Publication:

Changing trends in eclampsia and increasing cesarean delivery – an interesting retrospective study from a tertiary care hospital of Raipur, Chhattisgarh, India

Background Despite all advances in obstetrical care eclampsia remains a puzzle and it still kills. Due to good antenatal and peripartum care, developed countries have a minimum incidence, while such changes have not occurred in developing countries especially in peripheral areas. So the incidence remains high in developing countries like India. Fetomaternal outcome in eclampsia depends on nature of convulsion quality and speed of care. Obstetrical management with the objective “Sooner the delivery betters the prognosis” has been shown to play great role in improving fetomaternal outcome.

Methods It’s a retrospective observational study done among all admitted eclamptic women over the period of 10 years from Jan 2005 to Dec 2014 in the Department of Obstetrics and Gynecology, Pt. Jawahar Lal Nehru Memorial Medical College & Dr B. R. A. M. Hospital Raipur (CG), by reviewing maternal death register, admission register and antenatal record of women.

Results A total of 1153 eclamptic women were admitted over 10 year study period. The incidence of eclampsia was 1.935 %. Out of total 298 Maternal deaths 131 were due to eclampsia (43.95%). Most of the patients belonged to age 20-30 years, were with low parity and presented most commonly after 34 weeks of gestation with antepartum eclampsia. There was an increasing trend of DIC and HELLP related maternal morbidity and mortality. DIC was the most dreadful complication with the case fatality ratio of 50%. The no of convulsion was associated with increased operative interference. We observed a better perinatal salvage by LSCS (72.91%).There was an increasing trend of maternal death due to eclampsia over the 10 year study period. Increasing trend of cesarean delivery in eclamptic women was also observed from 37.09% in 2005 to 83.55% in 2014. Better perinatal outcome was seen with lesser convulsion to delivery interval.

Conclusions Contrary to various studies hypertensive disorder to be the fourth most common cause of maternal death in developing countries, eclampsia came out to be the leading cause of maternal mortality in our study. Better antenatal and peripartum care can reduce its occurrence and related morbidity and mortality. Optimum outcome can be achieved by the speed with which the peripartum care is given. Cesarean delivery is preferable if vaginal delivery is not anticipated within 8 hrs as it gives better fetomaternal outcome.