DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20201240

Comparative study: normotensive and preeclampsia mother presenting with imminent symptoms of eclampsia in third trimester of pregnancy

Raji C., Suba S.

Abstract


Background: This prospective study compares the maternal and fetal outcome in normotensive and preeclampsia mother presenting with imminent symptoms of eclampsia in third trimester. This prospective study was conducted in the department of obstetrics and gynaecology, Government Theni Medical College, Tamil Nadu, India in 2019.

Methods: A total 100 antenatal mothers were selected for the study. Group A - 50 known case of preeclampsia presented with imminent symptoms. Group B-50 previously normotensive patients present with imminent symptoms of eclampsia. Maternal and fetal outcome were analysed.

Results: Incidence of eclampsia - 0.1%, HELLP syndrome - 0.04%, pulmonary edema - 0.06%, PRES - 0.07%, abruptio placenta - 0.14% and maternal death in Group A was 2% and in Group B was 8%. Maternal complications are more in normotensive women (46%) presented with imminent symptoms than in preeclampsia women (26%) with imminent symptoms. Incidence of IUGR in Group A was 46%, whereas in Group B 12%. Incidence of preterm babies in Group A was 18%, whereas in Group B was 42%. Perinatal death incidence was 2.2% in imminent eclampsia.

Conclusions: Because known preeclampsia patients were aware of imminent symptoms and presented early to hospital. Early identification and treatment of this dreadful outcome at the imminent state itself can reduce the complications. In current status on preventive aspect of eclampsia, atypical presentation should also be considered for which new screening and diagnostic tools has to be developed.


Keywords


Fetomaternal outcome, Non severe preeclampsia, Severe preeclampsia

Full Text:

PDF

References


Uzan J, Carbonnel M, Piconne O, Asmar R, Ayoubi JM. Pre-eclampsia: pathophysiology, diagnosis, and management. Vasc Health Risk Manag. 2011;7:467-74.

Jido TA, Yakasai IA. Pre-eclampsia: a review of evidence. Ann Afr Med. 2013;12(2):75-85.

Park JH, Chung D, Cho HY, Kim YH, Son GY, Park YW, et al. Random urine protein/creatinine ratio readily predicts proteinuria in preeclampsia. Obstet Gynecol Sci. 2013;56(1):8-14.

Duley L. The global impact of pre-eclampsia and eclampsia. Semin Perinatol. 2009;33(3):130-7.

Swati S, Ekele BA, Shehu CE, Nwobodo EI. Hypertensive disorders in pregnancy among pregnant women in a Nigerian Teaching Hospital. Nig Med J. 2014;55(5):384-8.

World Health Organization. Trends in Maternal Mortality: 1990 to 2008. 2010. Available at: https://www.who.int/reproductivehealth/publication/ monitoring/9789241500265/en/. Accessed on 14th August 2018.

Chan P, Brown M, Simpson JM, Davis G. Proteinuria in pre-eclampsia: how much matters? Int J Obstet Gynaecol. 2005;112:280-5.

Waugh JJS, Smith MC. Hypertensive Disorders. In: Edmond DK (ed). Dewhurst’s Textbook of Obstetrics and Gynaecology. 8th ed. John Wiley and Sons, Ltd.; 2012:101-110.

Cunningham FG, Leveno KJ, Bloom SL, Spong CY, Dashe JS, Hoffman BL, et al. Hypertensive disorders. Williams Obstetrics. 24th ed. USA: McGraw-Hill companies; 2014:728-779.

Mustapha R, Ahmed S, Gupta A, Venuto R. A Comprehensive review of hypertension in pregnancy. J Preg. 2012;10(5):91-109.

Sabitha K, Gopal BV, Raj KG, Rafi MD, Sudhakar T, Ramadevi C, et al. Preeclampsia: its effect on renal, cardiovascular, hepatic and thyroid functions a review. Am J Clin Med Res. 2014;2(6):111-3.

The American College of Obstetricians and Gynecologists. Diagnosis and Management of Preeclampsia and Eclampsia. ACOG Practice Bulletin 33, 2002. Available at: journals. Iww.com/green journal/Full text/2002/01000 /ACOG_Practice_Bulletin_No_. Accessed on 13th August 2018.

von Dadelszen P, Magee LA, Devarakonda RM, Hamilton T, Ainsworth LM, Yin R, et al. The prediction of adverse maternal outcomes in preeclampsia. J Obstet Gynaecol Can. 2004;26:871-9.

