outcomes in pregnancies complicated by eclampsia. Aims and Objectives: This study aims to study perinatal outcome of babies born to mothers with antepartum eclampsia and to correlate outcomes with convulsion delivery interval. Materials and Methods: A study included 200 patients diagnosed and managed as antepartum eclampsia in the Department of Obstetrics and Gynaecology in MGM Medical College, Indore. A detailed pro forma was prepared and was filled with patient’s information, investigations, treatment, and birth details. The final outcome of both, the mother and her newborn, including stillbirths and early neonatal deaths was included in the study and the perinatal outcome was correlated with convulsion delivery interval. Results: Incidence of antepartum eclampsia in our study was 2.1%. About 86.4% of women lack regular antenatal care at health care center. Only 7% of women delivered within 6 h of onset of convulsion. Case fatality rate was found to be 13%. There were 59.5% premature deliveries. Perinatal mortality (stillbirth and early neonatal deaths) was 42.5%. Significant association was found between convulsion delivery interval and perinatal outcome (P<0.05). Furthermore, association between use of multiple antiepileptic agents and perinatal outcomes was statistically significant. Conclusion: Eclampsia being a major cause of perinatal mortality need early diagnosis, prompt referral from peripheral health centers, and timely intervention for improvising both perinatal and maternal outcomes.

A prospective observational study on posterior reversible encephalopathy syndrome in COVID-19 eclampsia patients in tertiary care hospital

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is associated with neurological symptoms in one third of COVID-19 patients which is attributed to its hypercoagulable state or its neurotropism which is not yet defined. PRES (Posterior Reversible Encephalopathy Syndrome) is a rare clinico- neuro-radiological entity which can be associated with multiple clinical conditions and was observed frequently with preeclampsia and eclampsia patients. Neuro- imaging is important to diagnose PRES. This study is a prospective observational study in COVID -19 positive eclampsia patients at Gandhi Hospital, Telangana during March 2021-august 2021.Among 55 COVID-19 positive eclampsia patients, 17 had PRES out of which 64.7% had antepartum eclampsia. Seven patients had severe COVID-19 disease out of which five patients required noninvasive ventilation and two patients required invasive ventilation. In my study, PRES was more common among primigravida, common age group 21-25 years. Mean SBP/DBP is 177±12 / 110±6 mm Hg respectively. Incidence of Thrombocytopenia is more in COVID-19 eclampsia patients. COVID -19 related complications are seen in 41.17% whereas eclampsia related maternal complications are seen in 29.4%. There was one maternal death and perinatal mortality was 17.64%.COVID -19 positive eclampsia patients have more predilection to PRES. Diagnosis, treatment of eclampsia in COVID-19 should be evaluated and treated for PRES. Regular antenatal visits and regular bp monitoring can prevent eclampsia and its complications and can reduce maternal morbidity, mortality. Use of anticoagulants and corticosteroids may fasten the recovery rate.

A Study of Maternal and Fetal Outcome of Thrombocytopenia in Pregnancy

Background: Thrombocytopenia is found to complicate pregnancies in India. The major function of platelets is the initiation of haemostasis. Thrombocytopenia can result in spontaneous bleeding from any part of the body. It may be associated with serious bleeding at delivery and may require emergent maternal and neonatal care. Introduction: After anaemia, thrombocytopenia is the most frequently occurring hematologic disorder in pregnancy. It is found to complicate 7% to 8% of pregnancies in India. The major function of platelets is the initiation of haemostasis, and hence, thrombocytopenia can result in spontaneous bleeding from any part of the body. It may be associated with serious bleeding at delivery and may require emergent maternal and neonatal care. Thrombocytopenia is diagnosed if the platelet count 150 × 109/l, caused by increased platelet lysis or reduced inefficient production. Aims & Objectives: To study the maternal and fetal outcome of thrombocytopenia in pregnancy and to study some of the causes of thrombocytopenia in pregnancy. Methodology: Total 113 cases with maternal thrombocytopenia were included in present study after satisfying inclusion and exclusion criteria and followed till delivery. We studied maternal complications gestational age at delivery, indication of induction of labour and method (if required) and mode of delivery, NICU stay were recorded. Results: Majority of the patients i.e. 63 patients (55.8%) were in the age group of 20-25 years. Among 113 cases; primigravida (56 cases, 49.6%) and multigravida (57 cases, 50.4%) were almost equally distributed. Majority of the study population was diagnosed with Gestational thrombocytopenia 50.4% followed by severe pre-eclampsia 22.12%, HELLP syndrome 8.8%, abruption 5.3% antepartum eclampsia and dengue 2.7% each. Maternal mortality was seen in 2 cases (1.8%). Mean birth weight was found to be 2.45 Kgs. of 113 babies, neonatal mortality was seen in 15 cases, NICU admission was indicated in 18 babies and KMC care was needed for 1 baby. Conclusion: The most common cause of thrombocytopenia during pregnancy is Gestational Thrombocytopenia (GT) followed by pre-eclampsia, eclampsia and HELLP syndrome. With platelet counts above 70,000/ μLno prior history of thrombocytopenia the condition is more likely to be GT. The lack of well-defined symptomatology and clinical presentation makes early and accurate diagnosis difficult leading to delay in treatment.

