Pattern of liver enzymes and maternal outcome in eclamptic patients admitted to the Intensive Care Unit, University College Hospital, Nigeria

Introduction: Eclampsia, a hypertensive disorder, is one of the leading causes of maternal mortality in developing countries like Nigeria. We evaluated the relationship between the pattern of liver enzymes and maternal mortality in eclamptic women. Method: A retrospective study of 55 eclamptic women admitted to the Intensive Care Unit (ICU), University College Hospital, Nigeria, was conducted. Data were obtained on their demographic, obstetric, and clinical characteristics, liver enzyme patterns, and maternal outcome. Analysis was by descriptive statistics, univariate analysis, and non-parametric tests with level of significance set at p<0.05. Results: Maternal deaths occurred in 27.3% and elevation of liver enzymes was observed more among the dead patients compared with those who survived. Alanine aminotransferase (ALT) was the most commonly elevated liver enzyme, occurring in almost all (90.9%) the patients. Maternal mortality was significantly associated with age (p=0.001), saturated oxygen levels (p=0.007), elevated alkaline phosphatase (p=0.008), alanine aminotransferase (p=0.013), aspartate aminotransferase (p=0.016), and total bilirubin (p<0.001). Conclusion: Maternal mortality due to eclampsia was clinically associated with age, elevated liver enzymes and a lower serum level of total bilirubin. Liver transaminases are therefore important prognostic indicators associated with eclampsia.

Éclampsie en réanimation polyvalente: facteurs déterminants du décès / Eclampsia in polyvalent intensive care unit: determinants of death

Contexte et objectif . L'éclampsie étant une cause majeure de mortalité maternelle, notre objectif était de décrire l'évolution et identifi er les facteurs prono stics des éclampsies admises en réanimation. Méthodes. Etude rétrospective, analytique portant sur les cas d'éclampsie admis du 01 janvier 2015 au 31 décembre 2019. Les données étudiées étaient d'ordres épidémio-clinique, thérapeutique et évolutif. L'analyse a été réalisée à l'aide du test de Fisher au seuil de signifi cativité 5%. Résultats. Soixante-douze (72) dossiers ont été retenus et la prévalence était de 5,46%. L'âge moyen était de 23,87 ans ± 1,52. Les crises étaient survenues en anté partum à 52,78%. Une césarienne a été réalisée dans 65,28% des cas. Les anticonvulsivants les plus utilisés étaient le phénobarbital (51,39%), le sulfate de magnésium (38,89%) et le diazépam (26,39%). La ventilation mécanique a été indiquée dans certains cas : 38,89%. Nous avons observé des complications dans 59,72% des cas dont les plus fréquentes étaient le syndrome d'hémolyse, de cytolyse hépatique et de thrombopénie (30,56%), l'état de mal convulsif (25%) et l'insuffi sance rénale aigüe (19,44%). La mortalité était de 12,5%. Les facteurs de mauvais pronostic étaient la ventilation mécanique et la présence de certaines complications. Les facteurs améliorant le pronostic étaient l'éclampsie du post partum et le sulfate de magnésium. Conclusion. Les complications étaient fréquentes, la mortalité élevée et les facteurs pronostics concernaient la période de survenue des convulsions, le type de complications associées et les moyens de prise en charge

Context and objective. Eclampsia being a major cause of maternal mortality, our objective was to describe the evolution and identify the prognostic factors of eclampsia admitted to intensive care. Methods. R0etrospective, analytical study of cases of eclampsia admitted from January 1, 2015 to December 31, 2019. The data studied were epidemiologicalclinical, therapeutic and evolutionary. The analysis was carried out using Fisher's test at the 5% signifi cance level. Results. 72 fi les were retained and the prevalence was 5.46%. The mean age was 23.87 years ± 1.52. The seizures had occurred antepartum in 52.78%. A caesarean section was performed in 65.28% of cases. The most used anticonvulsants were phenobarbital (51.39%), magnesium sulphate (38.89%) and diazepam (26.39%). Mechanical ventilation was indicated in some cases: 38.89%. We observed complications in 59.72% of cases, the most frequent of which were hemolysis syndrome, hepatic cytolysis and thrombocytopenia (30.56%), convulsive status epilepticus (25%) and insufficiency acute renal (19.44%). Mortality was 12.5%. The poor prognostic factors were mechanical ventilation and the presence of certain complications. The factors improving the prognosis were postpartum eclampsia and magnesium sulphate. Conclusion. Complications were frequent, mortality high and the prognostic factors concerned the period of onset of the seizures, the type of associated complications and the means of management.

