Obstetrics and Gynaecology

ECLAMPSIA SCENARIO IN A DISTRICT HOSPITAL

Available data pertaining to Eclampsia cases admitted in Thane Civil Hospital during one year was evaluated.

Distance Traveled by Patients varied from 1km to 125 km and average time taken varied from 1 to 10 hrs.

Both distance and duration for admission after first convulsion are positively correlated (p=0.25)
Ideally hospital providing specialized medical care should be available within 25 kms.

43 out of the 48 cases were referred from other hospitals/health centres (cottage hospital, RH)
Only 5 cases came directly to Thane Civil Hospital.

22(46%) subjects were registered antenatally with an average of 4.4 visits each.

26 (52%) women were unregistered with no Antenatal care. Overall average age of the woman was 22.3 yrs. Age at marriage varied from 13-24 years. At the time of admission Premonitory symptoms were noticed by 25% women only. 58.3% women were conscious, 18.8% semiconscious.14.6% disoriented and 8.3% unconscious.Convulsions were mainly antenatal and nos. varied from 1-11.

Maternal Morbidity:
Moderate to severe Anemia, Moderate to severe Edema, Impaired Renal Function, Impending Renal Failure, Acute Respiratory Distress Syndrome, Metabolic Encephalopathy, Takayasu's Disease, Aortoarteritis, Hyperpyrexia, Neck rigidity.
There was no case of DIC.

Treatment:
All women received inj.MgSO4, injection administered by staff nurse.

Total doses varied from 14 to 79 gm (average 25 gm) (including MgSO4 given at FRU also).

Inj. Diazepam was also given during convulsions to 27 women.

T. Depin was given for immediate control of High B.P. in almost all women (n=45 i.e.94%) and even after discharge in 32 women (67%).

T. Aldomet was given to 7 subjects. Inj. Pethedine/Inj. Phenargan was given to 4 women

Inj. Lasix was given in 15 subjects.

Inj. Mannitol was given in 5 subjects.

Labor:
Spontaneous 35(73%), Induced 13(27%), Augmented 26(54%)

Delivery Details:
Live Births 30 (Normal 26, Forceps 2, LSCS 1, Breech 1), Still Birth 14

Maternal Mortality:
1 (before delivery) Cause of death: Cardio Respiratory Failure following ARDS

Maternal Transfer:
3 (before delivery) for-
1) Metabolic Encephalopathy, Meningitis, Hyperpyrexia, Neck rigidity

2) Uremia with impending renal failure

3) Fulminant Eclampsia

Neonatal Deaths:
3 Avg. Wt. of Live Born Babies: 2350 gms

Baby Salvage Rate: 60%

With a very basic rudimentary setup for the management of eclampsia in the district hospital the Maternal Mortality Rate was 2.1% and Baby Salvage Rate was 60%.