Imminent Eclampsia Research Articles

Complete Lung Atelectasis Following Caesarean Section in a Case of Imminent Eclampsia- A Case Report

In the early postpartum period, acute life-threatening problems can occur and cause maternal morbidity and mortality. In the present case report, a 19-year-old primipara had undergone caesarean delivery following which she developed breathlessness, tachycardia and fall in oxygen saturation after 14 hours of surgery. Her Chest X-Ray (CXR) report confirmed a complete collapse of the left lung. Contrast-enhanced Computed Tomography (CECT) of the thorax showed a complete collapse of the left lung due to obstruction at the level of the proximal main stem bronchus. Medical management with mucolytics was administered. The patient showed improvement clinically and a repeat CXR after 24 hours showed normal lung findings with complete resolution of collapse and medical management was continued. The patient recovered progressively and follow-up of the patient was uneventful. This is a rare case of development of respiratory distress and atelectasis, hence proper diagnosis is essential.

Posterior reverse encephalopathy syndrome with myriad of etiologies and presentations

We hereby report cases of posterior reverse encephalopathy syndrome (PRES) with varying etiologies, presentations, and treatment outcomes. In this series, amongst four cases of PRES with sudden diminution of vision, two were male patients with high blood pressure, one was a case of pulmonary tuberculosis, and one case of imminent eclampsia. All patients were treated with respect to underlying etiopathology. Although appalling at presentation, the cases showed marked improvement clinically within the first week. There is need for high index of suspicion, and improvement of clinical condition suggests excellent prognosis in PRES cases.

FETOMATERNAL OUTCOME IN EARLY ONSET SEVERE PRE ECLAMPSIA

Introduction:Preeclampsia is a multisystem disorder occurring exclusively during pregnancy whose exact etiology is yet unknown. It occurs in approximately 5-7% of pregnancies. Early onset preeclampsia (<34 weeks gestational age) occurs in less than 1% of pregnancies and is often associated with maternal morbidity as the riskof progres­sionto severe maternal disease is inversely related with gestational age at onset. Material And Methods:100 pregnant women admitted to labor room in the department of OBG, Govt. medical college,Kota Rajasthan between 1 February 2021 – 31 January 2022who fulfilled the criteria ( Gestational age ≥ 24 weeks &< 34 weeks , diastolic BP ≥ 110 mm Hg, with any features of severe pre eclampsia ) were included in this study . Results:In the present study, Out of 100 patients of early onset severe preeclampsia was more common in Primigravida 59(59%)in the age group of 21-30 years. Mean gestational age at diagnosis was 31weeks 3 days ± 2weeks 3 days. Most underwent termination of pregnancy after 32 weeks. Maternal indication was found to be the most common cause for termination. 31(31%) patients of the total experienced complication like imminent eclampsia, HELLP syndrome ,Acute renal failure and abruption placentae . 65 (65%) delivered by caesarean section. Mean birthweight was 1.59 kg ± 0.5kgand neonatal complication rate was 71(71%). Conclusion:Early onset severe preeclampsia is associated with significant maternal and fetal complications. Decision regarding termination of pregnancy has to be taken based on both maternal and fetal factors.

Presentation And Outcome of Eclampsia in a Tertiary Centre

Aim & Objective: Demographic datas like the patients age, gestational age, admission BP, blood and urine investigation, neuroimaging, Management, mode of delivery, neonatal and maternal outcomes were analysed in patients presenting with eclampsia in a tertiary care centre. Introduction: The onset of convulsions in a woman with pre eclampsia that cannot be attributed to other causes is termed eclampsia. Eclampsia is a major cause of maternal and neonatal morbidity and mortality. Magnesium sulfate is the drug of choice for reducing the rate of eclampsia and also to prevent recurrent convulsions in eclampsia. Materials and Methods: The study was conducted retrospectively on cases presenting with eclampsia in the OBG department, Government Rajaji Hospital for a period of 6 months from July 2019 to December 2019. Results: During the 6 month study period, total 26 cases of eclampsia was reported out of 5843 deliveries (0.4%). Total 657 cases of hypertensive disorders of pregnancy (11.2%) was reported out of which 65 cases were severe pre-eclampsia (9.8%). 65% (11) of eclampsia presented as Antepartum eclampsia, 30.7%(11) cases presented as postpartum eclampsia, 3.8%(1) case as intrapartum eclampsia. One case presented as both antepartum and postpartum eclampsia. No case of maternal mortality was reported during the study period. Conclusion: Early detection of cases of pre-eclampsia and imminent eclampsia, proper evaluation and treatment with anti-hypertensives and Magnesium sulphate will reduce the occurrence of eclampsia. Multidisciplinary approach in a tertiary care centre can reduce the maternal mortality and morbidity. Proper knowledge of management of eclampsia can reduce the mortality. IV labetalol and its careful use is mandatory. Perinatal mortality is high mainly because of prematurity.

