Clinical Characteristics and Outcomes of Postpartum Eclampsia Patients admitted to the Intensive Care Unit of Tertiary Level Hospital.

Abstract

Hypertensive disorders, particularly eclampsia, remain one of the leading causes of maternal mortality in our country. Postpartum eclampsia is one of the deadliest complications which may drag a mother up to Intensive Care Unit (ICU). Limited resource of critical care must be used for those patients who are most likely to get benefit. Timely recognition and treatment of the critically ill patient may improve the outcome and reduce morbidity and mortality. To find out the clinical characteristics and outcome of Postpartum eclampsia patients admitted to the intensive care unit of tertiary level hospital. It is a cross-sectional descriptive type of observational study conducted in the ICU of Mymensingh Medical College Hospital (MMCH), over a period of one year from July 2019 to June 2020. All women admitted to ICU during this period were considered for inclusion and 65 patients with diagnosis of postpartum eclampsia were selected. For each eligible patient, sociodemographic profile, indication of ICU admission, Data of ICU interventions and maternal outcome was then classified, edited, coded and entered into computer for statistical analysis by using SPSS V22.0 and presented in graph, pie chart and tabulated form. Out of 65 patients highest 25(38.46%) belonged to the age group (21-25) years and majority 52(80.0%) of patients from rural area. Most of the patients were primiparous 35(53.84%) among them 19(29.23%) patients were unbooked. Majority 48(73.84%) of patients had seizures in ≥48 hours and commonest prodromal symptom was headache 57(87.69%). Out of 65 patients, 55(84.61%) patients had vaginal delivery and 10(15.38%) patients had cesarean delivery. Commonest maternal complication was pulmonary edema 28(43.07%), 19(29.23%) patients had cerebrovascular accident, 10(15.38%) patients had HELLP syndrome, 8(12.30%) patients had Acute kidney injury, 7(10.76%) patients had MODS, 4(6.15%) had aspiration pneumonia and 2(3.07%) patients had pulmonary embolism. Most of the patients 59(90.0%) needed advance monitoring, 30(46.0%) patients received mechanical ventilation, and 27(41.0%) patients received vasoactive drugs. There were 5 maternal deaths giving rise a case fatality rate of 7.69%. Maternal mortality in present standard obstetric care is well controlled due to intensive care monitoring. Appropriate antenatal care and postnatal care are important in preventing obstetric complications.