Clinical spectrum and outcome of pregnancy with liver diseases - A prospective study.

Liver diseases constitute a family of diseases in pregnancy which are less often studied individually. Spectrum of liver diseases directly or indirectly related to pregnancy comprise 3% of all pregnancies. The biggest challenge is to arrive at a diagnosis in such cases. With this study we aimed to study the prevalence of different Liver diseases in pregnancy in our population and its effect on fetomaternal outcome. This was a prospective observational study carried out from March 2018 to March 2020. A total of 184 pregnant women with diagnosis of some form of liver disease as evident from their symptoms, signs or biochemical investigations were included in study cohort. Primigravida accounted for majority of study cohort (44.02%). Approximately 90.21% belonged to 20-35 yrs. Age group. Intrahepatic cholestasis of pregnancy (IHCP) was the most common liver ailment (66.84%) followed by viral hepatitis (10.32%), Hyperemesis gravidarum (7.06%) and HELLP syndrome (6.52%). There was one case of Acute fatty liver of pregnancy (0.54%), four cases of Pre-eclampsia with liver dysfunction (2.17%), seven cases of Jaundice in pregnancy (3.80%) and 3 cases of pre-existing liver diseases (1.63%). 5 cases (2.71%) of antepartum eclampsia, 5 cases (2.71%) of postpartum eclampsia and 1 case (0.54%) of post-partum HELLP was seen. 33.33% patients were delivered early by induction or caesarean section because of liver dysfunction.14.67% required blood or blood products transfusion.1.63% had postpartum hemorrhage.1.08% mothers required intensive care admissions. Neonatal outcome was poor with 6.41% being growth restricted, 9.61% premature, 8.97% were intrauterine dead fetuses, 2.56% had early neonatal deaths and 7.05% needed neonatal intensive care unit admissions. Timely admission, quick diagnosis and appropriate management of patients with liver diseases in pregnancy can make a significant difference in mortality and morbidity rates due to liver ailments in pregnancy.

Pregnancy Outcomes With COVID-19 Lessons Learned From the Pandemic.

BackgroundSevere acute respiratory syndrome coronavirus-2 (SARS-CoV-2) that causes Coronavirus disease has caused one of the most damaging pandemics in the recorded human history.ObjectiveTo assess pregnancy outcomes with COVID-19 lessons learned from the pandemic.Study designThis retrospective observational study was conducted at Teerthanker Mahaveer Medical College and Research Centre, Moradabad, a level 3 COVID hospital in Northern India, with a patient pool of all the antenatal females diagnosed COVID 19 positive via a positive quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR) test of maternal pharyngeal and nasal swab samples in the given time period of three months and ten days, i.e., May 25, 2020 to September 3, 2020. In conjunction with maternal outcomes, neonatal outcomes including evidence of perinatal transmission of SARS-CoV-2 was assessed by testing neonatal pharyngeal swab samples.ResultsOut of 100 COVID-19 positive patients, the average age of women was 26.2 years, 73 women (73%) were asymptomatic, and 50 patients (50%) women had associated co-morbidities such as anaemia in 38 (38%) women, gestational diabetes mellitus (GDM) and pregnancy-induced hypertension (PIH) in four patients (4%) each, respectively. No case of spontaneous abortion in early gestation was reported. Out of 100 patients, 32 (32%) patients delivered during their stay, out of which 17 women (53.1%) delivered via cesarean section which was performed mainly due to obstetric indications. One maternal death was reported due to antepartum eclampsia which was unrelated to COVID-19 complications. Five neonates were born prematurely, out of which three were delivered followed by spontaneous premature preterm rupture of membranes (PPROM).The Appearance Pulse Grimace Activity Respiration (APGAR) score was recorded to be ≥9 at the five minutes mark in 28 out of 30 live babies (93.3%) and the birth weight of the babies ranged from 1.8 to 3.5 kg) with an average birth weight of 2.71 kg. Two neonatal deaths were reported due to respiratory distress. There were two documented intrauterine demise (IUD) cases both due to PIH. Furthermore, all 30 live neonates tested for SARS CoV-2 had negative results.ConclusionThe spectrum of Coronavirus infection leans more towards asymptomatic and mild symptomatic clinical presentation. Favourably, the likelihood of spontaneous preterm birth was not escalated in our current study and remained low. The rate of intrauterine fetal demise and neonatal death were less. As none of the neonates tested positive for COVID-19, there is no corroborative proof of vertical perinatal transmission.

