Eclampsia: maternal and perinatal outcome among tribal population of Bastar, Chhattisgarh, India in a tertiary care centre

Abstract

Background: Eclampsia is one of the major causes of maternal and perinatal morbidity and mortality in India and other developing countries. This problem is continued in spite of challenging efforts to reviev each and every pregnant woman with eclampsia and to analyse the factors affecting the outcome. The aim of the research is to study the demographic profile, maternal as well as perinatal outcome of patients with eclampsia and factor affecting it in tertiary care centre of tribal population.

Methods: A prospective observational and analytical study was conducted over a period of 1.5 years from 1/12/2013 to 1/06/2015 in the OBGY department of Govt. Medical College and Associated Maharani Hospital, Bastar, Chhattisgarh, India. All the patients of eclampsia or developed eclampsia admitted in the department were included in the study. Data was collected and analyzed included various maternal parameters and foetal parameters and pregnancy outcome.

Results: During the study period of 1.5 years, incidence of eclampsia among rural and tribal population of Bastar was 4.76%. Among 250 cases of eclampsia, total 28 maternal deaths were there, showing high case fatality rate of 11.2%. 2 maternal deaths were antenatal. Most common cause of maternal death was postpartum haemorrhage (21.4%) and pulmonary oedema (21.4%). In spite of high case fatality rate, these eclamptic cases developed various complications. One of the factors contributing in poor maternal outcome and developing maternal complication was delay in delivery time from the time of onset of convulsion. Among the cases delivered early (<6 hrs), only 11.4% cases developed some form of complication whereas among the cases delivered after 24 hrs of onset of convulsion, 74.1% cases developed complications. Data of study showed poor perinatal outcome as well. 70% delivery was preterm, 62.4% live birth, 34.4% IUD and 4.4% early neonatal deaths giving 42% of very high perinatal mortality rate.  Most common cause of high perinatal mortality and poor perinatal outcome was prematurity (54.5%) and meconium aspiration. Most common mode of delivery was vaginal delivery (82%) which was associated with more perinatal complication (47.3%). In our study most of the cases (60.4%) were of very young age (15-24 years) primi gravid (78.8%) and unbooked /referred (76.8%). Majority of them developed ante partum eclampsia (80.8%) before 37 weeks of gestation (70%).

Conclusions: The incidence of eclampsia in our institute was very high with corresponding very high maternal and perinatal morbidity and mortality which emphasizes the need of education, improvement in health care services and universal antenatal checkup and enhancement in timely referral with improvement in transport facilities.