A clinical study of perinatal and maternal morbidity and mortality in gestational hypertension, preeclampsia and eclampsia

In India, hypertensive disorders complicating pregnancy are common and continue to be responsible for the largest proportion of perinatal deaths resulting from prematurity and IUGR and are major contributors to perinatal and maternal morbidity and mortality.
 The aim: The present study is undertaken to analyse the cases of preeclampsia and eclampsia, including consequences concerning preterm delivery, IUGR, IUD and stillbirth and for the evaluation of a safe motherhood program at the population level.
 Materials and methods: The present study was conducted on 105 selected cases from the census (sample of 12,589 patients) of pregnancy-induced hypertension (gestational hypertension, preeclampsia and eclampsia).
 Results: Hypertensive cases complicating pregnancy of the foetal deliveries conducted during the study period, out of which Gestational hypertension (GTN) cases reported were 44. Preeclampsia (PE) cases were 39, severe preeclampsia (SPE) were 1 and Eclampsia cases were 21. Labetalol alone was used in 62 cases, and 44 babies were born without any complications. As an anticonvulsant magnesium sulphate (MgSO4, 7H2O) was used in all cases of imminent eclampsia and eclampsia (MgSO4 PRITCHARD Regime) in a total number of 38 cases. Preterm / prematurity was the most common cause of perinatal death. The total number of NICU admissions was 42 (40 %).
 Conclusions: The early use of anti-hypertensive drugs, the optimum timing of delivery, strict fluid balance, and anticonvulsants in cases of eclampsia will help to achieve a successful outcome. Early transfer to a specialist centre is important, and the referral centres should be well-equipped to treat critically ill patients.

MATERNAL NEAR MISS: AN INDIAN TERTIARY CARE CENTRE AUDIT

ACKGROUND: Despite advances in medical sciences and increased awareness of measures for safe child birth, unacceptably high maternal morbidity and mortality continues in developing countries like India. Ours being a tertiary care centre, draws a lot number of high risk pregnancies and referrals. By auditing the near miss cases2 i.e., a critically ill pregnant or recently delivered woman who was on the verge of death but survived a problem during pregnancy, childbirth, or within 42 days of the pregnancy's termination, we aim to identify the causes, factors leading to near miss2 and the management given to near miss2 and maternal deaths. The AIMS AND OBJECTIVES: present study aims to determine the magnitude, as well as to identify the pattern of Maternal Near Miss2 (MNM), at Siddhartha Medical College, Vijayawada, during the study period of two years. To anal OBJECTIVES: yse 1)Adverse events leading to a maternal near-miss2, 2) Disorders underlying these cases, 3)Sociodemographic factors and 4)Contributing factors A hospital based retros METHODOLOGY: pective observational study to assess the frequency and nature of maternal near miss2 events among the obstetric cases managed at Siddhartha Medical College, Vijayawada over a period of two years. The followi RESULTS: ng are the major causes identied leading to maternal near miss2 during our study Severe Eclampsia 17%, Post-partum Haemorrhage 17%, Pulmonary Edema due to severe pre eclampsia3 9%, Antepartum Eclampsia 9%, HELLP 9%, Ruptured ectopic pregnancy 7%, Cardiac failure 7%, Postpartum Eclampsia 7%, Imminent Eclampsia 4%, Abruption 4%, Rupture uterus 2%. In our study Maternal near miss2 ratio incidence: 0.0254, Severe maternal outcomes ratio : 3, Maternal near miss2 to mortality ratio: 0.433 CONCLUSION: We observed in majority of the cases level 1 and level 2 delays in reporting to our institution