Aspects cliniques et évolutifs de la pré-éclampsie sévère traitée à la maternité Befelatanana, Madagascar / Clinical aspects and outcome of severe pre-eclampsia treated at the Befelatanana maternity hospital, Madagascar

Pre-eclampsia is a major public health problem and is one of the main causes of maternal-fetal morbidity. The main objective of this study is to describe the clinical and evolutionary aspects of severe pre-eclampsia. Methods: This was a retrospective, monocentric, descriptive, observational and cross-sectional study of 6 months, from January 01, 2019 to June 30, 2019, conducted at the level of the resuscitation service of the university hospital of gynecology obstetrics Befelatanana (CHU GOB). Results: Three hundred and fourteen (5.10%) cases out of 6153 admissions of severe pre-eclampsia were collected in the study; the average age was 27.29 ±7.47 years. Eclampsia (30.25%, n= 95), retroplacental hematoma (13.38%, n= 42) and acute renal failure (7.96%, n= 25) were the most frequent maternal complications. Maternal prognosis was favorable in 92.36% of cases (n= 290). Maternal death represented 3.18% (n= 10). Prematurity (44.82%, n= 95), fetal hypotrophy (37.26%, n= 79) and fetal asphyxia (14.15%, n= 30) were the most common fetal complications. Fetal death was 26.47% (n= 81). Conclusion: It is necessary to reinforce the information and education of parturients on the first signs for an early detection, diagnosis and management

Les facteurs associés aux morbi-mortalités maternelles de l'éclampsie à la maternité de Befelatanana / Factors associated with maternal eclampsia morbidity and mortality at the maternity hospital of Befelatanana

L'éclampsie est une complication neurologique majeure de la pré-éclampsie sévère, responsable d'une lourde morbidité et mortalité maternelle. L'objectif de cette étude était de déterminer les facteurs associés aux morbimortalités maternelles de l'éclampsie. Patients et Méthodes : Il s'agissait d'une étude rétrospective, transversale, descriptive et analytique ; sur une période de 36 mois, allant de Janvier 2019 à Décembre 2021, réalisée à la maternité de Befelatanana. Les paramètres cliniques et obstétricales, la prise en charge, les complications et l'évolution maternelle ont été les paramètres étudiés. Résultats : Sur 21 514 accouchements, 461 cas (2,14%) d'éclampsie ont été recensé dont 288 cas inclus dans l'étude. L'âge moyen était de 23,29±6 ans ; l'âge gestationnel était > 37 semaine d'aménorrhée dans 60,10% (n= 173) des cas et la grossesse étaient mal suivies dans 49,70% (n=143) des cas. Les complications maternelles dominées par : la détresse respiratoire aigüe sur pneumopathie d'inhalation; le coma prolongé ; une hémorragie intracérébrale et l'association à d'autres complications tel que : un HELLP syndrome, un hématome rétroplacentaire et une insuffisance rénale oligo-anurique aigue. Les facteurs associés aux décès étaient : l'existence de trouble de la conscience postcritique (p=0,026 ; OR=3,2 [1,09-9,37]), l'existence de coma prolongé ≥24h (p=10-8 ; OR=34 [11,47-100,71]), l'existence d'une insuffisance rénale aigue (p=10-4 ; OR=4,42 [2,08-9,4]) et l'association à un HELLP syndrome (p=10-8 ; OR=29,16 [12,08-70,41]). Conclusion : La morbi-mortalité de l'éclampsie reste encore très élevé à Madagascar ; une éducation de la population Malagasy doit être renforcer sur le suivi médical rapproché de la grossesse

