Maternal and perinatal outcome of eclampsia in tertiary health institution in Southeast Nigeria

Objective: To evaluate the maternal and perinatal outcome in patients with eclampsia at Nnamdi-Azikiwe-University-Teaching-Hospital (NAUTH), Nnewi, Nigeria. Methods: A retrospective study of cases of eclampsia managed at NAUTH over a 10 year period – 1st January, 2000 to 31st December, 2009. Maternal outcome was measured in terms of complications and maternal death. Foetal outcome was assessed in terms of low birth weight, pre-term births, low apgar score, and perinatal deaths. Results: There were 57 cases of eclampsia out of a total of 6,262 deliveries within the study period, giving a prevalence of 0.91%. Majority, 71.7%, had caesarean section. There were 17.4% maternal deaths mainly from pulmonary oedema, 6 (13.0%), acute renal failure, 4 (8.7%), and coagulopathy, 3 (6.5%). Perinatal deaths were 25.5% as a result of prematurity, 42 (82.4%), and low birth weight, 36 (70.6%). Twenty-one (41.2%) of the new born had Apgar score of less than seven at 5?min while 13.0% were severely asphyxiated. Conclusion: Eclampsia was associated with high maternal and perinatal morbidity and mortality in this study. There is need to review existing protocol on eclampsia management with emphasis on appropriate health education of pregnant mothers, good antenatal care, early diagnosis of pre-eclampsia with prompt treatment.     

A Review of Eclampsia in Melbourne: 1978–1992

Summary: A retrospective review of all cases of eclampsia diagnosed at 3 obstetric teaching hospitals in Melbourne from January, 1978 to December, 1992 was undertaken. Ninety cases were identified; there were 5 maternal deaths and 17 perinatal deaths. Severe maternal morbidity such as pulmonary oedema, acute renal failure or HELLP syndrome was found in 26%. Significant maternal thrombocytopenia (<100 × 10⁹/L) was found in 50% and 35% had abnormal maternal liver function tests. Forty six women received magnesium sulphate for treatment of eclampsia and of these 3 had further seizures compared to 4 of 18 who received phenytoin (odds ratio 0.24 (0.04-1.52) X², p=0.09). Eclampsia remains a significant complication of pregnancy with high maternal and perinatal mortality and morbidity. Results of this study show a trend that is in agreement with recent randomized controlled trials which demonstrate a reduced incidence of seizures and maternal and fetal complications with tbe use of magnesium sulphate. The results of these recent trials suggest that magnesium sulphate should be the drug of choice in the prevention and treatment of eclampsia.     

Severe pre-eclampsia and eclampsia in Abha, the south west region of Saudi Arabia.

A retrospective study was conducted over a 10-year period on 32,000 maternities at Abha General Hospital, Abha, Saudi Arabia, to estimate the contribution of eclampsia and severe pre-eclampsia to maternal mortality and morbidity and also fetal wastage. It included 18 cases of eclampsia and 297 cases of severe pre-eclampsia. Multiple regression analysis revealed that only the presence of prodromal symptoms significantly affected the occurrence of eclampsia, p < 0.05, while nulliparous patients were a high risk group for eclampsia. Maternal complications including eight cases of massive ascites occurred exclusively in severe pre-eclamptics. Although no maternal deaths were reported, the perinatal mortality rate was 16.6% and 14.1% among the eclamptics and severe pre-eclamptic patients, mainly from prematurity. Regarding the eclamptic patients, 17(94.4%) had the first fit before arrival at the hospital, 13(72.2%) before labour, while 3(16.6%) had fits before and during labour and 1(5.6%) had the fits after delivery. Suggestions are proffered to reducing maternal morbidity and perinatal mortality and morbidity.     

Maternal mortality in Northern Nigeria: a population-based study

OBJECTIVES: To determine the incidence and causes of maternal mortality as well as its temporal distribution over the last decade (1990-1999). STUDY DESIGN: All maternal deaths recorded within the study period in the State of Kano, Northern Nigeria, were analyzed. Maternal mortality ratios (MMR) were computed using the Poisson assumption to derive confidence intervals around the estimates. A non-linear regression model was fitted to obtain the best temporal trajectory for MMR across the decade of study. RESULTS: A total of 4154 maternal deaths occurred among 171,621 deliveries, yielding an MMR of 2420 deaths per 100,000. Eclampsia, ruptured uterus and anemia were responsible for about 50% of maternal deaths. CONCLUSION: We found one of the highest maternal mortality ratios in the world. Maternal mortality could be reduced by half at study site with effective interventions targeted to prevent deaths from eclampsia, ruptured uterus and anemia.     