RELATO DE CASO: SINDROME DE KLIPPEL-TRENAUNAY

INTRODUCTION: Klippel-Trenaunay syndrome (KTS) is a rare congenital disease, characterized by the triad: capillary malformations that manifest as port wine stain, typically venous varicosities, bone and soft tissue hypertrophy. CASE REPORT: LFRR, term newborn weighing 3360g, male, cesarean delivery due to imminent eclampsia (G3P2C0). Apgar score 9/9 with physical examination showing left lower limb with port wine stain, increased volume and diffuse violaceous lesions extending from the toes to the buttocks, palpable and symmetrical peripheral pulses. DISCUSSION: KTS management does not have a wellestablished consensus, and conservative treatment can be performed using non-invasive measures (elastic or non-elastic compressive stockings) associated or not with psychological support, elevation of the affected limb and physiotherapy. Active conducts such as sclerotherapy can be used in small areas, as well as the use of laser therapy on port wine stains and ulcerations. Sirolimus may be a promising therapeutic option for the management of venous malformations, including KTS, leading to an improvement in symptoms such as pain and a decrease in the size of the lesions. CONCLUSION: KTS, as a rare syndrome, has scarce literature. The main management is based on the use of conservative therapies, others related to the complications presented and now begins the phase of using off-label drugs (Sirolimus) that slow down the progression of the disease.

Relationship between maternal abo blood group and rh typing with maternal and perinatal outcome

The ABO blood group type has been considered an independent risk factor in pregnancy-related complications leading to significant morbidity and mortality in pregnant mothers and neonates.
 Aim: To study the relationship between maternal ABO blood group and Rh typing with maternal and perinatal outcomes.
 Materials and methods: Prospective Observational study was carried out for 24 months from November among 1000 pregnant women attending outpatient for ABO blood group and Rh typing with maternal and perinatal outcome.
 Results: Among 1000 subjects, 43.5 % belonged to blood group O, followed by 30 % in blood group B. 20.7 % had blood group A, and 5.8 % had AB blood group. In the present study, 95.4 % had Rh+ve, and 4.6 % had Rh-ve typing. The incidence of preterm labour was high at 6.3 % in the O+ve blood group, followed by 1.8 % in the AB +ve, 0.6 % in the A+ve and 0.3 % in the B+ve blood group. A statistically significant association was found between blood grouping and preeclampsia with high incidence among the A+ve blood group. A statistically significant association was found between blood grouping and imminent eclampsia with high incidence among the AB+ve blood group. There was a statistically significant association found between blood grouping and intrauterine death.
 Conclusion: The findings in the present study will help clinicians to identify the patients at risk of developing adverse pregnancy outcomes like preeclampsia and imminent eclampsia; hence, the timely intervention will help to improve maternal and perinatal outcome and also helps to reduce the complications of preeclampsia and imminent eclampsia.

Modulatory effect of two regimens of magnesium sulfate on the systemic inflammatory response in pregnant women with imminent eclampsia.

This study compared the modulatory effect of two intravenous magnesium sulfate (MgSO4) regimens on the systemic inflammatory response in pregnant women diagnosed with imminent eclampsia. In a single-blind cross-sectional study, 33 women were allocated according to the Zuspan (n=16) and Sibai (n=17) MgSO4 regimens, and treated for 24h. Blood samples were collected pre-administration of the loading dose, at 24h of the maintenance dose of MgSO4, and at 48h, when patients were without treatment. Plasma was used to determine interleukin (IL)-1 beta (IL-1β), IL-6, IL-10, tumor necrosis factor-alpha (TNF-α), heat shock protein (Hsp70), and heme oxygenase-1 (HO-1) by ELISA. The treatment with the Zuspan's regimen didn't change plasma concentrations of TNF-α, IL-10, and Hsp70 in the three-time points studied. However, it decreased IL-1β at 24h and 48h and IL-6 at 48h, and increased HO-1 concentration at 48h. On the other hand, compared to the pre-treatment period, Sibai's regimen induced a significant decrease in TNF-α, IL-1β, IL-6, and Hsp70, while increased HO-1 levels both at 24h and 48h and, IL-10 concentration at 48h. Sibai's regimen determined an early and efficient immunoregulatory effect on systemic inflammatory response in preeclampsia, suggesting that the maintenance dose of two grams of MgSO4 was better than one gram in the treatment of imminent eclampsia.

Diagnosis and Management of Preeclampsia: Suggested Guidance on the Use of Biomarkers.