Evaluation of Perinatal Outcome in Women with Impaired Glucose Homeostasis During Pregnancy

Background: Glucose tolerance testing in pregnancy identifies many women with glycaemic responses that exceed normal range but that do not meet the threshold required to diagnose Gestational Diabetes Mellitus. It is controversial whether maternal hyperglycemia less severe than in diabetes is associated with increased risk of adverse pregnancy outcome or not. Materials and methods: All women were subjected to Glucose Challenge Test(GCT) with 50 gram glucose either at first visit or between 24-28 weeks on the basis of risk profile. High risk cases were screened at first visit and the rest between 24-28 weeks. Patients with a GCT value ≥200mg/dl were not subjected for GTT and were diagnosed as GDM.Value of GCT <140 mg/dl was taken as normal. Irrespective of GCT result, women were subjected to Oral Glucose Tolerance Test (OGTT) as recommended by WHO with 75 gram glucose using WHO criteria. Study group was identified with 4 categories with abnormal glucose homoeostasis as defined by the following criteria: 1. Abnormal GCT (>140 mg/dl) with normal OGTT; 2. Normal GCT with only Impaired Fasting Glucose(IFG) in OGTT; 3. Normal GCT with Gestational Glucose Intolerance(GGI); 4. Patients diagnosed as GDM: a. If fasting is >126mg/dl; b. If 2hr OGTT ≥ 140mg/dl & ≤ 199 mg/dl; c. If value of either GCT or OGTT >200 mg/dl. The control group comprised of women with normal GCT and normal OGTT. In all the above groups, adverse prenatal outcome and maternal outcomes were evaluated by the primary and secondary outcome measures. Results: There were 10 cases (15.3%) of hypertensive disorder of pregnancy in the study group (3 cases of gestational hypertension in abnormal GCT, 3 cases of pre eclampsia in each GGI and GDM and 1 antepartum eclampsia in GGI category) and 2 cases in control group (3%) (p=0.03). There were 2 cases of Fetal Growth Reduction (FGR) and 5 cases of Premature Rupture Of Membranes(PROM) in both study and control group. There was 1 case of cholestasis of pregnancy in study group. Term inductions were 11 and 13 in the study and control group respectively.Within the study group number of cases induced were more in GGI(n=7) and GDM(n=4) category. There were 14 caesarean sections (21.5%) and 2 (3%) instrumental deliveries among the study group. However there were 6 caesarean sections (9.2%) and no instrumental deliveries among control groups. The rate of elective LSCS is more in GDM (n=5) vs other 3 categories and the difference is significant (p=0.04) The overall number of LSCS (14 cases) was significantly higher in GDM. Conclusion: Cases with abnormal glucose homeostasis of lesser degree than GDM, like only abnormal GCT, IFG and GGI also were observed to have adverse maternal outcomes than controls, in form of hypertensive disorders of pregnancy, significantly higher LSCS rates, and increased risk of macrosomia. Instead of 2 step procedure, single step screening cum diagnostic test with 75 gm OGTT for diagnosing GDM could be an option to be universally practiced.