Eclampsia in twin pregnancy

A clinical analysis of 37 cases of twin pregnancy complicated by eclampsia showed that: (1) the incidence of twins in the total 1,030 cases of eclampsia was three times the figure in the general population, (2) the maternal mortality was slightly higher and perinatal mortality slightly lower than in unselected eclamptic patients, (3) patients with postpartum eclampsia showed significant differences in comparison with antepartum and intrapartum cases, (4) perinatal and maternal mortality were lower in cases delivered by cesarean section, (5) perinatal mortality was significantly higher in male fetuses, and (6) five of the six maternal deaths occurred in cases of male twins. In addition, the data suggest the presence of a reciprocal negative influence between maternal eclampsia and male twins and that this type of eclampsia may be the best example of essential preeclampsia.     

Eclampsia in Finland in 1990-1994

BACKGROUND: Eclampsia is a serious threat to both maternal and fetal well-being. We started the present study because no recent data are available on the incidence of eclampsia and the outcome of patients with this serious disorder in Finland. METHODS: The incidence of eclampsia in Finland in 1990-1994 was studied retrospectively. The data were retrieved from the National Birth Register and the Finnish Hospital Discharge Register. Patient records were reviewed. RESULTS: Seventy-seven cases of eclampsia were found in the hospital records, which gave an eclampsia incidence of 2.4 per 10,000 deliveries (95% confidence intervals 1.9 to 2.9). Eclampsia was preceded by severe pre-eclampsia in 84% and by mild pre-eclampsia in 8% of the patients. Ten mothers suffered from severe eclampsia-related complications but, fortunately, none of the mothers died. Perinatal mortality was 5%, and 33% of the newborns were small for gestational age. CONCLUSIONS: Eclampsia is rare in Finland. Its low incidence is probably due to improved neonatal care that allows earlier deliveries before the progress of preeclampsia to eclampsia.     

Maternal and perinatal outcome of eclampsia over a decade at a tertiary hospital in Kuwait

Aims: To determine maternal and perinatal outcome of eclampsia patients over a decade.

Methods: Analysis of case records of all eclampsia cases from January 2005 to December 2014.

Results: There were 30 cases of eclampsia. The most significant risk factors for developing pre-eclampsia are unbooked cases (97%), nulliparity, young age, marriage?≤4 months, history of pre-eclampsia in previous pregnancy, remarriage, preexisting diabetes mellitus, interval between pregnancies?≥10 years, positive family history. The incidence of eclampsia was 0.05%, antepartum eclampsia 15 (50%), intrapartum 6 (20%) and postpartum 9 (30%) with no maternal deaths, and 1 perinatal death. Perinatal mortality was 33.3/1000. 22 (73%) patients received magnesium sulphate (MgSO₄) and 8 patients (27%) received Diazepam, of which 1 had recurrence of convulsions. All 15 antepartum cases were delivered by cesarean section as were 2 intrapartum. 13 (43%) of women delivered vaginally. Only 6 (20%) patients were of low socio-economic status and were primary school educated. Severe maternal complications occurred in 8 (27%), with abruptio placentae being the most common 3 (38%).

Conclusions: Incidence of eclampsia was low, with no maternal deaths. MgSO4 was found to be highly effective. Lack of antenatal care is a major risk factor.     

The Changing Pattern of Eclampsia

Summary: Between 1940 and 1974, 955 patients with eclampsia were treated at the Royal Women's Hospital, Melbourne. The incidence in booked patients has fallen from 1 in 200 to 1 in 2,800 at present. There were 57 maternal deaths, with a progressive decline in the mortality rate from 8% in the 1940–1949 period to 2.7% between 1960 and 1969; no maternal deaths have occurred in the 5 years subsequently. Including previable cases, the perinatal wastage has been reduced from 30% to 14%. The incidence of multiple pregnancy was 6.2%. The Caesarean section rate was 5%. In booked patients, postpartum eclampsia is now the commonest variety and is of milder severity than formerly.     

Late Onset Preeclampsia is not an Innocuous Condition

Objective: To describe the profile and outcome of late-onset preeclampsia (LOPE). Methods. Retrospective study of 264 singleton pregnancies presenting before delivery at two referral centres in South Africa. Results: Primigravid patients constituted 56.8% of the group, while 57.6% were graded as severe. Median gestational age at diagnosis was 37 (34–43) weeks. 30.7% of patients experienced ≥1 major maternal complication including 34 (12.9%) cases of eclampsia. There were no maternal or early neonatal deaths. Five intrauterine deaths occurred, all due to placental abruption. The perinatal mortality rate was 18.9 per thousand births. Conclusions: Late-onset preeclampsia often presents as severe disease.     

