A Study on Fetomaternal Outcome of Preterm Eclampsia and its Relationship with Mode of Delivery

Introduction: Eclampsia (Greek, “shining forth”) is an acute and life-threatening complication of pregnancy, and is characterized by the appearance of tonic-clonic seizure, usually in a patient who had developed pre-eclampsia. Pre- eclampsia and eclampsia are collectively called hypertensive disorders of pregnancy and toxemia of pregnancy. This study aimed to analyze the feto-maternal outcome of preterm eclampsia and its relationship with the mode of delivery. Methods: This descriptive type of cross-sectional study was conducted at the eclampsia unit of the Department of Obstetrics and Gynecology, Dhaka Medical College Hospital, Dhaka, Bangladesh. The study was carried out from February 2012 to July 2012. A total of 92 subjects were enrolled in this study as per inclusion criteria. Result: In this study, the prevalence of eclampsia was 10.12%, and preterm eclampsia was 1.31%. The majority of the patients (48.91%) were within 20-25 years of age, and only 1.09% were >30 years of age. Most of the patients were primi gravida (78.26%). The majority of the patients (54.35%) reported within 3-5 hours. Most of the patients came at 33-34 weeks gestation, but quite a significant percentage (30%) came at 28-32 weeks of gestation. A large number of patients delivered spontaneously, a fair number of patients were induced & a few patients required LSCS. In both SVD & induced groups, the majority of the patients (62% & 66% respectively) were delivered within 7-12 hours. In the SVD group, 10% of patients were delivered within 6 hours whereas in the cesarean section group 85% of patients were delivered within 6 hours. Maximum patients (81%) had induction delivery intervals between 7-12 hours. 12 (60%) patients had LSCS done due to fetal distress, 2 (10%) due to previous H/O LSCS, 1 (5%) due to primi gravida with a twin pregnancy, and 5(25%) due to primi gravida with breech presentation. Of patients who presented at 28-32 weeks of gestation, among them 16 had SVD, 11 patients had induction of labor, and LSCS was done in only one case & which was stillborn. The majority of the babies in the SVD & induced group developed asphyxia (81% & 90% respectively) and the majority needed admission to NICU (62% & 73% respectively). PND was also high (>50%) in both groups. Of patients who presented at 33-34 weeks of gestation, 19 had SVD, 15 patients had induction of labor, and only 4 patients required LSCS. A significant number of babies in all three groups (42%, 47% & 100% respectively) were healthy. Although in SVD & induced groups a large number of babies developed asphyxia (58% & 47% respectively) and admission was required in NICU 26% in both groups. PND was few in both groups. For patients who presented at 35-36 weeks of gestation, the majority was delivered by LSCS (15) & outcomes of babies were good in this group as well as in the SVD group. Only one baby developed birth asphyxia. The maternal outcome was good in all three groups (85%, 91%, & 100% respectively). No maternal complication occurred in the cesarean section group. In SVD & induced group few maternal complications occurred such as recurrent convulsion (12% & 13% respectively), CVD (single case in both groups), pulmonary edema (1), HELLP syndrome (1), and septicemia (1). Three mothers die in SVD & induced group. Conclusion: This study concluded that early-onset eclampsia has been associated with worse perinatal outcomes. Gestational age <32 weeks who do not go into labor spontaneously may offer induction, as the cesarean section does not carry any good prognosis to the fetus but rather increases morbidity to the mother. When gestational age crosses >33 weeks, a complete evaluation of the fetal condition, mental condition, and cervix is necessary to plan for the mode of delivery.