It is a challenge to consider preeclampsia (PE) diagnosis and management in low and middle-income settings, where it represents a major public health concern. The placenta is the underlying cause of disease, and the plasma concentrations of proangiogenic and antiangiogenic factors released by the placenta can reflect the risks of disease progression. Antiangiogenic proteins, such as soluble fms-like tyrosine kinase 1 (sFlt-1), and proangiogenic, like placental growth factors (PlGF), are directly and inversely correlated with the disease onset, respectively. Narrative review on the use of biomarkers (sFlt-1 to PlGF ratio) with a suggested guidance protocol. Key considerations on the use of biomarkers: the sFlt-1/PlGF ratio is mainly relevant to rule out PE between 20 and 36 6/7 weeks in cases of suspected PE; however, it should not replace the routine exams for the diagnosis of PE. The sFlt-1/PlGF ratio should not be performed after confirmed PE diagnosis (only in research settings). In women with suspected PE, sFlt-1/PlGF ratio < 38 can rule out the diagnosis of PE for 1 week (VPN = 99.3) and up to 4 weeks (VPN= 94.3); sFlt-1/PlGF ratio > 38 does not confirm the diagnosis of PE; however, it can assist clinical management. In cases of severe hypertension and/or symptoms (imminent eclampsia), hospitalization is imperative, regardless of the result of the sFlt-1/PlGF ratio. The use of biomarkers can help support clinical decisions on the management of suspected PE cases, especially to rule out PE diagnosis, thus avoiding unnecessary interventions, especially hospitalizations and elective prematurity.

“CLINICALAND LABORATORY PROFILE OF PREGNANT WOMEN WITH SARSCOV-2 INFECTION AND PRE-ECLAMPSIA: CASE SERIES FROM A TERTIARY CARE HOSPITAL”.

SARS-CoV-2 infection in pregnancy is associated increased maternal and fetal complications .Pre eclampsia is one of the complication frequently seen in association with COVID-19 infection .With the available literature to date it is still uncertain whether pre eclampsia risk is increased in pregnancy with COVID-19 infection or pre eclampsia like syndrome is caused due to COVID-19 infection .This is a case series of seven pregnant women with COVID-19 infection and pre eclampsia/pre eclampsia like syndrome from a teritiary care hospital. Four of these women presented with increased severity of preeclampsia and three patients were newly diagnosed cases of preclampsia /preeclapmsia like syndrome.Maternal complications seen in this series included HELLP syndrome,abruption placenta ,imminent eclampsia ,preterm delivery .Fetal complications included prematurity , IUGR,intrauterine fetal demise ,meconium aspiration syndrome .

O-006. Modulatory effect of two regimens of magnesium sulfate on the systemic inflammatory response in pregnant women with eclampsia or imminent eclampsia

O-006. Modulatory effect of two regimens of magnesium sulfate on the systemic inflammatory response in pregnant women with eclampsia or imminent eclampsia

IMMINNENT ECLAMPSIA AND ECLAMPSIA- RISKS FACTORS AND CLINICAL PRESENTATION, 2 YEARS STUDY

Background: The anatomical, Physiological and biochemical adaptations to Pregnancy are well orchestrated. In certain cases departure from this normal course leads to the pregnancy being complicated. Complications that so develop, endanger the life of both mother and her unborn child. One such dreaded complication is pregnancy induced hypertension. Eclampsia is defined as the pre- eclampsia when complicated with convulsion and/ or coma. However, eclampsia usually proceeds pre-eclampsia. It is one of the leading causes of maternal and perinatal mortality as well as morbidity, throughout the world. Approximately 50000 women die worldwide each year from eclampsia. The reported mortality rate ranges from 1-20%. The perinatal mortality rate of neonates born to eclamptic mothers ranges form 1.3-3%.&#x0D; Aims: 1.To evaluates the risk factors and clinical presentation in women with imminent eclampsia preoperatively.&#x0D; &#x0D; To evaluate the risk factors and clinical presentation in women with eclampsia.&#x0D; &#x0D; Materials and Methods&#x0D; The present study will be carried out in department of Obstetrics &amp; Gynecology and MEDICINE of National institute of medical sciences (NIMS), Jaipur from October 2012 to September 2014. The study will be conducted on the antenatal and postnatal women admitted in the in patient department of NIMS, Jaipur Study Design: Prospective and retrospective observational study. Study Period October 2012 to September 2014. All the women are evaluated for demographic data, antenatal history, obstetric history, menstrual history, medical and surgical history, mode of delivery, onset of eclampsia, treatment received and maternal and fetal complications.&#x0D; Result: From the present study, it can be concluded that the age group 21-30 years is most prone for eclampsia and imminent eclampsia and the disease severity is higher in age group less than 30 years. Low socioeconomic status and poor educational status contribute for their increased incidence. These patients generally have higher proteinuria with headache followed by epigastria pain and vomiting. These women are mostly delivered by caesarian section and deliver low birth baby (&amp;lt; 2.5kg), which needs immediate attention and is admitted to nursery.&#x0D; Conclusion: Eclampsia and imminent eclampsia is a major health problem in pregnant women. And it carries high morbities and mortality. Eclampsia is more complicated than imminent Eclampsia.&#x0D; Keywords: Eclampsia, hypertension, preeclampsia, proteinuria