Maternal Death Cause by Antepartum Eclampsia, With HELPP Syndrome and AKI Stage III : A Preventable Recurrent Death

Background: Eclampsia and severe preeclampsia is of the most frequent cause of maternal death. We usually find the case like this in our daily practice. The case most likely could be prevented. Eclampsia defined as a generalized seizure following preeclampsia in pregnancy. Eclampsia/Preeclampsia (EPH-Gestosis) cause a multisystem dysfunction such as HELLP syndrome, microangiopathy hemolytic anemia, liver dysfunction, and thrombocytopenia. Eclampsia and HELLP syndrome lead to maternal mortality, which happened mostly during third trimester. Most of the patient came to the hospital in a bad condition where the multi organs failure were exist. EPH-Gestosis are due to maternal death in 43,75%. Even the case usually severe, it’s a preventable death. A proper strategy is needed to reduce or to avoid the maternal death.Objective: To analyse a maternal death with eclampsia and how to prevent this recurrent death.Case Report: A woman, 30 years old, G2P1A0 32 weeks pregnant not in labor with antepartum eclampsia was admitted to Mohammad Hoesin General Hospital (MHGH) Palembang, a referral case. Patient experienced generalized seizure six times before coming to MHGH which every seizure duration is less than five minutes and unconscious. On physical examination, patient was conscious, with blood pressure of 160/100 mmHg, pale, and cold extremities. By ultrasound examination, it showed 34 weeks pregnancy with single life fetus. Laboratory examination showed leukocytosis (25.000/mm3), thrombocytopenia (58.000/mm3), hyperbilirubinemia, elevated SGOT and SGPT (1691 and 861 U/L), elevated creatinine serum (2,46 mg/dl), and elevated LDH (3629 U/L). The patient was treated based on the protocol for stabilization with intramuscular injection of MgSO4 40%, nifedipin 10 mg per oral, intravenous injection of dexamethasone 12 mg, and plan to terminate the pregnancy by caesarean procedure. The male baby was born, 2000 g weight and APGAR score 4/6/8. After the cesarean the consciousness not so well. Collaborating therapy to handle the case, with the anesthesiologist, internist and neurologist. Maternal death occurred in 3 days hospitalized …caused by multi organ failure (MOF). Conclusion: The maternal death caused by antepartum eclampsia and the complication. The diagnosis of antepartum eclampsia and HELLP syndrome was decided based on history taking, physical examination, and supporting examination. Multiple organ failure exist in this case when the patient came to MHGH. Patient already treated and tried to overcome the complication but maternal death still occurred. This maternal death has a likely same story of previous death pattern. It is needed a strategy to prevent or to reduce the maternal death and how to make a good effort to cease the case become severe or worst.

Maternal Death Cause by Antepartum Eclampsia, With HELPP Syndrome and AKI Stage III : A Preventable Recurrent Death

Background: Eclampsia and severe preeclampsia is of the most frequent cause of maternal death. We usually find the case like this in our daily practice. The case most likely could be prevented. Eclampsia defined as a generalized seizure following preeclampsia in pregnancy. Eclampsia/Preeclampsia (EPH-Gestosis) cause a multisystem dysfunction such as HELLP syndrome, microangiopathy hemolytic anemia, liver dysfunction, and thrombocytopenia. Eclampsia and HELLP syndrome lead to maternal mortality, which happened mostly during third trimester. Most of the patient came to the hospital in a bad condition where the multi organs failure were exist. EPH-Gestosis are due to maternal death in 43,75%. Even the case usually severe, it’s a preventable death. A proper strategy is needed to reduce or to avoid the maternal death.Objective: To analyse a maternal death with eclampsia and how to prevent this recurrent death.Case Report: A woman, 30 years old, G2P1A0 32 weeks pregnant not in labor with antepartum eclampsia was admitted to Mohammad Hoesin General Hospital (MHGH) Palembang, a referral case. Patient experienced generalized seizure six times before coming to MHGH which every seizure duration is less than five minutes and unconscious. On physical examination, patient was conscious, with blood pressure of 160/100 mmHg, pale, and cold extremities. By ultrasound examination, it showed 34 weeks pregnancy with single life fetus. Laboratory examination showed leukocytosis (25.000/mm3), thrombocytopenia (58.000/mm3), hyperbilirubinemia, elevated SGOT and SGPT (1691 and 861 U/L), elevated creatinine serum (2,46 mg/dl), and elevated LDH (3629 U/L). The patient was treated based on the protocol for stabilization with intramuscular injection of MgSO4 40%, nifedipin 10 mg per oral, intravenous injection of dexamethasone 12 mg, and plan to terminate the pregnancy by caesarean procedure. The male baby was born, 2000 g weight and APGAR score 4/6/8. After the cesarean the consciousness not so well. Collaborating therapy to handle the case, with the anesthesiologist, internist and neurologist. Maternal death occurred in 3 days hospitalized …caused by multi organ failure (MOF). Conclusion: The maternal death caused by antepartum eclampsia and the complication. The diagnosis of antepartum eclampsia and HELLP syndrome was decided based on history taking, physical examination, and supporting examination. Multiple organ failure exist in this case when the patient came to MHGH. Patient already treated and tried to overcome the complication but maternal death still occurred. This maternal death has a likely same story of previous death pattern. It is needed a strategy to prevent or to reduce the maternal death and how to make a good effort to cease the case become severe or worst.

