Eclampsia In Relation Research Articles

A 13-Year Review of Eclampsia and Anesthetic Techniques at a Single Tertiary Care Center

Objective: To assess recent perinatal outcomes of women with eclampsia in relation with the choices of anesthesia. Materials and Methods: The electronic medical records of women with eclampsia that delivered at a single tertiary care center between January 2005 and December 2017 were retrospectively reviewed. Anesthesiologists had the discretion to decide the choice of anesthesia for cesarean delivery. Results: The authors identified 45 eclampsia cases from 113,914 deliveries during the study period. The mean ± standard deviation (SD) of maternal age and gestational age at delivery of the cases was 24.4±8.5 years and 35.4±3.0 weeks, respectively, and 32 (71.1%) were primigravids. There were 29 (64.4%), eight (17.8%), and eight (17.8%) eclampsia cases that occurred antepartum, intrapartum, and postpartum, respectively. Out of the cohort, 35 (77.8%) underwent Cesarean delivery, of which 18 (51.4%) and 17 (48.6%) received general anesthesia or combined, and regional anesthesia, respectively. There was one (2.2%) maternal and three (6.67%) neonatal deaths. The general anesthesia group had a higher incidence of platelets of less than 100,000/mL and higher admission to the intensive care unit (p<0.05). Conclusion: Eclampsia remains a cause of serious perinatal morbidity. Most eclampsia occurred without prior risks, warning signs, or a critically high blood pressure. With proper patient selection and individualization, general or regional anesthesia is safe. The higher intensive care unit admissions were likely attributable to severe sequelae of eclampsia in those that underwent a general anesthesia. Keywords: Eclampsia, General anesthesia, Spinal anesthesia, Epidural anesthesia, Perinatal outcomes

Epidemiology of Eclampsia in Bangladesh

Background: The purpose of these study was to find out the risk of eclampsia in relation to several demographic and anthropometric factor and to find out a way to prevent eclampsia.
 Objective: To find out the epidemiology of eclampsia and to reduce maternal and neonatal mortality and morbidity due to eclampsia.
 Materials and Methods: A cross sectional descriptive study was conducted to assess the fetomaternal outcome of eclampsia. The study was carried out at the Eclampsia unit, Dhaka Medical College Hospital, Dhaka over a period of six months from 1st July 2008 to 31st December 2008. A total of 48 patients with diagnosis of antepartum and intrapartum eclampsia were consecutively taken in the study. The test statistics used to analyse the data were descriptive statistics.
 Results: About 39.6% of the patients was under the age of 20 years, 43. 7% patient was between the age of 20-25 years. By occupation 77.1% patient was housewife, 17.9% patient was Garments worker and 4.1% patient was day labour. By level of education about 56.3% patient was illiterate, 29.2% patient was of primary level. About 57% of patients remained unconscious. About 7% of patients developed acute renal failure,16.7% CVA,14.6% HELLP syndrome and 39.6% pulmonary oedema. The mean hospital stay was 9.5 ± 3.3 days. Majority (93.8%) of the patients recovered while 6.3% died.
 Conclusion: Eclampsia is still a major cause of maternal mortality and morbidity in Bangladesh. A qualitative and quantitative improvement in prenatal consultation should make it possible to reduce incidence of eclampsia in our community. Monitoring of high-risk patients may reduce the complication rate.
 KYAMC Journal Vol. 11, No.-4, January 2021, Page 189-192

Spatio-temporal patterns of pre-eclampsia and eclampsia in relation to drinking water salinity at the district level in Bangladesh from 2016 to 2018

This analysis examines whether salinity in drinking water is associated with pre-eclampsia and eclampsia (PE/E), a leading cause of maternal morbidity and mortality. Bangladesh’s national health information system data were extracted at the district level (n = 64) to assess PE/E rates, and these were overlaid with three environmental measures approximating drinking water salinity, remotely sensed low-elevation coastal zone (LECZ), monthly rainfall data, and electrical conductivity of groundwater (i.e., water salinity). Results from a negative binomial fixed effects model suggest PE/E rates are higher with less rainfall (dry season), lower population density, and that district level rates of PE/E increase with higher groundwater salinity and in the high risk LECZ category closest to the coast. Results suggest that drinking water salinity may be associated with PE/E and that using national health surveillance data can improve understanding of this association. This approach can potentially be leveraged in the future to inform targeted interventions to high risk regions and times.

