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

Abstract

Context: 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. Settings and Design: Retrospective descriptive data based study. Materials and Methods: 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 used: 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 <0.05 was considered to be statistically significant. Results: 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 <0.00). There was no significant change in the incidence of eclampsia over four years. Conclusions: 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. Key Messages: 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.