Maternal and Perinatal outcome in eclampsia at a teaching hospital of Eastern Nepal

Introduction: Eclampsia is a multisystem disorder with potential life-threatening complications that can result in significant maternal and fetal morbidity and mortality. The case fatality rate of eclampsia is 1.8% in developed countries, 17.7% in India and 13% in Nepal. The incidence of pre-eclampsia and eclampsia is high in developing countries due to hypoproteinemia, malnutrition and poor obstetric facilities.
 Objective: To assess the maternal and perinatal outcome in patients of eclampsia
 Methodology: This was a hospital based cross-sectional study where all the patients presenting with eclampsia from June 2019 to November 2020 in the department of Obstetrics & Gynecology, Birat Medical College and Teaching Hospital were enrolled for the study. Data analyzed included various maternal parameters and fetal parameters along with the mode of delivery, outcome of baby, postpartum maternal condition and maternal mortality were noted.
 Results: Among 6631 deliveries, 50 patients had eclampsia with the incidence of 7.54/1000 deliveries. Thirty four (68%) patients were of 20-30 years of age, 37 (74%) were primigravidas, 36 (72%) from rural areas, 34 (68%) were illiterate, 49 (98%) were low to middle socioeconomic status, 41 (82%) were unbooked and 33 (66%) patients had antepartum eclampsia. Eleven (22%) women developed eclampsia related complications. There were 02 (4%) maternal deaths and the common causes were HELLP Syndrome and pulmonary oedema. Neonatal outcome consisted of live births in 39 (78%) newborns, 03 (6%) were still births, 08 (16%) were birth asphyxia and 15 (30%) were low birth weight.
 Conclusion: Majority of the patients were young, illiterate, unbooked primi gravidas with poor to average socioeconomic status from rural areas. Majority of the eclamptic women nearly 39 (78%) cases delivered via caesarean section for better neonatal outcome. Two (4%) eclamptic women died as a result of eclamptic complications and three (6%) newborns had neonatal deaths because of low birth weight and prematurity. Adequate antenatal screening, early detection of hypertension, timely referral, and early initiation of treatment and termination of eclamptic patients can help to improve the maternal and perinatal outcomes.

Posterior reversible encephalopathy syndrome (PRES): A rare disease; review of literature

Posterior reversible encephalopathy syndrome (PRES) is a complex multifactorial disorder diagnosed by clinical symptoms and radiological features. Clinically it presents with headache, diminution of vision, altered mental status, seizures and prolonged comatose state. Diagnosis is confirmed by brain imaging studies (CT/MRI) by presence of vasogenic edema of white matter in parietal and occipital lobes. It is commonly seen in young aged adults with female preponderance. Most commonly it is seen in woman with hypertension and preeclampsia/eclampsia. Early diagnosis and prompt treatment helps in better management of syndrome and thereby preventing the permanent complications. Authors here review the literature via discussing a case of 20 year old pregnant woman who came with ante partum eclampsia and was diagnosed with PRES syndrome. Keywords: Eclampsia, Encephalopathy, Headache, Preeclampsia, PRES.

Medico-Social Characteristics of Patients with eclampsia in a metropolitan hospital in North western Nigeria: Is there a changing pattern?

Background: Eclampsia is a recognized cause of maternal and neonatal morbidity and mortality in North western Nigeria. It’s a preventable obstetrics calamity were adequate antenatal care services are provided.Objective: To review medico-social characteristics of patients with eclampsia at a metropolitan Specialist Hospital in North-western Nigeria,Methodology: Eighty consecutive patients that presented with eclampsia at Murtala Mohammed Specialist Hospital were recruited for the study from 1st December, 2016 to 28th February, 2017. Data were collected using structured questionnaire, administered by research assistants. Information obtained included sociodemographic data, duration of fits before presentation and maternal-fetal outcome.Results: A total of 1931 patients delivered within the study period, among them 80 had eclampsia. This gives an incidence of 4.0%. Teenage pregnancy accounted for 35%. Forty-nine patients (61.2%) were primigravidae and up to 95% were booked. Majority of the patients 40(50%) had antepartum eclampsia while only 10(12.5%) had postpartum eclampsia. Most of the patients (73.8%) presented within 12 hours of convulsions and (87%) had vaginal delivery. There were 3 maternal deaths with case fatality rate of 3.8%. Live birth was achieved in 65%. Fresh still birth and Macerated still births were recorded in 20% and 12.5% respectively.Conclusion: The incidence of eclampsia is still high despite introduction of free maternity care services. Socio medical factors and poor quality of Antenatal Care services may be the contributing factors to development of eclampsia. There is need to review and improve the quality of antenatal care services offered at the primary health care centers.