Risk factors for preeclampsia and eclampsia in Sidama region, southern Ethiopia: a nested case-control study

Introduction: though Ethiopia has made a significant improvement in the reduction of maternal mortality, the high burden of preeclampsia remains a concern in the Sidama region of southern Ethiopia. This study aimed to determine the risk factors for preeclampsia and eclampsia in the Sidama region of southern Ethiopia. Methods: a nested case-control study was conducted from August 8, 2019, to October 1, 2020 in the Sidama region. Two-stage sampling techniques were used to recruit study participants. First, seven of the 13 public hospitals were selected using a random sampling technique. Second, cases and controls were selected from a cohort of pregnant women enrolled at ≥20 weeks of gestation up until the 37th week. Data were collected in a face-to-face interview using a locally translated and validated tool. Binary logistic regression analysis was used to identify risk factors for preeclampsia and eclampsia Results: of the planned sample size of 816 women, we enrolled 808 (404 cases and 404 controls). Of the 404 cases, (59.40%, 240/404) had preeclampsia without severity features, (30.94%, 125/404) had preeclampsia with severity features, and (9.65%, 39/404) had convulsions. After controlling for confounders, women having a low wealth status were 98% [AOR: 1.98, 95%CI: 1.34-2.92] at higher risk for preeclampsia and eclampsia compared to women having a high wealth status. Women who had early neonatal deaths were 5 times more likely to be developed preeclampsia and eclampsia than women who did not have early neonatal deaths [AOR: 5.09, 95%CI: 1.69-9.36]. Women who did not attend school were three times more likely to develop preeclampsia and eclampsia [AOR: 3.00, 95% CI: 1.10-8.19] compared to women who attended college/university. Conclusion: in this study, a higher risk for preeclampsia and eclampsia was observed among women with low wealth status, women who had early neonatal deaths and women who did not attend school. Some of these factors could be positively influenced by educational interventions. Maternal and child health providers should screen pregnant women at risk for preeclampsia and eclampsia using these factors. Findings of this study will provide epidemiological evidence for policy makers and implementers to reduce the occurrence of preeclampsia and eclampsia.

Retinal changes among pre-eclamptic patients in University of Benin Teaching Hospital, Benin, Nigeria

Background: Preeclampsia is one of the hypertensive disorders in pregnancy that contributes significantly to maternal and fetal morbidity and mortality, with the impact felt more in developing countries. It is characterized by endothelial dysfunction and vasospasm of vessels which can be observed by an ocular fundal examination. The aim of this study was to determine the ocular fundus findings of women with preeclampsia. Methods: This was a cross-sectional study, carried out at the University of Benin Teaching Hospital involving a total of 220 pregnant women. The women were divided into two groups of 110 pregnant women (A&B).Their Age and Gestational age was cross-matched and retinopathy graded according to Keith and Wagner classification. Group A was made up of Preeclamptic women and Group B was made up of healthy pregnant women. Visual acuity was measured using Snellens' chart, and the fundus was examined with direct ophthalmoscope. Results: This showed that the retinal changes observed in the preeclamptic women were associated with their age (P = 0.009), gestational age (P = 0.044), blood pressure (P = 0.001), Proteinuria (P = 0.001), Severity of the disease (P = 0.001), visual acuity (P = 0.035) as well as with the visual symptoms (P = 0.001) but not statistically significant with the gravida (P = 0.799). Conclusion: Our study highlights the importance of timely ophthalmoscopy which helps to assess severity of disease (pre-eclampsia) which affects the decision of induction of delivery to predict and prevent possible complications which in turn immensely helps in judicious management of disease. Also, the study revealed that preeclamptic women who are multigravida are more likely to have retinopathy than primigravid

An Evaluation of Risk Factors Associated with Pregnancy Related Acute Kidney Injury in Women Admitted to the High Dependency Care Unit at Women and Newborn Hospital, Lusaka-Zambia