Eclampsia at a tertiary care hospital of Nepal: A five year study

Background and Objectives: Eclampsia poses a global threat in terms of feto-maternal morbidity and mortality and all medical practitioners fear the ailment. It is one of the major causes behind preventable maternal death. Etio-pathogenesis of the disease condition is ambiguous and is considered to be multi-factorial. This study was done to analyze cases of eclampsia in relation to maternal and fetal outcomes at a tertiary level care hospital.
 Materials and Methods: A descriptive cross-sectional observational study was carried out in patients developing eclampsia over a period of five years starting from July 2011 to June 2016 at National Medical College and Teaching Hospital, Birgunj. Relevant data were collected from the statistics section of hospital reviewing the case sheets.
 Results: There were 291 cases of eclampsia out of 16,445 deliveries and prevalence of eclampsia was calculated to be 1.77%. Fourty-five percent of eclamptic women had age less than 20 years and two-third was primigravida. Approximately 84% of women were unbooked. Antepartum eclampsia was observed in 78.8% followed by postpartum eclampsia (14.8%) and intrapartum eclampsia (6.5%). At the time of admission systolic blood pressure more than 140 mmHg and diastolic blood pressure more than 90 mmHg were noted in 79% and 92.1% cases respectively. Caesarean section was the preferred mode of delivery and was performed in 62.9% cases. ICU admission was required in 35.7% and remaining cases were managed in general/eclampsia ward. Renal failure was the most common cause of maternal mortality seen in 29.4%. Still birth was noted in 13.4%.
 Conclusion: Institutional obstetric patients are gradually facing eclampsia as prime cause of maternal death and unfortunately most of the cases are primigravid at younger age. All health care professionals should be proficient to manage eclamptic women instantaneously.
 Key words: Eclampsia; Fetal Mortality; Maternal Mortality; Pre-Eclampsia

A Prospective Observational Study on Maternal and Fetal Outcome in Eclampsia in a Tertiary Care Hospital

Background: To study maternal outcome in eclampsia in relation to respiratory complications, fever, DIC, renal system affection and electrolyte imbalance. (2) To study the fetal outcome in eclampsia in relation to small for gestational age, intrauterine death, neonatal mortality, perinatal mortality and need for NICU admission. Methods: It was a cross-sectional prospective study conducted at Department of Obstetrics and Gynaecology at Department of Gynaecology, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab, India. All patients admitted with eclampsia was enrolled for the study as per the criteria given. It was a a cross-sectional prospective study conducted on women admitted with eclampsia after the gestational age of 20 weeks and presented with convulsions. The outcome in relation to maternal and neonatal morbidity and mortality was studied on the basis of various complications and defined parameters. Results: A total of 50 patients were enrolled in the study. The most common age group of patients who had eclampsia after 20 weeks of gestation belonged to age group of 31-35 years followed by 26-30 years and the least common age group was between 41- 45 years of age. The mean age was found to be 28.23 years. The most common indication of LSCS in patients with eclampsia was fetal distress followed by Unfavourable cervix, failure of induction and contracted pelvis. The most common complications seen in patients with eclampsia included Respiratory complications like aspiration pneumonia, pleural effusion and pulmonary edema. Conclusions: Less ANC visits were associated with more threat and complications. Eclampsia was found to be associated with preterm delivery. Increase in convulsion to delivery interval lead to increase severity of complications.

