DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20204945

Critical care management of eclampsia patients - one year study

Bharti C. Parihar, Babli Yadav, Jaya Patel

Abstract


Background: Critically ill eclampsia patients present a unique challenge to the obstetrician, anesthesiologist and intensivists. In developing countries, maternal mortality is still high due to lack of good maternal antenatal services and obstetric intensive care. This study aims to provide a comprehensive review for the management and outcome of critically ill eclampsia patients admitted in the obstetric intensive care unit (ICU), GMC, Bhopal.

Methods: This study was a hospital based cross sectional study. The study included 145 eclampsia patients who were admitted in obstetric ICU for critical care management. For each eligible patient, sociodemograhic profile, indications of ICU admission, data on ICU interventions and maternal outcome were documented.

Results: During study period, total obstetric admission were 19,815 and 14,731 live births. Out of 348 eclampsia patients, 145 patients were admitted to the obstetric ICU, giving an ICU admission rate of 9.8/1000 live births. 98.03% patients were unbooked referred obstetric emergencies.The average duration of stay in obstetric ICU was 5.4+3.1 days. 72.9% patients had antepartum eclampsia, 17.2% patients had postpartum eclampsia and 10.8% patients had intrapartum eclampsia. 41% patients received mechanical ventilation, 90% patients received oxygen and advanced monitoring, 48.6% patients received vasoactive drugs and 53.7% patients received blood transfusions. There were 26 maternal deaths giving a case fatality rate of 17.93%.

Conclusions: Early referral of eclampsia patients or at risk patients to a tertiary care centre may help to reduce maternal morbidity and mortality. Early diagnosis and prompt treatment through a multidisciplinary team in an ICU setting can prevent complications and reduce morbidity and mortality.


Keywords


Eclampsia, Critical care, Maternal mortality

Full Text:

PDF

References


Duley L. Maternal mortality associated with hypertensive disorders of pregnancy in Africa, Asia, Latin America and the Caribbean. Br J Obstet Gynecol. 1992;99:547-53.

Ghulmiyyah L, Sibai B. Maternal mortality from preeclamsia/eclampsia. Semin Perinatol. 2012;36:56-9.

Khan KS, Wojdyla D, Say L, Gulmezoglu AM, Van look PF. WHO analysis of causes of maternal death: A systematic review. Lancet. 2006;367:1066-74.

Sibai BM. Diagnosis, prevention and management of eclampsia patients. Br J Obstet Gynecol. 2005;105;402-10.

Walker JJ. Pre-eclampsia. Lancet. 2000;356:1260-5.

Ebeigbe PN, Aziken ME. Early onset pregnancy-induced hypertension/eclampsia in Benin City, Nigeria. Niger J Clin Pract. 2010;13:388-93.

Olusanya O, Amiegheme N. Biosocial factors in maternal mortaliy: A study from a Nigerian mission hospital. Trop J Obstet Gynaecol. 1988;1:88-9.

Ruiz Urbay AA, Cruz Martinez H, Foryseud. Compartmento de la enfermedad obstetrcagrave. Naev Anos en UnaUnidad de CuidosoIntensivasMedi. 2002;8:18.

Waterstone M, Bewleys S, Wolfe C. Incidence and predictors of severe obstetric morbidity; Case control study. BMJ. 2001;322:1089-94.

Knight M. UKOSS. Eclampsia in the United Kingdom 2005. BJOG. 2007;114:1072-8.

Koofreh ME, Ekott M, Ekpoudom DO. The prevalence of preeclampsia among pregnant women in the University of Calabar. Saudi J Health Sci. 2014;3:133-6.

Lapinsky SE, Kruczynksi K, Slutsky AS. Critical care in the pregnant patient. Am J Respir Crit Care Med. 1995;152:427-55.

Singh S, Ahmed EB, Egondu SC, Ikechukwn NE. Hypertensive disorders in pregnancy among pregnant women in a Nigerian Teaching Hospital. Niger Med J. 2014;55:384-8.

Igberase GO, Ebeigbe PN. Eclampsia: Ten years of experience in a rural tertiary hospital in the Niger delta, Nigeria. J Obstet Gynaecol. 2006;26:414-7.

Seaward GR, Lapinsky SE, Kruczynski K, Farine D, Grossman RF. Critical care management of the obstetric patients. Can J Anaesth. 1997;44:325-9.

Campbell LA, Klocke RA. Update in non pulmonary critical care: Implication for the pregnant patients. Am J Crit Care Med. 2001;163:1051-4.

Thorton CE, Von Dadelszen P, Makris A,Tooher JM, Ogle RF, Hennessy A. Acute pulmonary edema as a complication of hypertension during pregnancy. Hyperten Pregnancy. 2011;30:169-79.

Benedetti TJ, Kates R, Williams V. Haemodynamic observations in severe preeclampsia complicated by pulmonary edema. Am J Obstet Gynaecol. 2005;152:330-4.

Tuffnell DJ, Jankowicz D, Lindow SW, Lyons G, Mason GC, Russell IF, et al. Outcomes of severe preeclampsia /eclampsia in Yorkshire. BJOG. 2005;112:875-80.

Sharshar T, Lamy C, Mas JL. Incidence and causes of strokes associated with pregnancy and puerperium;a study in public hospitals of ILE de France. Stroke. 2005;26(6):930-6.

Sibai BM, Tasliminel-Nazar A, Amon E, Mabie BC, Ryan GM, et al. Maternal perinatal outcome associated with the syndrome of hemolysis, elevated liver enzymes and low platelet count in severe preeclampsia/eclampsia. Am J Obstet Gynecol. 2006;155:501-9.

Neligan PJ, Laffey JG. Clinical review: special populations- critical illness and pregnancy. Crit Care. 2011;15:227-30.