Epidemiology and fetomaternal outcomes in cases of imminent eclampsia and eclampsia- retrospective study

The most common complication in pregnancy is Hypertension complicating 12-22% of all pregnancies. Among these pre-eclampsia is the leading cause constituting 10% of all pregnancies worldwide. In hospital practice in India, the incidence of pre-eclampsia varies from 5% to 15% and of eclampsia about 1.5%. According to WHO report 2008, eclampsia constitutes for 12% of all maternal deaths in developing countries. Thus it is important to study its Epidemiology and Management strategies. Retrospective descriptive data based study. The data is collected after reviewing the medical records of all gravid women with hypertensive disorder of pregnancy who presented between July 2010–July 2014. Data was collected on predesigned, standardised proforma of National Eclampsia Registry. Statistical analysis was performed using SPSS version 22. Data was expressed as Mean, percentages, proportions. Chi-square test was used to find association between various categorical variables. p-value &amp;#60;0.05 was considered to be statistically significant. During the study period there were 22,591 deliveries. There were 1468 mild and severe pre-eclampsia cases and 309 imminent eclampsia and eclampsia cases. The proportion of Pregnancy Induced Hypertension (PIH) cases was found to be 7.85% and that of eclampsia 1.36%. 74.34% of the patients belonged to age group between 20-30 years. 69.11% patients were primigravidas with significant corelation to parity (p value &amp;#60;.00). 68.4% cases were unbooked with p value &amp;#60;.00. 84.3% cases presented between 29-36 weeks. 56.96% patients had headache and 28.48% had headache with vomiting as premonitory symptoms. 74.4% patients had antepartum, 9.14% intra partum and 16.46% postpartum eclampsia. Increasing proteinuria was significantly related to no. of convulsions (p &amp;#60;.05). Maternal complications were seen in 21.68% cases. Maternal deaths during study period due to eclampsia complications were 1.3%. Perinatal complications were seen in 19.41% babies; prematurity being most common (40%). Low birth weight was seen in 68.09% babies which was statistically significant (p value &amp;#60;0.00). There was no significant change in the incidence of eclampsia over four years. Present study highlights various risk factors for pre-eclampsia. Unbooked, young primigravida with significant proteinuria are at increased risk for pre-eclampsia-related morbidity and mortality. As doctor to patient ratio is below par, the role of ASHA workers is important. Government efforts to track all pregnancies will ensure adequate antenatal care especially to the socio-economically deprived and rural population. Doctors working in peripheral hospitals should have periodic training in the management of preeclampsia and eclampsia to avoid missed opportunities as well as better transport facilities to handle obstetric emergencies. As no change in incidence of eclampsia over years, ASHA workers to be trained to identify warning signs. Doctors working in peripheral hospitals should have periodic training in the management of preeclampsia and eclampsia to avoid missed opportunities.

INTRODUCTION DU SULFATE DE MAGNESIUM DANS LA PRISE EN CHARGE DE LA PREECLAMPSIE SEVERE AU CHUGOB

Introduction: Preeclampsia is a major cause of maternal and newborn morbi-mortality mostly through eclampsia and its complications. Magnesium sulphate is now approved to prevent eclamptic seizures. Our survey is aimed at showing the benefits and risks of its use in the management of severe preeclampsia. &#x0D; Methods: A prospective and descriptive study was led for nine months from April to December 2016 at CHUGOB about 90 severe preeclamptic women up to 28 weeks of gestation with imminent eclampsia and/or decision of delivery (or in labor); treated by magnesium sulphate before, during and/or after delivery. &#x0D; Results: The prevalence of this pathology was 1, 9%. It occurred before 37 weeks of gestation in 62, 22% of the cases, with middle age of 28, 89 years old. Systolic arterial blood pressure was greater than 160 mmHg (92, 22%), accompanied by significant proteinuria (61, 11%), and clinical signs of imminent eclampsia (65, 56%). Fifty five of them (61, 11%) needed antihypertensive therapy. The mainly side effects were minor (feeling of warmth in 54, 44%). There were six overdoses which regressed when treatment was stopped and calcium gluconate administered. No patients had eclampsia nor death. The newborn morbi-mortality hadn’t been affected. &#x0D; Conclusion: Magnesium sulphate is effective especially in imminent eclampsia. The benefits from its use were above the risks for the mother and her baby with rigorous clinic follow up.&#x0D; We recommend it.