Repercusión de la preeclampsia/ eclampsia en la mujer peruana y su perinato , 2000-2006

Objetivos: Determinar las características maternas de la preeclampsia (PE) y eclampsia (E) en hospitales del Perú y las repercusiones en las madres y sus recién nacidos. Diseño: Estudio observacional, analítico, de corte transversal. Lugar: Hospitales del Ministerio de Salud (MINSA), Perú. Participantes: Gestantes sin PE/E y con preeclampsia y eclampsia, y sus recién nacidos. Métodos: Se realizó un estudio de los datos del Sistema de Información Perinatal SIP 2000 de 310 795 gestantes y sus 314 078 recién nacidos (RN) atendidos durante los años 2000 a 2006 en 28 hospitales del Ministerio de Salud del Perú. Para el análisis de los datos se usó los paquetes estadísticos SPSS 14.0 y Epi Info 6.0. Principales medidas de resultados: Características maternas y neonatales y repercusiones por la PE/E. Resultados: Del total de gestantes, 295 075 no tuvieron PE/E (94,9%) y 15 720 sufrieron de PE/E (5,1%) [14 993 (4,8%) preeclampsia y 727 (0,24%) eclampsia]. Se asociaron a la PE de manera significativa la edad materna de 35 años o más, el embarazo gemelar, el desprendimiento prematuro de placenta y el parto por cesárea; y se relacionaron a la eclampsia ser menor de 20 años, la soltería, analfabetismo/educación incompleta, el embarazo múltiple, desprendimiento prematuro de placenta y el parto por cesárea. En los recién nacidos de madres con PE/E, hubo significativamente peso bajo para la edad gestacional, Ápgar bajo que requirió reanimación y peso menor a 2 500 g al egreso del RN. Hubo tendencia a mayor mortalidad materna y neonatal en la eclampsia, en relación a las gestantes sin PE/E o con preclampsia sin convulsiones. Conclusiones: En el presente estudio sobre la PE/E en hospitales peruanos del MINSA, la incidencia y la morbimortalidad materna y neonatal fueron similares a la de otros países y se asociaron a factores sociales y etarios. Es indispensable continuar actualizando la información, para conocer la evolución de esta temible complicación del embarazo en nuestro país.

Clinical guidelines in severe pre‐eclampsia and eclampsia

PurposeThis article aims to assess the standard local recommended management of women with severe pre‐eclampsia and eclampsia in relation to recommendations in a national clinical guideline using a criterion‐based survey.Design/methodology/approachA total of 227 maternity units in the UK were asked to provide a copy of their guideline for the management of severe pre‐eclampsia and eclampsia. Responses were obtained from 107 units (47.1 per cent), 37 units were using regional guidelines and 72 guidelines were available for assessment. A total of ten audit criteria were agreed by committee, based on national recommendations. Guidelines were then audited to assess concurrence with these criteria.FindingsThe standard of guidelines was highly variable with only four guidelines (4.5 per cent) satisfying all ten key guideline points. The majority of guidelines had clear criteria for inclusion (87.5 per cent) but in almost a quarter of all guidelines no mention was made of informing consultant staff once these criteria were met.Practical implicationsThe study shows that the standard of local guidelines for management of these potentially fatal conditions is highly variable. Confidential inquiry has repeatedly recommended the use of regional guidelines. Perhaps it is time for the development of a national guideline representing consensus agreement of an evidence‐based approach.Originality/valueIn the UK eclampsia and pre‐eclampsia continue to be a leading cause of maternal mortality and morbidity. This paper provides a valuable insight into the standard of guidelines used in the management of these conditions.

Late postpartum eclampsia: A preventable disease?