Objective:To evaluate factors associated with Pregnancy-related KidneyInjury(PRAKI) inwomen admitted to high dependency care unit at Women and Newborn Hospital in Lusaka, ZambiaMethodology:This was an unmatched case-control study conducted in the high-dependency care unit at Women and Newborn Hospital in Lusaka. Study participantswererecruitedconsecutivelybyconveniencesampling.Participants'medicalrecords were reviewed to capture serum creatinine levels;whileastructuredquestionnairewasadministeredto eligible andconsentedstudy participants to capture data on sociodemographic, obstetric, and medical factors. Serum creatinine levels above 84µmol/l were used as criteria for classifying PRAKI. Excel was used for data cleaningandStatav13usedforanalysis.Descriptive statistics were done for all variables followed by univariate and multivariable logistic regression to determine association. 95% CI was usedand p value of<0.05 was consideredsignificant.Results:Thestudy comprised of185 study participants, split into 85 women with PRAKI (cases) and 100 women without PRAKI (controls). The median age was 29 years with 11years interquartile range. 75.3%of the study participants wereinmarriagerelationships.Pre-existinghypertension was the most prevalent medical condition in both the cases (51.8%) and the controls (38%). Sickle celldisease was much less common at 1.2% in cases and 8% in controls. Among the obstetric conditions, preeclampsia was the most common condition at 77.6% and 60% in cases and controls respectively. Eclampsia was found in 38.8% of cases and 11% of controls. Sepsis was least common at 4.7% of cases. This study found that obstetricfactorssuch as eclampsia (AOR = 5.12, 95% CI [2.14 ­ 12.23]; p≤0.0001), preeclampsia (AOR = 2.46, 95% CI [1.12 ­ 5.39]; p = 0.025), and postpartum haemorrhage were associated with the development of PRAKI. Medical conditions were not associated with PRAKI.

Maternal deaths due to eclampsia in teenagers: lessons from assessment of maternal deaths in South Africa

Background: Eclampsia remains a major cause of maternal mortality, particularly in teenage pregnancies. Healthcare professionals providing antenatal must regard teenagers as a high risk group for the pre-eclampsia-eclampsia syndrome. Setting: Data extracted from the South African Saving Mothers Report: 2014­2016. Aim: To establish the clinical details in teenage maternal deaths owing to eclampsia. Method: Retrospective review of the case records and maternal death assessment forms of teenagers that died due to eclampsia during 2014­2016. Results: There were 47 teenagers (aged 14 to 19 years) who died from eclampsia. Of these 18 out of 47 (38%) deaths occurred in the post-partum period. Forty (85.1%) of the patients had antenatal care. Three (6.4%) had post-partum eclampsia, and of the remaining 44 of the 47 (93.6%), the gestational age at first occurrence of a seizure ranged from 25 to 39 weeks. The blood pressures at the time of seizure ranged from systolic of 131 to 210 mmHg and diastolic of 89 to 130 mmHg. The commonest final causes of death were intracerebral haemorrhage associated with severe hypertension and multi-organ failure. Avoidable factors included transport delays, referral to the wrong levels of health care and poor care by health professionals. Conclusion: Teenage pregnancy is a risk factor for eclampsia-related death; awareness of borderline elevations of blood pressure levels from baseline values (prehypertension levels) and taking following national guidelines on the management of hypertensive disorders of pregnancy will decrease deaths from eclampsia

Medico-social characteristics of patients with eclampsia in a metropolitan hospital in North western Nigeria: is there a changing pattern?

Background: Eclampsia is a recognized cause of maternal and neonatal morbidity and mortality in North western Nigeria. It's a preventable obstetrics calamity were adequate antenatal care services are provided. Objective: To review medico-social characteristics of patients with eclampsia at a metropolitan Specialist Hospital in North-western Nigeria. Methodology: Eighty consecutive patients that presented with eclampsia at Murtala Mohammed Specialist Hospital were recruited for the study from 1st December, 2016 to 28th February, 2017. Data were collected using structured questionnaire, administered by research assistants. Information obtained included sociodemographic data, duration of fits before presentation and maternal-fetal outcome. Results: A total of 1931 patients delivered within the study period, among them 80 had eclampsia. This gives an incidence of 4.0%. Teenage pregnancy accounted for 35%. Forty-nine patients (61.2%) were primigravidae and up to 95% were booked. Majority of the patients 40(50%) had antepartum eclampsia while only 10(12.5%) had postpartum eclampsia. Most of the patients (73.8%) presented within 12 hours of convulsions and (87%) had vaginal delivery. There were 3 maternal deaths with case fatality rate of 3.8%. Live birth was achieved in 65%. Fresh still birth and Macerated still births were recorded in 20% and 12.5% respectively. Conclusion: The incidence of eclampsia is still high despite introduction of free maternity care services. Socio medical factors and poor quality of Antenatal Care services may be the contributing factors to development of eclampsia. There is need to review and improve the quality of antenatal care services offered at the primary health care centers