Clinical profile of pregnant women with pregnancy induced hypertension

Multisystem disorders of unknown aetiology characterized by development of HTN to the extent of 140/90 mm Hg or more with Proteinuria after 20thwk of pregnancy in a previously normotensive and non proteinuric patient. May appear before 20wks in cases of hydatidiform mole, acute polyhydramnios and multiple pregnancies. BP≥ 140/90 mm Hg before pregnancy or diagnosed before 20 weeks gestation not attributable to gestational trophoblastic disease (OR) Hypertension first diagnosed after 20 weeks gestations and persistent after 12 weeks postpartum. In chronic HTN, the foetus is more prone for growth restriction, preterm delivery, and death of foetus. 50% of the cases belong to The Labetalol Group, while the other 50% comprise The Nifedipine Group, selected randomly. Each group comprised a total of 62 cases, 50 of them are Mild PIH cases while the other 12 cases are the cases of Severe Hypertension, Imminent Eclampsia, Eclampsia, Placental Abruption etc. Most of the cases of Labetalol Group progressed up to term, of which one case crossed the EDD. This woman was discharged at her request and she reported to the hospital only after crossing the EDD. As many as 69.35% (43 cases) delivered vaginally in Labetalol Group, whereas the Caesarean section rate for Nifedipine group is about 48.39%. Emergency Caesarean section rate was 25.80% in Labetalol group where as it was 37.10% in the Nifedipine Group

Low Dose Magnesium Sulphate Regime for Eclampsia and Imminent Eclampsia

Low Dose Magnesium Sulphate Regime for Eclampsia and Imminent Eclampsia

Predictive Value of the Signs and Symptoms Preceding Eclampsia: A Systematic Review.

To estimate the predictive value of signs and symptoms that occur before onset of eclampsia among pregnant women. Electronic databases, including MEDLINE, EMBASE, Cochrane, and ClinicalTrials.gov were searched from inception to 2018. Search terms included eclampsia, predict, likelihood ratio, predictive value, and risk. Abstracts and later full texts were selected for review if a diagnosis of eclampsia was made, a comparator arm included (women without a diagnosis of eclampsia), and predictors of imminent eclampsia reported. Of 2,791 retrieved records, 11 were selected. Significant heterogeneity existed between studies, with differing designs, settings, participants, and signs or symptoms. In total, 28 signs or symptoms were reported, with visual disturbances and epigastric pain most common (six studies), followed by headache (five studies), and any edema (four studies). Data on study characteristics and predictive value of signs or symptoms were extracted, and, where appropriate, bivariate mixed-effect meta-analysis was applied to raw data. None of the pooled estimates were able to accurately predict eclampsia nor rule out eclampsia in their absence, with moderate specificity (83-94%) and poor sensitivity (29-56%). There is a dearth of high-quality studies investigating the predictive value of imminent signs and symptoms of eclampsia. Owing to the small number of studies, heterogeneity, and inconsistent reporting, it is difficult to provide accurate estimates of the predictive value of prodromal symptoms of eclampsia. Of the most commonly reported symptoms-visual disturbances, epigastric pain, and headache-none were able to accurately predict, nor rule out, imminent eclampsia. PROSPERO, CRD42018095076.

156. Proteinuria concentration of pregnant women with preeclampsia: This value would be an indicator of pregnancy interruption?