Objective: The purpose of this study was to determine whether there is a shift in the timing of eclampsia in relation to delivery and whether traditional symptoms precede impending postpartum eclampsia. Study Design: A multicenter analysis of data from patients with eclampsia from March 1996 through February 2001 at the University of Cincinnati, the University of Tennessee, Memphis, and Central Baptist Hospital, Lexington. Data were collected regarding the relationship of the patient's first seizure to delivery, prodromal symptoms, neuroimaging studies, use of magnesium sulfate, antihypertensive therapy, and follow-up medical care. The analysis focused on women who had late postpartum eclampsia. Results: During the study period, 89 patients were diagnosed with eclampsia. Twenty-nine women (33%) had postpartum eclampsia, of whom 23 women (79%) had late onset (>48 hours). Interestingly, only 5 of these 23 women (22%) had been previously diagnosed with preeclampsia. Twenty-one patients (91%) with late postpartum eclampsia had at least 1 prodromal symptom, and 12 patients (52%) had >1 symptom that heralded the seizure: 20 women (87%) had headache; 10 women (44%) had visual changes; 5 women (22%) had nausea or vomiting; and 2 women (9%) experienced epigastric pain. Only 7 of these 21 women (33%) sought care for their symptoms, of whom 6 women (86%) had clinical evidence of preeclampsia that was not considered by the treating physician. Among all patients with eclampsia, there were 7 cases of aspiration pneumonia, 3 cases of pulmonary edema, 3 cases of pleural effusion, 2 cases of disseminated intravascular coagulation, and no cases of maternal death. Conclusion: Current obstetric treatment in the United States has resulted in a shift of eclampsia toward the postpartum period, with most cases being seen as late post partum. To reduce the rate of late postpartum eclampsia, efforts should be directed to the education of the health care providers and patients regarding the importance of prompt reporting and evaluation of symptoms of preeclampsia during the postpartum period. (Am J Obstet Gynecol 2002;186:1174-7.)

Epidemiology of eclampsia.

The purpose of this study was to examine the risk of eclampsia in relation to several maternal characteristics and exposures, including demographic characteristics, reproductive history, and tobacco use during pregnancy. A case control study was conducted using data for all singleton births from the Washington State birth certificates for 1984-1990. In the check box feature employed by these certificates, eclampsia is listed under maternal conditions. Risk estimates, adjusted for various confounders, were calculated comparing eclampsia among exposed versus unexposed women. The risk of eclampsia was elevated in women without prenatal care, those with weight gain of more than thirty pounds during pregnancy, nulliparous women, and those with chronic hypertension. The association with tobacco smoking were inverse and dose related. Women's race, urban or rural place of residence, history of pre-term births, and anemia were not associated with eclampsia. Our data reaffirm the importance of prenatal care, and provide further evidence of an inverse relationship with prenatal smoking. As eclampsia and pre-eclampsia are important pregnancy complications, further research is needed to explore their possible causes.

A Study of Late Postpartum Eclampsia - 178 Cases

Objective: The purpose of this study was to determine whether there is a shift in the timing of eclampsia in relation to delivery and whether traditional symptoms precede impending postpartum eclampsia. Study Design: A cross - sectional hospital - based study conducted at Gynae Unit, Dhaka Medical College Hospital from January 2006 - December 2007. Data was collected regarding the relationship of the patient's first seizure to delivery prodromal symptoms, neuroimaging studies, use of magnesium sulfate, antihypertensive therapy and follow up medical care. The analysis focused on women who had late postpartum eclampsia. Result: During the study period 178 patients were diagnosed with eclampsia. Fifty eight women (33%) had postpartum eclampsia, of which 46 women (79%) had late onset (> 48 hrs.). Interestingly only 10 of these 46 women (22%) had been previously diagnosed with preeclampsia. Forty two pt.(91%) with late postpartum eclampsia had at least 1 prodromal symptom, and 24 pt. (52%) had> 1 symptom that heralded the seizure : 40 women (87%) had headache , 20 women (44%) had visual changes, 10 (22%) had nausea or vomiting and 4 (9% ) experienced epigastric pain. Only 14 of this 42 women (33%) sought care for their symptoms , of whom 12 women (86%)had clinical evidence of preeclampsia that was not considered by the treating physician. Among all patients with eclampsia there were 14 cases of aspiration pneumonia,6 cases of pulmonary edema, 6 cases of pleural effusion 4 cases of DIC and no cases of maternal death. Conclusion: Current obstetric treatment has a resulted in a shift of eclampsia toward the postpartum period with most cases being seen as late postpartum. To reduce the rate of the postpartum eclampsia, efforts should be directed to the education of the health care providers and patients regarding the importance of prompt reporting and evaluation of symptoms of preeclampsia during the postpartum period. DOI: 10.3329/bmj.v37i2.3594 Bangladesh Medical Journal 37(2) 2008 52-55