Pregnancy induced hypertension and associated factors among women attending delivery service at Mizan-Tepi University Teaching Hospital, Tepi General Hospital and Gebretsadik Shawo Hospital, Southwest, Ethiopia

BACKGROUND: Disorders of pregnancy induced hypertensive are a major health problem in the obstetric population as they are one of the leading causes of maternal and perinatal morbidity and mortality. The World Health Organization estimates that at least one woman dies every seven minutes from complications of hypertensive disorders of pregnancy. The objective of this study is to assess pregnancy induced hypertension and its associated factors among women attending delivery service at Mizan-Tepi University Teaching Hospital, Gebretsadikshawo Hospital and Tepi General Hospital. METHODS: A health facility based cross-sectional study was carried out from October 01 to November 30/2016. The total sample size (422) was proportionally allocated to the three hospitals. Systematic sampling technique was used to select study participants. Variables with p-value of less than 0.25 in binary logistic regression were entered into the multivariable logistic regression to control cofounding. Odds ratio with 95% confidence interval was used. P-value less than 0.05 was considered as statistically significant. RESULTS: The prevalence of pregnancy induced hypertension was 33(7.9%); of which 5(15.2%) were gestational hypertension, 12 (36.4%) were mild preeclampsia, 15(45.5%) were severe preeclampsia and 1 (3%) eclampsia. Positive family history of pregnancy induced hypertension [AOR5.25 (1.39-19.86)], kidney diseases (AOR 3.32(1.04-10.58)), having asthma [AOR 37.95(1.41-1021)] and gestational age (AOR 0.096(0.04-.23)) were predictors of pregnancy induced hypertension. CONCLUSION: The prevalence of pregnancy induced hypertension among women attending delivery service was 7.9%. Having family history of pregnancy induced hypertension, chronic kidney diseases and gestational age were predictors of pregnancy induced hypertension

Outcomes of patients admitted to the intensive care unit for complications of hypertensive disorders of pregnancy at a South African tertiary hospital ­ a 4-year retrospective review

Background. Hypertensive disorders of pregnancy (HDP) are a major cause of maternal mortality and adverse outcomes. A previous study in the intensive care unit (ICU) at King Edward VIII Hospital, Durban, South Africa, in 2000 found 10.5% mortality among eclampsia patients. Objectives. To describe the mortality and adverse neurological outcomes associated with HDP in a tertiary ICU, compare these with results from 2000 and describe factors associated therewith. Methods. The data of 85 patients admitted with HDP to ICU at King Edward VIII Hospital from 2010 to 2013 were retrospectively reviewed. Mortality and adverse neurological outcome (Glasgow Coma Scale (GCS) ≤14 on discharge from ICU) were assessed. Two sets of analyses were conducted. The first compared those alive on discharge from ICU with those who died in ICU. The second compared good neurological outcome with poor outcome (adverse neurological outcome, or death). Results. The mortality was 11.6%, and overall, 9% had adverse neurological outcomes. There was no significant difference in mortality between patients with eclampsia in 2010 - 2013 (11.0%) and those in 2000 (10.5%) (p=0.9). Factors associated with mortality were: intra- or postpartum onset of seizures; twins; failure to perform operative delivery when indicated; lowest GCS score <10; failure to use magnesium sulphate when indicated; respiratory failure; and lower respiratory tract infections. Factors associated with poor outcomes (adverse neurological outcome, or death) were: parity (better outcomes in primiparous patients); time of antenatal onset of hypertension (worse if earlier onset); HIV infection; failure to perform operative delivery when indicated; lowest GCS score <10; failure to use magnesium sulphate when indicated; use of anticonvulsants other than magnesium sulphate or benzodiazepines in eclampsia. Conclusion. The lack of improvement in ICU eclampsia mortality demonstrates a need to develop and implement a protocol for HDP management

