A study of the obstetric and perinatal outcomes of eclampsia and the use of levetiracetam in its management

Abstract

Background: Hypertensive disorders are a common cause of maternal morbidity and mortality complicating 3 to 10% of pregnancies. Eclampsia is a major complication of hypertensive disorders of pregnancy, particularly in developing countries, resulting in poor foeto-maternal outcomes. In some cases of eclampsia use of the gold standard i.e. magnesium sulphate, is restricted and is sometimes ineffective when used as monotherapy. Levetiracetam is an anti-epileptic drug that is relatively safe in pregnancy, does not require intensive monitoring and has potential use in eclampsia. The primary aim of this study was to establish the incidence of eclampsia and its maternal and perinatal outcomes. It also aimed at studying the utility of levetiracetam in the treatment of eclampsia.

Methods: It is a retrospective, observational study conducted at Seth G. S. Medical College and K.E.M Hospital, Mumbai (a tertiary care centre). Data of a period of one year was collected from hospital records. The eclamptic patients’ demographic profile, maternal and perinatal outcomes and the use of levetiracetam were noted.

Results: The incidence of hypertensive disorders of pregnancy was 7.53% while that of eclampsia was 0.737%. The maternal and perinatal case fatality rates were 18% and 26% respectively. 50% of the cases had other concurrent maternal complications. 44.11% of the live births required neonatal intensive care unit admission. 55% of the cases who were treated with levetiracetam, either as monotherapy or in combination with magnesium sulphate, made a complete recovery.

Conclusions: The significant number of hypertensive disorders of pregnancy complicated by eclampsia and its associated co-morbidities indicate the need for early detection of hypertension in pregnancy and timely intervention.