Fetal outcome in Premature Rupture of Membrane – A study conducted in a tertiary level hospital in Bangladesh

Background: Perinatal mortality is high if premature rupture of membrane (PROM) occurs when fetuses are of previable gestational age.
 Objective: To find out the effect of premature rupture of membrane in pregnancy on its fetal outcome.
 Methods: A cross-sectional study was conducted in Department of Obstetrics and Gynaecology of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, from February to July of 2008, on 50 pregnant women with more than 28 weeks of pregnancy both primigravid and multigravid with rupture of membranes prior to labour. Women who were admitted with rupture of membranes with established labour, or having antepartum hemorrhage, pre-eclampsia or eclampsia were excluded from the study. Out of 775, only 95 patients were admitted with history of premature rupture of membrane (PROM). Among those patients, 50 cases were included in this study as per inclusion and exclusion criteria. Then their mode of delivery and outcome of fetal parameters were recorded.
 Results: 48 live births were observed and there were 2 fetal losses. Among 48 live newborns, 28 (58.33%) were male and 20 (41.66%) were female. 54.16% of babies had APGAR score at 5 minutes after birth was >7 and those needed no treatment. APGAR score was 7 in 45.82% babies; all of them were treated and cured. Among the newborns, 52.08% babies had birth weight >2500 gm, 45.83% had their birth weight in between 1500 and 2500 gm, while 1 (2.08%) was between 1000 and 1500 gm. However, 22 (45.83%) were affected by the consequences of PROM and birth process. Among them, 36.36% developed jaundice, 29.27% suffered from birth asphyxia, and RTI and neonatal sepsis were evident in 18.18% each. 15% babies were treated conservatively in Department of Obstetrics, while 7% babies were treated in the Neonatal Ward under Department of Paediatrics after admission.There was no neonatal loss.
 Conclusion: Despite progress in obstetric and neonatal care over the past few years, fetal outcomes in pregnancies with PROM remains disappointing to date.
 Mediscope Vol. 7, No. 2: July 2020, Page 108-112

A RETROSPECTIVE STUDY OF FETOMATERNAL OUTCOME IN ECLAMPSIA

In India the perinatal and maternal outcome in eclampsia cases is still poor due to inadequate antenatal care in rural areas, financial restraints and non-availability of transportation facilities, and social taboos causing delay in management resulting in poor maternal and neonatal outcome. Aim of the study was to evaluate fetomaternal outcome in patients with eclampsia. This retrospective study was conducted over a period of 2 years from May 2018 to April 2020 at department of obstetrics and gynaecology of Government medical college and Sir T General hospital, Bhavnagar , Gujarat , India. During the review period total 50 cases of eclampsia reported.Incidence in our study is 0.43%.Results showed 86 % of eclampsia patients were of age less than 25 years. 82% of patients had antepartum eclampsia , 14 % had postpartum eclampsia and 4% had intrapartum eclampsia . 90% patients had 1 episodes of convulsion. 8% patients had 2 episodes of convulsions.2% pateint had 5 episode of convulsion. Out of 50 patients 36 patients were delivered by C-section and 14 patients by vaginal delivery.1 patient had twin pregnancy.Out of 51 newborn, 5 were stillbirth and 1 early neonatal death.Maternal mortility was 2 % .Eclampsia is still one of the important and common obstetric emergencies, which has a significant role in maternal and perinatal outcome. Regular Antenatal Care (ANC), proper health education, improvements of socioeconomic conditions and spreading of awareness in the community has major roles in prevention of eclampsia. Timely and appropriate intervention including primary management, early referral and judicious termination of pregnancy help in reducing morbidity and mortality of both mother and fetus.
 Keywords: Eclampsia, Fetomaternal outcome.

