32
PRE-ECLAMPSIA – A PATTERN OF FETO-MATERNAL OUTCOME IN WESTERN
RAJASTHAN: A RETROSPECTIVE ANALYSIS1 2 3Dr Ashok Kumar Kumawat , Dr. Rizwana Shaheen , Dr. Indra Bhati
ABSTRACT
Background : Pre-eclampsia is a multiorgan disorder unique to pregnancy typically
characterized by blood pressure ≥140/90 mmHg after 20 weeks gestation associated
with proteinuria ≥300 mg/24 h or ≥1+dipstick. Preeclampsia and the other hypertensive
disorders of pregnancy remain leading causes of maternal and perinatal morbidity and
mortality, complicating 5 to 10 percent of all pregnancies and together they form one
member of the deadly triad, along with haemorrhage and infection. Objective : To study
maternal outcomes in terms of severity, complications of pre-eclampsia; and maternal
mortality and foetal morbidity and mortality.
Material and Methods : This was a retrospective observational study over July 2018 to
June 2019 at Mathura Das Mathur hospital, Dr S N Medical College, Jodhpur Rajasthan.
The diagnosis of all cases was made on the basis of history, clinical examination and
ultrasonography.
Results : Total 100 patients were analysed in this study. Majority of the women studied
(67%) were in age group of 20-30 years; 72% were term and 28 % were preterm; and
most common mode of delivery was caesarean section (61%), Various maternal
complications arising due to preeclampsia were also studied, and it was found that
abruption was seen in 6%, HELLP/DIC was seen in 4% patients, eclampsia in 3%,
pulmonary oedema in 2%%, NICU admission in 9% whereas maternal mortality
occurred in 1% of patients. Foetal outcome also observed in the form of prematurity,
IUGR, Birth asphyxia and neonatal intensive care unit admission.
Conclusion : Pre-eclampsia is one of the most common medical complications of
pregnancy associated with significant maternal and neonatal morbidity.
Keywords : Pre-eclampsia, Maternal and foetal outcome.
Introduction:
“Safe pregnancy is a beautiful voyage
ending with birth of two lives But, if
gets affected by preeclampsia,
becomes a journey through a ring of
fire”
Hypertensive disorders are among
the most common medical disorders
during pregnancy and continue to be
the major cause of maternal and
perinatal morbidity and mortality.
Pre-eclampsia is a mult iorgan
disorder unique to pregnancy
typically characterized by blood
pressure ≥140/90 mmHg after 20
weeks gestation associated with
p r o t e i n u r i a ≥ 3 0 0 m g / 2 4 h o r
≥1+dipstick.1,2 Pre-eclampsia and the
other hypertensive disorders of
pregnancy remain leading causes of
maternal and perinatal morbidity and
mortality, complicating 5 to 10
percent of all pregnancies and
together they form one member of
t h e d e a d l y t r i a d , a l o n g w i t h
haemorrhage and infection. Of these
ORIGINAL RESEARCH ARTICLE
rd1 - 3 year resident, 2- Sr. Prof. & Unit Head, 3 - Sr. Professor & HOD
Department of Obstetrics & Gynecology
MDM Hospital, Dr. S. N. Medical College, Jodhpur
Corresponding Author - Dr. Ashok Kumar Kumawat
33
disorders, preeclampsia syndrome is
the most dangerous, affecting 3.9
percent of all pregnancies globally.3
The WHO reviews of maternal mortality
wor ldwide suggest 16 percent
mater n a l d eath s in d eve lop ed
countr ies due to hypertens ive
disorders.4 Importantly, more than
half of these hypertension-related
deaths are preventable.5 India
accounted for 19% of maternal deaths
worldwide.6 Five percent of maternal
deaths in India are due to hypertensive
disorders.7
Pre-eclampsia can affect virtually every
o r g a n s y s t e m l e a d i n g t o
thrombocytopenia, renal insufficiency,
liver dysfunction, pulmonary edema,
visual disturbances, cerebrovascular
and cardiovascular complications,
placental abruption, acute renal
failure, disseminated intravascular
coagulation, multiple organ system
failures, postpartum haemorrhage
and maternal death. Prematurity,
intrauterine growth restriction, fetal
distress, neonatal asphyxia, low birth
weight, stillbirth and perinatal death
are fetal and neonatal complications to
be anticipated and dealt with when the
m o t h e r h a s p r e e c l a m p s i a . 8
Preeclampsia is a principal cause of
fetal morbidity and mortality, also the
leading reason of maternal ICU
a d m i s s i o n s , a n d r e s p o n s i b l e
for15–20% of materna l deaths
worldwide.9
Delivery of the infant and placenta is
the only effective treatment. Delivery
at an earlier gestational age, however,
is associated with an increased risk of
adverse neonatal outcome.10 Women
with preeclampsia have an increased
rate of cesarean section consequent
upon the high incidence of intrauterine
growth restriction, fetal distres, and
prematurity10. Cesarean section on
the other hand increases the risk of
cardiopulmonary morbidity associated
with pre-eclampsia.11 This is due to the
altered hemodynamics in women with
pre-eclampsia, particularly in an
emergent situation.
AIMS
1. To study the distribution pattern
of pre-eclampsia among
different group of patients with
special reference to age, parity,
booked/ unbooked status and
gestational age at presentation.
2. To study maternal outcomes in
terms of severity, complications
of pre-eclampsia, and maternal
mortality.
3. To study foetal morbidity and
mortality.
MATERIALS AND METHODS
This was a retrospective study done
during one year period from July 2018
to June 2019 at Mathura Das Mathur
hospital, Dr S N Medical college,
Jodhpur, Rajasthan. This study was
done by analysis of hospital records of
patients admitted with diagnosis of
pre-eclampsia after approval by the
ethical committee of the institution.