Introduction Proteinuria (⩾300 mg/24 hs) is one of the parameters that define preeclampsia. According to the literature, proteinuria concentration ⩾two or five grams defines severe preeclampsia, and massive proteinuria is defined by at least 10 g. Objective To identify and classify the severity of proteinuria in preeclamptic pregnant women. Methods Were studied 101 preeclamptic women, who received obstetric care during the year of 2015 at the Maternity of the Botucatu Medical School Hospital, Botucatu, SP, Brazil. Proteinuria was classified as mild (300–1999 g), two severe grades (2000–4999 g and ⩾5000 g) and massive (⩾10,000). The following parameters were evaluated: demographic [age, race, marital status] and obstetric characteristics [parity, gestational age at pregnancy resolution, forms of preeclampsia (superimposed or not upon chronic hypertension, early or late onset, mild or severe, and type of delivery). Results In the studied population predominated the age between 20 and 35 years old, white race and stable union. Parity was similar between primiparous and multiparous, with 41.6% of prematurity and 69.3% of caesarean section. In the characterization of pre-eclampsia predominated pure (80.2%), severe (73.3%) and late (81.2%) forms. Among the parameters of severity, predominated hypertensive crisis (49.5%), proteinuria (33.7%) and imminent eclampsia (22.8%). The median values and range of proteinuria were 900 mg/24 h (300–36,014 mg), and classified as mild (66.4%) or severe ⩾2000 mg (33.6%). Considering severe (⩾5000 mg) and massive proteinuria the values were 22.7% and 10.8%, respectively. Discussion Proteinuria was a parameter of severity in one third of cases of preeclampsia, with 10.8% of massive grade. In our service, one year of follow-up of pregnant women, who developed severe preeclampsia showed persistence of proteinuria and/or albuminuria in 27% of patients. However, there is no literature indication of which proteinuria concentration should be an indicator for gestation interruption in order to avoid future impairment of renal function of these women.

Management of Eclampsia and Imminent Eclampsia, Maternal and Perinatal Outcome in 666 Cases—2003-2007 at Government Maternity Hospital in Hyderabad

Objective: This is an audit to evaluate the maternal and perinatal outcome in eclampsia and imminent eclampsia with the management adopted at a tertiary hospital. Methods: During a period of 34 months, from 2003-2007 at Government maternity hospital, Osmania medical college, Hyderabad, 666 women with eclampsia and imminent eclampsia were managed. The number of eclampsia and imminent eclampsia (IE) was 532 and 134, respectively. We have analyzed the clinical profile, parity, age, degree of proteinuria, the period of gestation in weeks, the antenatal care, the number of antenatal visits, referrals from other hospitals, the diastolic B.P. at the time of admission, the recurrence of convulsions and the complications. 1) All the cases of eclampsia and IE were managed with magnesium sulphate as an anticonvulsant. 2) Oral nifedipine, IV labetalol, sublingual nifedipine and nitroglycerine infusion were used to control severe hypertension. 3) Prostaglandin E1 (PGE1) was used for induction of labour (IOL), 25 mcg × 4th hrly, vaginal route and 50 mcg for less than 28 weeks gestation, in 290/424 cases of IOL. Other methods of IOL were employed in 134 cases. Results: Eclampsia (n = 532) occurred antepartum in 407 (75.56%), intrapartum in 76 (14.28%), post partum in 46 (8.64%) and intercurrent in 3 (0.5%) patients. The period of gestation was 34 weeks in 340 patients. Induction of labour with misoprostol was done in 290 with vaginal delivery in 235 (81%) and lower segment caesarean section (LSCS) for failed IOL in 55 (19%) and other methods of IOL were used in 134. The total number of deliveries was 656, with vaginal deliveries in 336 (66.46%) patients, ceasarean deliveries in 220 (33.54%) patients. Ten patients died undelivered. Maternal mortality was 17/666—2.55%. Cerebrovascular events were responsible in 13/17 (76.46%) patients, pulmonary embolisim in 2, aspiration pneumonia in one and sepsis in one. The perinatal mortality was 167/582 (28.69%), PNM when birth weight was >1.5 kg was 59/426 (13.84%), intrauterine fetal deaths at admission were 54 (8.5%), there were four sets of twins. Conclusions: 1) More effective measures to control hypertension and routine administration of anticonvulsant, magnesium sulphate to women with eclampsia should be practised from the first referral unit itself. 2) Our caesarean delivery rate of 33.54% in the very high risk cases of eclampsia and imminent eclampsia is very low compared to others. 3) Induction of labour with misoprostol was successful in 81% with consequent reduction in caesarean section rate and morbidity and mortality associated with caesarean deliveries. Misoprostol has proved to be a safe and effective inducing agent in eclampsia. 4) The maternal mortality in our series is 2.55%.