A comparative study of 25mcg of oral and vaginal misoprostol in induction of labour at term gestation in primigravida

Background: Labour induction is one of the common medical procedures in obstetrics. The aim is to end the pregnancy when continuity is a risk to mother or fetus. Prostaglandins have been used successively for cervical ripening and for induction of labour since early 1970’s.This comparative study is undertaken to evaluate the safety and efficacy of oral and vaginal routes of administation of misoprostol for induction of labor. Material and Methods: A prospective randomised controlled trial done on 196 Patients of admitted in Rajkiya Mahila chikitsalaya, JLN Medical College, Ajmer as per inclusion and exclusion criteria, informed consent was taken and randomization into two groups. The women in the oral group were 25 µg of misoprostol with a sip of water, and vaginal group had one 25 µg of misoprostol tablet inserted in the posterior vaginal fornix without use of lubricant (maximum upto 6 doses). Results: Our study showed that Full term (26.5%), followed by severe preeclampsia (24.4%), post-dated (16.3%), Mild PE (12.2%), Antepartum eclampsia (10.2%) and Polyhydramnios (10.2%) were indication for induction of labor. High rate of caesarean section in oral group than vaginal group 32 (32.6%) vs 16(16.3%). The commonest indication of caesarean section was fetal distress in both the groups. Failed induction was also higher in oral group than vaginal group 8(8.1%) vs 4(4%). Conclusion: Our study shows that for induction of labour vaginal route is preferable to oral route when used in equivalent dosage of 25 µg in primigravida. In vaginal route of administration compared to oral route number of dosage required is less, induction delivery interval is less, less incidence of failed induction, less rate of caesarean section, less requirement of oxytocin augmentation, less maternal side effects of the drug. The onset of uterine activity was earlier in oral group. Neonatal outcome is comparable in both groups. The increase efficacy associated with vaginal misoprostol raises the possibility of a local cervical effect with the vaginal administration.

Fetomaternal Outcome of Eclamptic Patient in Secondary Health Care Level-3 years study

Background: Eclampsia is defined as the development of seizures that cannot be attributed to other causes and /or unexplained coma during pregnancy or puerperium in a woman with pre-eclampsia. The purpose of this hospital based observational study is to evaluate the extent of the problem and to estimate the associate of foetal and maternal complications
 Methodology: The observational study was carried out Department of Obstetrics and Gynaecology in 250 bedded general Hospital Tangail from January 2015 to November 2017. All on the diagnosed patients of eclampsia were included in this study.
 Results: Regarding types of eclampsia 187(62.3%) patients had antepartum eclampsia, 78(26.0%) had postpartum eclampsia and 35(11.7%) had intrapartum eclampsia. Majority (57.0%) patients had 5-9 times of convulsion, 65(21.7%) had >10 times and 64(21.3%) had <5 times of convulsion. Most (95.0%) patients had cesarean section and 15(5.0%) had normal vaginal delivery (NVD). Maternal alive was found 293(97.7%) and death was 7(2.3%). Male baby was found 203(67.7%) and female baby was 97(32.3%). More than three fourth (75.7%) babies had weight 2.5-4.0 kg. Alive babies were found 282(94.0%), neonatal death was 8(2.7%) and intrauterine death was 10(3.3%).
 Conclusion: Improving ante-natal and emergency obstetric and neonatal care is mandatory to improve the outcome.
 Anwer Khan Modern Medical College Journal Vol. 11, No. 1: Jan 2020, P 11-15

Clinical and Radiological Features of Posterior Reversible Encephalopathy Syndrome in Patients with Antepartum Eclampsia

Clinical and Radiological Features of Posterior Reversible Encephalopathy Syndrome in Patients with Antepartum Eclampsia