Blood pressure was measured using
standard parameters with a proper
size cuff with patient in sitting position.
Proteinuria was measured using
dipstick method and ≥1+ on at least two
occasions was taken as positive.
Inclusion criteria were patients with
diagnosis of preeclampsia. Exclusion
criteria were patients with chronic
r e n a l d i s e a s e , s y s t e m i c l u p u s
34
erythematosus, connective tissue
disorder, molar pregnancy, thyroid
disorder, and diabetes.
All patients were evaluated for fetal
and maternal condition using various
biochemical and radiological test.
Biochemical test includes complete
blood count, liver function test, kidney
function test, urine for proteins with
dipstick/24 h urine collection, and
fundus examination. Fetal state was
assessed using ultrasonography and
nonstress test wherever required.
Patients were managed as per clinical
protocols, progression of disease, and
fetomaternal condition.
RESULTS:
A total of 100 patients were analysed in
this study.Majority of the studied
women (67%) were in mean age group
of 20-30 years, with 14% below 20 years
and 19% above 30 years. In our study,
62% were primigravida and 38% were
multigravida; 72% were term and 28%
were preterm. In 61% of patients mode
of delivery was caesarean section and
39% were vaginally delivered. Out of
the 100 babies 57% babies weigh
>2500gm, and 32% babies weight
between 1500-2500gm and 11% were
lesser than 1500gm.
Various maternal complications arising
due to preeclampsia were also studied,
and it was found that abruption was
seen in 6%, HELLP/DIC was seen in 4%
patients, eclampsia in 3%, pulmonary
oedema in 2%%, NICU admission in 9%
whereas maternal mortality occurred
in 1% of patients.
In all cases, fetal outcome was also
observed in the form of prematurity,
IUGR, Birth asphyxia , neonatal
intensive care unit admission. It was
seen that prematurity was present in
28% of patients, 4% of babies had
IUD/still birth, 16% of babies had birth
asphyxia, 7% of babies had IUGR
whereas NICU admission was seen in
12.5% of patients.
Discussion
Preeclampsia, which occurs only in the
presence of placenta, continues to be a
major cause of maternal and perinatal
morbidity and mortality world-wide.
We observed that chances of pre-
eclampsia were significantly higher in
younger age group (20-30 years).
Similar results have also been obtained
by various authors Yadav et al12 and
Singh A et al13.
Nulliparity has also been found to be
associated with pre-eclampsia. We also
observed that pre-eclampsia occurred
more frequently in primigravida (62%)
as compare to multigravida (38%).
35
Sibai and Cunningham14 reviewed a
number of worldwide studies and
concluded that the incidence of pre-
eclampsia in nulliparous populations
was more than that for multiparous. It
could be because of the failure of
normal invasion of trophoblastic cells
that leads to maladaptation of the
spiral arterioles.15
We also studied distribution of pre-
e c l a m p t i c c a s e s a c c o r d i n g t o
gestational age of presentation and
severity. It was observed that most of
the cases (72%) occurred at advanced
gestational age (>37 weeks) and
preterm in 38% cases. Similar results
have also been observed by Sajith et
al.16
We also observed that 61 out of 100
(61%) patients were delivered by lower
segment cesarean section (LSCS), and
39 patients were delivered by vaginally.
S imi lar resul ts have a lso been
observed by Yelmizaitun et al. (2010).17
This finding was in contrast with other
authors Chaim et al18 (2008) Yadav et
al19 (1997) in India (14.8%). This
difference in LSCS rate may be due to
difference in medical facilities and
quality of antenatal care (ANC) in
different parts of the world.
This present study showed that among
all partial HELLP and HELLP syndrome
and DIC were the most common
maternal complications seen in 9% of
patients; whereas PPH in 7% and
pulmonary edema each was seen in
2%; eclampsia developed in 3% and
maternal mortality rate was 1%. Similar
results have also been obtained by
Murphy and Stirrat (2000)20. In their
study, 21% had developed HELLP/ELLP
syndrome, 1.4% had eclampsia. In
another study conducted by Minire et
al. (2013),21 lower complications rate
were reported. In their study, 3.2%
patients had eclampsia, 4.2% had
HELLP syndrome, and 5.58% had
pulmonary edema, whereas DIC was
seen in 0.46% of patients. Higher
complication rates in our study could
be because of late patient presentation
for medical care.
Prematurity was the most common
complication associated with pre-
eclampsia, which was seen in 28%
cases. These results lower than
observed by Tuffnell et al22 (65.3%)
and Singhal et al.23(66%). Birth
Asphyxia was observed in 16%
patients. Similar results were also
observed by Singhal et al. (2009)23 who
found the risk of birth asphyxia
(21.43%). It could be because these
studies were conducted in different
c o u n t r i e s w h e r e p a t i e n t ' s
socioeconomic background and
medical facilities are better.
CONCLUSION :
“Prevention is Better Than Cure”
But this is not completely true for
pre–eclampsia. Since it cannot be
c o m p l e t e l y p r e v e n t e d , t i m e l y
diagnosis of high-risk patients and
prompt treatment in mild stage is the
key to prevent complications. This
study highlights various risk factors
and complications both to mother and
fetus for pre-eclampsia. Therefore, the
study advocates more research into
the field of pre-eclampsia to develop
effective strategy for prediction and
prevention of adverse outcomes.
Routine screening for hypertensive
diseases of pregnancy (HDP) based on
measurement of blood pressure
36
among all pregnant women should be
practised as recommended by WHO
and where resources are available, it is
desirable to do urinary protein analysis
a t e v e r y a n t e n a t a l v i s i t a s a
complement to routine blood pressure
measurement in remote areas of India
like our western Rajasthan.
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