Email this article Maternal and fetal outcome of pregnancy complicated by convulsions
Abstract
Background: Convulsions in pregnancy pose serious morbidity and mortality to both mother and the fetus. Eclampsia being the most common cause. However, many medical disorders like epilepsy, cerebral malaria, meningitis, metabolic disorders etc can result in convulsions in pregnancy. This study was conducted to determine the prevalence of various aetiologies leading to convulsions and to assess how the various demographic-clinical characteristics affect the maternal as well as fetal outcome in patients with eclampsia as compared to those with convulsions other than eclampsia.
Methods: This was an observational study conducted over a period of one and a half year at a tertiary institute in India. A total of 56 patients were studied in this duration. The primary objective was to determine the prevalence of the aetiologies causing convulsion as well as the maternal and fetal outcome of the pregnancy complicated by convulsions. The data regarding age, parity, mode of delivery, gestational age at birth, risk factors was obtained by a predesigned proforma.
Results: A total of 56 patients were included in the study after screening 18,840 patients in the hospital. Hence the estimated prevalence of convulsions in pregnancy was 1:336 in this hospital. The most common aetiology noted was Eclampsia (69.6%) followed by epilepsy (16.1%). Others included Cerebral Malaria (3.6%), Hypocalcemia (3.6%), Neurocysticerosis (2%), Hypokalemia (1.8%) and Hypoglycemia (1.8%). Maternal case fatality rate was 3.6%. Total perinatal mortality was 14.2% of which 6 (10.7 %) were still birth.
Conclusions: Eclampsia is a major cause of convulsions in pregnancy and considered to be the diagnosis unless proved otherwise. However other causes of convulsions should not be ignored. A thorough evaluation of the patient which lays a major emphasis on a detailed history taking and examination, form the crux of diagnosing the cause of convulsions and can expediate a timely and accurate treatment.
Keywords
Full Text:
PDFReferences
Douglas KA, Redman CWG. Eclampsia in the United Kingdom. The “BEST” way forward. Br J Obstet Gynaecol. 1992;99:355-6.
National Institute for clinical excellence. The Epilepsies. The diagnosis and management of the epilepsies in adult and children in primary and secondary care. Clinical Guideline 20. London: NICE, 2004.
Yerby MS. Quality of life, epilepsy advances, and the evolving role of anticonvulsants in women with epilepsy. Neurol. 2000;55(5 suppl 1):S21-S31; discussion S54-S5814.
Hvas C, Henriksen T, Ostergaard J, Dam M. Epilepsy and pregnancy: effect of antiepileptic drugs and lifestyle on birth a weight. Br J Obstet Gynaecol. 2000;107:896-902.
Ozdemir O, Sari ME, Kurt A, Sakar VS, Atalay CR. Pregnancy outcome of 149 pregnancies in women with epilepsy: Experience from a tertiary care hospital. Interv Med Appl Sci. Academic Publishing House. 2015 Sep;7(3):108-13.
Thomas S V., Jose M, Divakaran S, Sankara Sarma P. Malformation risk of antiepileptic drug exposure during pregnancy in women with epilepsy: Results from a pregnancy registry in South India. Epilepsia. 2017 Feb;58(2):274-81.
Thomas S V, Indrani L, Devi GC, Jacob S, Beegum J, Jacob PP, et al. Pregnancy in women with epilepsy : preliminary results of Kerala registry of epilepsy and pregnancy. Neurol India. 2001 Mar;49(1):60-6.
Maheshwari A, Athale S, Lekhra OP. Comparative safety of antiepileptic drugs during pregnancy. Neurology. 2013;80(7):689.
Patel SI, Pennell PB. Management of epilepsy during pregnancy: an update. Ther Adv Neurol Disord. SAGE Publications; 2016;9(2):118.
Danielsson KC, Borthen I, Morken N-H, Gilhus NE. Hypertensive pregnancy complications in women with epilepsy and antiepileptic drugs: a population-based cohort study of first pregnancies in Norway. BMJ Open. 2018 Apr 24;8(4):e020998.
Bansal R, Suri V, Chopra S, Aggarwal N, Sikka P, Saha SC, et al. Levetiracetam use during pregnancy in women with epilepsy: Preliminary observations from a tertiary care center in Northern India. Indian J Pharmacol. 2018;50(1):39-43.
Mawhinney E, Craig J, Morrow J, Russell A, Smithson WH, Parsons L, et al. Levetiracetam in pregnancy Results from the UK and Ireland epilepsy and pregnancy registers. Neurol. 2013 Jan 22;80(4):400-5.
Lowenstein D. H. seizures and epilepsy in harrisons principles of internal medicine Volume 2 (Eds) Fauci. A. S. Braunwald E. Isselbacher K. J. et al, 14th ed. McGrew Hill New York, 1998, 2311-2325.
Ali FE, Al-Bustan MA, Al-Busairi WA, Al-Mulla FA. Loss of Seizure Control Due to Anticonvulsant-Induced Hypocalcemia. Ann Pharmacother. 2004 Jun;38(6):1002-5.
Persson B, Hansson U. Hypoglycaemia in pregnancy. Baillière’s Clin Endocrinol Metab. 1993 Jul ;7(3):731-9.
Tjitra E, Anstey NM, Sugiarto P, Warikar N, Kenangalem E, Karyana M, et al. Multidrugresistant Plasmodium vivax associated with severe and fatal malaria: a prospective study in Papua, Indonesia. PLoS Med. 2008;5:e128.
Brabin BJ, Eggelte TA, Parise M, Verhoeff F. Dapsone therapy for malaria during pregnancy. Drug Safety. 2004 Aug 1;27(9):633-48.
Valecha N, Pinto RG, Turner GD, Kumar A, Rodrigues S, Dubhashi NG, et al. Histopathology of fatal respiratory distress caused by Plasmodium vivax malaria. Am J Trop Med Hyg. 2009;81:758-62.
Maiti B. Neurocysticercosis an update. JAPI. 1995;43:477-87.
D'Cruz RF, Ng SM, Dassan P. Neurocysticercosis in pregnancy: maternal and fetal outcomes. Oxford Med Case Reports. 2016 Jul;2016(7):138-40.
Sahai S, Sahai A. Pica causing neurocysticercosis in pregnancy presenting as eclampsia: a report of two cases. J Obstet Gynaecol India. 2013 Mar;63(1):68-9.
Nutman B, Thomas B., Weller P.F., Cestodes in Harrisons Principles of Internal Medicine, Vol 1, (Eds) Fauci A S Braunwald E, Isselbacher K.J., Wilson J.D. et al. 14th ed, McGraw Hill, New York, 1998:1224-1229.
Nash TE. Neva FA. Recent Advances in diagnosis and treatment of Neurocysticercosis N Eng J Med. 1994;311:1492-6.