Nevo O, Soleymanlou N, Wu Y. Increased expression of sFlt-1 in in-vivo and in-vitro models of human placental hypoxia is mediated by HIF-1. Am J Physiol. 2006;291(4):1085-93.

Levine RJ, Lam C, Qian C. Soluble endoglin and other circulating antiangiogenic factors in preeclampsia. N Engl J Med. 2006;355(10):992-1005.

Tranquilli AL, Brown MA. Zeeman GG, Dekker G, Sibai BM. The definition of severe and early-onset preeclampsia. Statements from the International Society for the Study of Hypertension in Pregnancy (ISSHP). Int J women Cardiovascular Health. 2013;3:44-7.

National Collaborating Centre for Women’s and Children’s Health. Hypertension in pregnancy the management of hypertensive disorders during pregnancy. NICE Clinical Guideline August 2010. Available at: https://www.nice.org.uk/guidance/cg107. Accessed on 26th August 2018.

Confidential Enquiry into Maternal and Child Health. Saving Mothers’ Lives: Reviewing maternal deaths to make motherhood safer 2003-2005: The Seventh Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom. Available at: https://www.hqip.org.uk/resource/cmace-andcemach-reports/. Accessed on 25th August 2018.

Ekine AA, Jeremiah I, Harry TC, West OL. Factors influencing the prevalence of Preeclampsia eclampsia in booked and unbooked patients: 3 years retrospective study in NDUTH, Okolobiri. World J Med Med Sci. 2015;3(1):1-14.

Agwu UM, Ifebunandu N, Obuna AJ, Nworie EO, Nwopko SO, Umeora OUJ. Prevalence of medical disorders in pregnancy in Ebonyi State university teaching hospital. J Basic Clin Reprod Sci. 2013;2(1):22-6.

Abubakar A, Abdullahi RA, Jibril HZ, Dauda MN, Poopola MA. Maternal ethnicity and severity of pre-eclampsia in Northern Nigeria. Asian J Med Sci. 2009;1(3):104-7.

Ebeigbe PN, Aziken ME. Early onset pregnancy induced hypertension/eclampsia in Benin City. Nig J Clin Pract. 2010;13:4.

Ugwu E, Dim CC, Okonkwo CD, Nwankwo TO. Maternal and perinatal outcome of severe preeclampsia in Enugu, Nigeria after introduction of Magnesium sulfate. Niger J Clin Pract. 2011;14(4):418-21.

Leveno KJ, Alexander JM, McIntire DD. Does magnesium sulfate given for prevention of eclampsia affect the outcome of labor? Am J Obstet Gynecol. 1998;178:707.

Pradeep MR, Shivanna L. Retrospective study of eclampsia in a teaching Hospital. Inter J Recent Trends Sci Technol. 2013;8(3):171-3.

Bhalerao A. Eclampsia: maternal and fetal outcome. J South Asian Feder Obstet Gynaecol. 2013;5(1):19-21.

Manjusha S, Vandana N, Goutham R, Sneha M, Atmaram PP. Eclampsia: a retrospective study in a tertiary care centre. Indian J Pharma Pract. 2013;6:1.

Knight M. Eclampsia in the United Kingdom 2005. Inter J Obstet Gynaecol. 2007;114(9):1072-8.

Sunita TH, Desai RM. Eclampsia in a teaching hospital: incidence, clinical profile and response to magnesium sulphate by Zuspan’s regimen. J Dent Med Sci. 2013;4(2):1-5.

Zwart JJ, Richters A, Öry F. Eclampsia in the Netherlands. Obstet Gynecol. 2008;112:820.

Walker JJ. Severe pre-eclampsia and eclampsia. Bailliere's Clin Obstet Gynaecol. 2000;14(1):57-71.

Yaliwal RG, Jaju PB, Vanishree M. Eclampsia and perinatal outcome: a retrospective study in a teaching hospital. J Clin Diagnos Res. 2011;5(5):1056-9.

Jofy TJ. Are we increasing serious maternal morbidity by postponing termination of pregnancy in severe pre-eclampsia and eclampsia. J Obstet Gynecol. 2004;24(7):765-8.

Cunningham DS, Christie TI. Effect of HELLP syn on maternal immune function. J Reprod Med. 1993;38(6):459-64.