Eclampsia: A five-year retrospective review in Sagamu, South-West Nigeria

Context: Eclampsia is one of the leading causes of maternal and perinatal morbidity and mortality in developing countries. This is the result of poor health-seeking behavior of pregnant women and inadequate comprehensive emergency obstetric services. This study reviewed the presentation and management of eclampsia in Sagamu over a 5-year period. Aims: This study aims to determine the prevalence, pattern of clinical presentation and fetomaternal outcomes of eclampsia. Settings and Design: This was a retrospective study conducted in Olabisi Onabanjo University Teaching Hospital Sagamu, Ogun state. Subjects and Methods: Relevant information was retrieved from case notes of all patients who presented with eclampsia from January 2014 to December 2018. Data were analyzed using SPSS version 21. Results: Out of the 4656 deliveries, there were 45 cases of eclampsia giving a prevalence of 0.97%. The modal age was 20–24 years. Majority were unbooked 41 (91.1%) and 29 (64.4%) of the women were nulliparas. Antepartum eclampsia was commonest occurring in 36 women (80%). The most common premonitory symptom was headache occurring in as high as 37 women (82.2%). Most of the patients 37 (84.4%) had an abdominal delivery. There were two maternal mortalities (4.4%) and four perinatal deaths (8.9%). There was no statistically significant association between factors such as booking status, type of eclampsia, mode of delivery and parity, and the fetal outcome (APGAR score at 1 min). Conclusions: Eclampsia is still one of the preventable causes of maternal and perinatal mortality in our environment. The prevalence of eclampsia in sagamu was 0.97%. Improved health-seeking behavior, antenatal care monitoring, and prompt diagnosis and management of preeclampsia will invariably reduce the prevalence of eclampsia.

Eclampsia in Australia and New Zealand: A prospective population-based study.

Eclampsia is a serious consequence of pre-eclampsia. There are limited data from Australia and New Zealand (ANZ) on eclampsia. To determine the incidence, management and perinatal outcomes of women with eclampsia in ANZ. A two-year population-based descriptive study, using the Australasian Maternity Outcomes Surveillance System (AMOSS), carried out in 263 sites in Australia, and all 24 New Zealand maternity units, during a staggered implementation over 2010-2011. Eclampsia was defined as one or more seizures during pregnancy or postpartum (up to 14days) in any woman with clinical evidence of pre-eclampsia. Of 136 women with eclampsia, 111 (83%) were in Australia and 25 (17%) in New Zealand. The estimated incidence of eclampsia was 2.2 (95% confidence interval (CI) 1.9-2.7) per 10000 women giving birth. Aboriginal and Torres Strait Islander women were over-represented in Australia (n=9; 8.1%). Women with antepartum eclampsia (n=58, 42.6%) were more likely to have a preterm birth (P=0.04). Sixty-three (47.4%) women had pre-eclampsia diagnosed prior to their first eclamptic seizure of whom 19 (30.2%) received magnesium sulphate prior to the first seizure. Nearly all women (n=128; 95.5%) received magnesium sulphate post-seizure. No woman received prophylactic aspirin during pregnancy. Five women had a cerebrovascular haemorrhage, and there were five known perinatal deaths. Eclampsia is an uncommon consequence of pre-eclampsia in ANZ. There is scope to reduce the incidence of this condition, associated with often catastrophic morbidity, through the use of low-dose aspirin and magnesium sulphate in women at higher risk.

Various Presentations of Preeclampsia at Tertiary Care Hospital of Sindh: A Cross-Sectional Study.

Preeclampsia is multi-systemic hypertensive pregnancy disorder accompanied by proteinuria. To determine the frequency of different presentations of preeclampsia in tertiary care hospital and find out its risk factors. The present study was hospital-based cross-sectional study and conducted from 1st August 2015 to 31st July 2016 in Gynaecology and Obstetrics Department, Liaquat University of Medical and Health Sciences (LUMHS), Hyderabad after ethical approval. A total of 112 pre-eclamptic women were enrolled during the study period by non-probability consecutive sampling. Patients were divided on the basis of their presentations into mild preeclampsia, severe preeclampsia, antepartum eclampsia, intrapartum eclampsia, HELLP syndrome, postpartum preeclampsia, postpartum eclampsia and atypical preeclampsia/eclampsia. All the sociodemographic factors and clinical variables were noted. Frequency and percentage were calculated for categorical variable and mean/standard deviation (SD) for continuous variables. Of the 112 preeclamptic women, 54.5% were admitted with antepartum eclampsia, 12.5% with severe preeclampsia, 8.9% with atypical preeclampsia/eclampsia, 8% with mild preeclampsia, 8% with postpartum eclampsia, 3.6% with HELLP syndrome, 2.7% with intrapartum eclampsia and 1.8% with postpartum preeclampsia. Overall, majority of the patients were primigravida (57%), had gestational age >34 weeks at presentation (58.9%) and < 7 antenatal visits (88.3%) during their pregnancy. Overall 17.8% had previous bad obstetrical events, 11.6% had previous history of preeclampsia and 64.3% had consanguineous marriages. Different presentations of preeclampsia may help obstetricians to rule out high- risk pregnancies and provide antenatal care to patients earlier to prevent complications to both mother and fetus.