Eclampsia. VI. Maternal-perinatal outcome in 254 consecutive cases

During a 12-year period, 254 cases of eclampsia were managed at this center. Eighty patients (32%) did not have edema, 58 (23%) had "relative hypertension," and 49 (19%) did not have proteinuria at the time of convulsions. Eclampsia developed at less than or equal to 20 weeks in 6 patients and beyond 48 hours post partum in 40 (16%). Convulsions developed in 33 while they were receiving standard doses of magnesium sulfate for preeclampsia during or after birth, and subsequent seizures developed in 36 (14%) after magnesium sulfate therapy was started. There was one maternal death (0.4%) and morbidity was frequent (acute renal failure, 4.7%; pulmonary edema, 4.3%; cardiorespiratory arrest, 3.1%; and aspiration, 2%. The use of multiple drug therapy was associated with significant maternal and neonatal complications. The total perinatal mortality was 11.8%, with the majority of them related to either abruptio placentae or extreme prematurity. These findings emphasize the need for intensive monitoring of women with preeclampsia throughout hospitalization and underscore the importance of maternal stabilization before and during transfer.     

Pregnancy outcome of intensive therapy in severe hypertension in first trimester

The purpose of the present clinical investigation was to determine the maternal and perinatal outcome associated with continuing pregnancy in 44 consecutive patients with severe chronic hypertension in the first trimester. Each patient was observed closely throughout pregnancy with frequent prenatal visits and intensive monitoring of the clinical status of both mother and fetus. There were no maternal deaths, but morbidity was very significant. Most patients required repeated hospitalizations and on many occasions parenteral medications were used to reduce blood pressure. Nineteen had transient and one permanent renal deterioration. These results confirm that pregnancy in women with severe hypertension is beset with considerable morbidity, but with expert intensive care, gestations can be concluded successfully in those women who refuse termination. Twenty-three patients (52%) developed superimposed preeclampsia, one patient developed pleural effusion, and one patient had postpartum hypertensive encephalopathy. In addition, there was no evidence of late puerperal maternal cardiovascular or renal damage on long-term follow-up. There were ten stillbirths and one neonatal death for an overall perinatal mortality of 25%. Seventy percent of the infants were delivered before 37 weeks' gestation, and 19 infants (43%) were small for gestational age. However, all the perinatal deaths and most of the neonatal morbidity occurred among the 23 patients with superimposed preeclampsia.     

Trends in maternal mortality over 29 years in a Kuwait Tertiary Teaching Hospital: signs of progress?

This study aims at (1) Assessing trends in maternal mortality in kuwait (2) Define strategies for prevention. Methods: Retrospective analysis of maternal deaths that occurred among, 55,979 live births at a tertiary hospital, between 1980 and 2009. Results: There were 14 maternal deaths, and 55,979 live births, giving a maternal mortality rate of 25 per 100,000 live birth. In terms of decades maternal mortality declined from 54.8 in 1980–90 to 28.4 in 1990–2000 and continued to decline to 12.2 in 2000–2009. Thromboembolism (28.6%), Obstetric haemorrhage (21.5%) and Eclampsia (14.3%) were the leading causes of direct deaths. Cardiac disease is the most common cause of indirect deaths (14.3%) followed by H1N1 pneumonia 7.1%. Eclampsia contributed to 40% of deaths, only in the 1980s. Thromboembolism caused 28.6% of deaths, 50% of which were in the last 9 years. Indirect deaths from cardiomyopathies (66.7%) gained prominence in the 1990s. No deaths from puerperal sepsis were reported after the 1980s (14.3%). Conclusions: Maternal mortality rates are decreasing significantly (p?<?0.01) at our institution over the last 29 years. Obstetric haemorrhage and thromboembolism remain important causes of maternal mortality. Substandard care was identified in 70% of Direct and 55% of indirect deaths.     

Maternal and perinatal outcome of preeclampsia with an onset before 24 weeks' gestation. Audit in a tertiary referral center

OBJECTIVE: Preeclampsia, with an onset before 24 weeks' gestation is a rare but severe condition in pregnancy with little data of maternal and perinatal outcome, particularly after expectant management. We therefore, evaluated pregnancy outcome in these women at our department where temporising management was introduced as the standard policy in early onset preeclampsia. STUDY DESIGN: We analysed retrospectively all consecutive women with preeclampsia, with an onset before 24 weeks' gestation, between 1 January 1993 and 31 December 2002 at a tertiary university referral center. RESULTS: Twenty-six pregnancies, of which two were twin pregnancies, resulted in 65% of the women in at least one major maternal complication: maternal death (n=1), HELLP syndrome (n=16), eclampsia (n=5) and pulmonary edema (n=4). Thirty percent of these women presented already with serious morbidity at admission. The median prolongation of the pregnancy was 24 days (range 3-46 days). The overall perinatal mortality was 82%: 19 fetal deaths and 4 neonatal deaths. CONCLUSION: Early onset preeclampsia, with an onset before 24 weeks' gestation, results in considerable maternal and perinatal morbidity and mortality. Therefore, expectant management should not be considered as a routine treatment option in these patients.     

