Maternal and perinatal out come in mild, severe pre eclampsia and eclampsia

INTRODUCTION: Pregnancy –induced hypertensive disease (PIH), in particular preeclampsia/eclampsia, remain important causes of maternal mortality and morbidity worldwide. The prevalence of PIH was 43.1 per 1000 pregnancies in a retrospective population-based study of 200,000 births in North Carolina, USA (Savitz 1992). For the past ten years, PIH has been the major cause of maternal mortality in England and Wales, and 56 per cent of deaths due to PIH were attributable to eclampsia (DOH report on confidential enquiries into maternal deaths in the United Kingdom 1985-1987). The Philippine Obstetrical and Gynecological Society committee on nationwide Statistics reported that 18.42 per cent of maternal deaths were due to PIH (POGS 1994). PIH also contributes to a great extent towards fetal wastage as per latest studies it is responsible for 20% perinatal deaths and 2-3% maternal deaths. PIH is defined as systolic blood pressure more than 140 mm of Hg or diastolic pressure more than 90mm Hg on 2 occasions 6 hrs apart in a previously normotensive pregnant women and associated with oedema and proteinuria. The criteria for diagnosing PIH are onset of hypertension for the first time after 20 weeks of pregnancy and patients becoming normotentive after delivery. This random study was taken up to evaluate the present status of maternal and perinatal outcome in mild and severe pre eclampsia and eclampsia in comparison with 200 normotensive control group at Kilpauk Medical College Hospital , Chennai in a period of 2003 to 2005. AIM OF STUDY: 1. To study the maternal and perinatal outcome in mild and severe pre Eclampsia and Eclampsia in comparison to the outcome in normal gravidae between the period of 2003 to 2005 at government K.M.C. Hospital, Chennai. 2. To study the factors that influence the maternal and perinatal outcome in mild, severe pre Eclampsia and Eclampsia. 3. To identify the factors affecting the maternal and perinatal outcome adversely so as to take steps to modify those factors for the improvement of materno fetal outcome. 4. To show the importance of proper antenatal, intranatal & postnatal care to improve the outcome. MATERIALS AND METHODS: 200 Cases of pregnancy induced hypertension complicating pregnancy admitted with duration of gestation between 21 weeks to 40 weeks were studied, 200 cases of normotensive patients of same period of gestation were taken as control group. Group A - Normotensive control patients. Group B - Pregnancy induced hypertension patients. Apart from routine clinical examination the following aspects were studied in the mother and fetus. SUMMARY: Incidence of preeclampsia in KMC is 11%. In our study there were 200 patients of mild, severe preeclampsia and Eclampsia were compared with 200 normotensive patients in terms of maternal and perinatal out come. - 60% of the preeclampsia Eclampsia patients were primi. - 42% were in the age group 21-25 years. - 78% were un booked - 98%of them belong to class 4or 5 socio economic status. - 5.5% had history of previous abortions and / or IUD. - 14.5%were recurrent PIH - About 9.5% had history of Hypertension in the family. - Complications like anemia, hypoproteinemia, antepartum Haemorrhage, post partum Haemorrhage, urinary infection and abnormal liver function test, fever, aspiration, severe renal failure, HELLP syndrome, and external injury due to fits are more in patients with PIH mainly severe PIH and Eclampsia. - 3 Patients developed HELLP syndrome, and all 3 died. - Clinical features like grading of Oedema and albuminuria were in ascending order with severity of PIH. - 65% of PIH patients were having normal Fundus examination but 30.5% had grade I retinopathy and 4.5% had grade II retinopathy. - Regarding biochemical parameters- With severity of PIH there were ascending order of biochemical abnormality. - 71% of them delivered via naturalis - LSCS was most commonly indicated for fetal distress (14%) - 55.5% of PIH patients particularly severe variety and Eclampsia were induced with prostaglandin. - 58.5% delivered at term - 4% taken for elective LSCS. - 66.5%of babies born to PIH mother were normal with good Apgar ( >7/10 ) - 33 babies were dead born/still born. - 16 babies died in the early neonatal period. - There was a slight male preponderance among babies (51.5%) - 32%of the babies weighed between 2.5 to 2.9 kg. - Total number of maternal death among PIH group is 3. All three died due to HELLP syndrome - Maternal mortality due to pregnancy induced hypertension is 3 (1.5%) in 200 cases of PIH. - Perinatal mortality rate = No of still born + neonatal death / 1000 live birth. - In our study the perinatal mortality rate due to PIH is 26.2/1000. CONCLUSION: This is the random study of 200 cases of maternal and perinatal outcome in mild and severe pre Eclampsia and Eclampsia in comparison to the outcome in 200 normal gravidae. Even though it is a random study it shows that the occurrence of preeclampsia and Eclampsia are found mostly in unbooked cases. There is an increase in incidence of maternal and perinatal morbidity and mortality in PIH patients, particularly with severe preeclampsia and Eclampsia. This study clearly illustrate that the regular monitoring of antenatal mothers with hypertension during pregnancy and labour has a welcoming result in modern obstetrics. Careful antenatal monitoring helps to identify the early warning signs of Eclampsia. Prompt care at this stage is often successful in preventing the high morbidity and mortality. The need for monitoring the pregnancy for early detection and proper management of a complication of pregnancy, with timely intervention as regards termination of pregnancy with facility for monitoring during labour and after care of the high risk infant, seems to play more important role in the final outcome. Both the foetus and maternal factors are to be taken into consideration. Once the blood pressure in these cases settles down with bed rest, sedatives and antihypertensive drugs, fetal factors are to be considered and decision taken accordingly to whether or not the foetus is in difficulty or whether it might benefit from continued intrauterine maintenance. If tests for fetal well being are normal and provided the mother’s condition does not threaten life, the pregnancy is allowed to continue until fetal maturity is reached. Once the fetal maturity is reached and confirmed by the various tests, termination of pregnancy is to be considered. Mode of delivery should be decided accordingly. This regimen of monitoring of PIH will definitely improve the pregnancy outcome. And More awareness to be created regarding early and regular antenatal check up to improve the pregnancy outcome in PIH patients