Maternal outcome in antepartum eclampsia caesarean versus vaginal delivery
Keywords:Eclampsia, Maternal morbidity, Maternal mortality, Vaginal delivery
Background: The term eclampsia is derived from a Greek word, meaning "like a flash of lightening". The onset of convulsions in a woman with pre-eclampsia that cannot be attributed to other causes is termed eclampsia. Eclampsia is an obstetric enigma. Though it has almost been eradicated from the developed world, it continues to be a major cause of maternal and fetal mortality and morbidity in the developing countries. The real challenge of eclampsia has not been met. In spite of considerable progress made in the field of obstetrics, the incidence of eclampsia and its consequent complications has not decreased significantly in our country over the past few decades. It is indeed sad that even today antenatal care is available only to a fraction of our rural population. However, the management of eclampsia still poses a fascinating challenge to the obstetrician, requiring the greatest skill, judgement and patience.
Methods: This is an observational and prospective study of 200 cases admitted with eclampsia in MKCG medical college. The study was extended from October 2015 to September 2017. The inclusion criteria were antepartum eclampsia, primigravida and multigravida, duration of gestation>28 weeks. Patients with pregnancy & convulsion attributed to epilepsy or other causes were excluded from the study.
Results: Of the 200 cases, caesarean section was done in 51.50% of the cases, while vaginal delivery was carried out in 48.5% of the cases. It was observed the caesarean section was having better maternal outcome than vaginal delivery.
Conclusions: In antepartum eclampsia in primigravidas with more than 28 weeks gestation with unfavorable cervix on admission, an early decision for caesarean section either within 6 hours of admission or 12 hours of first fit whichever is earlier is paramount in improving the maternal outcome”. Prompt termination of pregnancy by caesarean section reduces maternal mortality, improves maternal outcome by reducing complications.
Dutta DC. Textbook of Obstetrics. 8th Ed. Calcutta, New Central Book Agency Pvt. Ltd.;2004:234-54.
Hoffman B, Roberts S, Horsager R, Rogers V, Santiago-Muñoz P, Worley K. Williams Obstetrics. 24th Ed. McGraw Hill Co. Inc.;2010:761-808.
World Health Organization International Collaborative study of hypertensive disorder of pregnancy. Am J Obstet Gynecol. 1958;158:80-3.
Martin JN, JR May WL, Rinchart BK, Martin RW, Magaan EF. Increasing maternal weight; a risk factor for pre-eclampsia but apparently set for HELLP syndrome. Southern Med J. 2000;93(7):689-91.
Bhaskar Pal, Geeta N, Vivek P. A study of eclampsia. J Obstet Gynecol. 1996 Feb;46(1):34-9.
Krishna Menon. Caesarean section in eclampsia. J Obstet Gynecol Br Emp. 1961;68:461.
Bhattacharya PK, Purkayastha S, Basu M, Robinsanath M. Caesarean section in eclampsia: Still a dilemma. J Obstet Gynecol India. 1992;42:51-5.
Igberase GD, E Beigbe PN. Eclampsia: Ten years experience in a rural tertiary hospital in the Niger delta, Negeria. J Obstet Gynecol. 2006;26:414-7.
Sardesai SS, Maira S, Patel A, Patel U. Low dose of magnesium sulphate therapy for eclampsia and imminent eclampsia: Regime Tailored for Indian women. J Obstet Gynecol India. 2003;53:546-50.
Swain S, Singh S, Das L, Sahoo B. Maternal and perinatal outcome of eclampsia in a tertiary care centre. Int J Reprod Contracept Obstet Gynecol. 2016;5:384-90.
Bathla S, Suneja A, Guleria K, Agarwal N. Dilantin as anticonvulsant in eclampsia. J Indian Med Assoc. 2002 Sep;100(9):561-4.
Sunita TH, Desai RM, Hon N, Shinde KJ, Hashmi SI. Eclampsia in a teaching hospital: incidence, clinical profile and response to magnesium sulphate by Zuspan’s regimen. IOSR J Dent Med Sci. 2013;4:1-5.
Kanhi AK. Abstracts, free communication papers, 42nd All India Congress of Obstetrics and Gynecology, 1998.
Mundle S, Mullik I. Risk factors in pregnancy outcome in eclampsia. Abstracts Free Communication Papers. 42nd All India congress of Obstetrics and Gynecology. 1998.
Zuspan FP. Toxemia of pregnancy, In: Sciarra JJ and Gerby AB (ed.). Gynecology and Obstetrics, Vol. 2 revised edition. Hagerstown: Harper and Row Publishers;44.
Begum MR, Begum A, Quadir E, Akhter S, Shamsuddin L. Eclampsia: Still a problem in Bangladesh. Med Gen Med. 2004;6:52.
Habeebullah S, Agarwal A, Swain S, Arora R. Impact of mode of delivery on maternal mortality in eclampsia. JIMA. 1997;95:40.