Pulmonary edema in severe preeclampsia-eclampsia: analysis of thirty-seven consecutive cases

During approximately a 9-year period, 37 severe preeclamptic-eclamptic patients had pulmonary edema for an incidence of 2.9%. The incidence was significantly higher in older patients (p less than 0.0001) and in multigravid patients (p less than 0.05). Eleven (30%) had antepartum edema with 10 (90%) of the 11 having preexisting chronic hypertension. Twenty-six (70%) had postpartum edema with an average onset of 71 hours post partum. The majority of these patients had excessive colloid and crystalloid infusions for various medical, surgical, and obstetric complications. There were four maternal deaths and morbidity was significant. Eighteen patients had disseminated intravascular coagulopathy, 17 had sepsis, 12 had abruptio placentae, 10 had acute renal failure, six had hypertensive crisis, five had cardiopulmonary arrest, two had rupture of the liver, and two had ischemic cerebral damage. The overall perinatal mortality was 530/1000 and neonatal morbidity was significant. Pulmonary edema is infrequent in severe preeclampsia-eclampsia without associated medical, surgical and obstetric complications. The occurrence of pulmonary edema in such patients is associated with high maternal and perinatal mortality and morbidity.     

Maternal Mortality in EcLampsia in the Guinea Savannah Region of Nigeria

Eclampsia is still very prevalent in Northern Nigeria, constituting the third commonest cause of maternal deaths with a mortality rate of 9-10% annually. In order to identify some factors that may be associated with maternal deaths in eclamnsia in this region, nine deaths that occurcd during a qrospective study of 100 eclamptics in 1979 were reviewed. It was discovered that maternal death occured twice more commonly in the under 16 and rarely in mothers over 20 years of age. There was an almost two fold mortality rate among multinarous patients implying that eclampsia occurs in this grouo in the nresence oi some other underlying medical condition. Intrapartum eclamnsia (mortality rate of 11. 1%) was more lethal than antepartum (6.8%) and nost nartum (5.8%) ones. There was no correlation between degree of hypertension or number of fits and maternal mortality, though there was slight rise when the diastolic pressure was higher than llOmmHg at the time of fits. Abdominal delivery was associated with a lower mortality (3.1%) than vaginal delivery (10.4%). Mortality rose ten fold if eclamnsia was associated with sepsis. It was concluded that lethal factors in eclampsia in this environment differed some what from those in more industrialised communities; early marriage, intrapartum fits and sepsis playing significant roles.     

HELLP Syndrome: 8 Years of Experience from a Tertiary Referral Center in Western Turkey

Objective. This study was performed to determine the incidence, symptomatology, complications, mode of delivery, treatment modalities, and risk factors for maternal outcome and perinatal outcome in women with HELLP syndrome. Methods. A total of 303 pregnancies with hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome diagnosed antenatally were reviewed between 2002 and 2009. Demographic data, including age, parity, gestational age, and clinical and laboratory findings, were recorded from the medical files. In addition, delivery route, indication of cesarean section, and fetal and maternal complications were determined. Results. Acute renal failure (20.5%) was the most common complication. Eclampsia was present in 303 women with HELLP syndrome (52%). There were four maternal deaths (1.4%). The perinatal mortality rate was 20.3%. The percentages of intracerebral hemorrhage and maternal death were higher in women with eclampsia than in those without (6.3% vs. 0.8%, p = 0.01 and 4.8% vs. 0.4%, p = 0.02, respectively). A nadir platelet count of ≤50,000 cells/mm³, a peak serum AST of >150 IU/L, and a peak serum LDH of ≥1400 IU/L were not independent risk factors of an adverse outcome. Conclusion. We concluded that the incidence rates of serious maternal and fetal morbidities and mortalities are increased in HELLP syndrome. Laboratory parameters of HELLP syndrome are not independent risk factors for adverse neonatal–maternal outcome. Adequate and prompt diagnosis and management are crucial in patients with HELLP syndrome.     

Prolongation of pregnancy following eclampsia

Eclampsia is a serious complication of preeclampsia with high maternal and perinatal mortality and morbidity rates. The recommended management is induction of labour when convulsions are controlled and the women's condition is stabilised. Here, we report about stabilisation after eclampsia followed by prolongation of a preterm pregnancy for 11 days within early gestational weeks.