Clinical trends of severe pre-eclampsia

Abstract

Introduction: More than 70% of maternal deaths are due to five major complications: haemorrhage, infection, unsafe abortion, obstructed labour, and hypertensive disorders of pregnancy, including preeclampsia and eclampsia. Preeclampsia refers to a syndrome characterized by the new onset of hypertension and proteinuria after 20 weeks gestation in a previously normotensive woman. Eclampsia refers to the development of grand mal seizures in a woman with gestational hypertension or preeclampsia. The World Health Organization (WHO) estimates the incidence of preeclampsia to be seven times higher in developing countries (2.8% of live births) than in developed countries (0.4%). Multiorgan involvement may be seen in such cases, and the impairment of uteroplacental perfusion could potentially lead to gestational complications and poor fetal outcomes including intrauterine fetal growth restriction and preterm delivery. As the situation worsens, it may become life-threatening for both the mother and the fetus, in terms of increasing the rate of mortality and morbidity. Therefore, this study attempts to provide comprehensive information and a representative picture of potential maternal and infant health outcomes among women with preeclampsia/ eclampsia. Methods: The present Retrospective observational study was carried out at department of obstetrics and gynaecology amongst 44 Pregnant individuals with severe preeclampsia admitted in tertiary care hospital during January 2023 to June 2023. All basic demographic details like maternal age, parity, address, booking status, gestational age at diagnosis, chief complaints, pre-monitory symptoms (like headache, vomiting, blurring of vision and epigastric pain), detailed menstrual history, obstetric history and antenatal complication, past history of medical illness, if any in present pregnancy which was assessed from antenatal records. The high-risk factors that were noted- nulliparity, previous history of preeclampsia, maternal age >40, molar pregnancy, vascular, endothelial or renal diseases, maternal smoking, obesity (BMI>35 kg/m2) and certain genetic factors. Results: Majority of the patients had impending Eclampsia 41 (41%), headache 23(23%) followed by vomiting 11 (11%). 92 (92%) of the patients had platelet count more than 1 lakh, 4 patients had < 75,000 platelet count, majority 82(82%) of the patients had creatinine levels ≤ 0.8. 24 (24%) patients required ICU admission, 8 (8%) had PPH, 7 (7%) had Eclampsia and 7 (7%) landed with HELLP syndrome. The pregnancy in 79(79%) patients completed with LSCS. In 91(91%) cases final outcome was live birth and 9(%) ended with IUD. In majority 28(28%) of the babies had birth weight between 1.6 – 2 kgs, 24 (24%) had birth weight between 2.1 – 2.5 kgs, while 24 (24%) had birth weight less than 1.5 kgs. 56(56%) of the patients needed NICU support while 44(44%) were with their mothers. Conclusion: Timely recognition and appropriate management are essential to mitigate risks to maternal and fetal health. Further research is needed to explore interventions aimed at improving outcomes in severe preeclampsia.

Keywords: hypertensive disorders, preeclampsia, Eclampsia, HELLP syndrome, proteinuria