A prospective review of eclampsia at a regional hospital, eastern Ethiopia: incidence, clinical correlates, management and pregnancy outcome

Objective: The aims of the study were to determine the incidence of eclampsia and describe its clinical correlates and pregnancy outcomes.Patients and Methods: A one-year prospective study of 93 cases of eclampsia using a structured questionnaire which included socio-demographic data, clinical presentation, work-up, management and feto-maternal outcomes was done at Karamara Regional Hospital, Eastern Ethiopia.Results: The incidence of eclampsia was 2.7% (93 in 3500 deliveries). Most of the cases were young (45%), nulliparous (70%) women who had not received any antenatal care (63%). Almost two thirds of the women (n=57, 61%) presented with eclampsia in antepartum, whereas 26 cases (28%) occurred in intrapartum, and there were 10 cases (11%) with eclampsia postpartum. Preceding symptoms were reported in 78.5 % of patients with severe hypertension recorded in 66%. The average gestational age at presentation was 32 weeks. Hydralazine was used for emergency control of hypertension in 91% of the cases. Magnesium was administered to 92 (99%) of the patients. Delay greater than 12h from admission to delivery occurred in 45% of the women with eclampsia. Cesarean section (CS) was performed in 14 (17%) and instrumental delivery in 15 (18%). The maternal and perinatal case fatality rates of eclampsia were 34.7% and 11% respectively.Conclusion: The incidence of eclampsia was very high with corresponding high maternal and perinatal deaths. The presentation of patients was late and the work up and management of cases substandard. Hence capacity building of health facilities, implementation of standard guidelines and criteria based auditing are recommended

L'éclampsie: aspects diagnostique, thérapeutique et pronostique A la cugo du CNHU-HKM de Cotonou en 2016

Introduction : L'éclampsie est une complication fréquente et grave de la prééclampsie. Elle est responsable de morbidité et de mortalité maternelle et périnatale élevées. Objectif : Etudier les aspects diagnostique, thérapeutique et pronostique de l'éclampsie à Cotonou. Matériel et Méthodes : Il s'agissait d'une étude observationnelle transversale descriptive, menée du 1er janvier au 31 août 2016 à la Clinique Universitaire de Gynécologie et d'Obstétrique (CUGO) du Centre National Hospitalier Universitaire Hubert Koutoukou Maga (CNHU-HKM) de Cotonou. Résultats : L'incidence de la crise éclamptique était de 1,9%. Les patientes affectées étaient jeunes avec un âge moyen de 25,4 ans, primigestes (60,3%), nullipares (64,7%) avec un mauvais suivi de la grossesse. L'éclampsie est survenue en antépartum dans 75% des cas. L'HTA était sévère (95,6%), la protéinurie massive (61,8%) et le coma léger (52,9%). Le Sulfate de magnésium était l'anticonvulsivant de choix (100%) et la césarienne la principale voie d'accouchement (100%). Le pronostic maternel et périnatal était mauvais avec une mortalité maternelle de 2,9%, une mortinatalité de 5,9% et une mortalité néonatale de 27,3%. Conclusion : L'éclampsie demeure une complication fréquente et redoutable de la prééclampsie à Cotonou. Un bon suivi de la grossesse s'avère capital pour un diagnostic et une prise en charge précoces de la prééclampsie avant l'apparition de la crise éclamptique

Hypertension in pregnancy among rural women in Katsina State, Nigeria

Hypertension in pregnancy (HIP) is defined as a systolic blood pressure ≥140 or diastolic blood pressure ≥90 mmHg or both. It could be described as chronic, gestational, preeclampsia or eclampsia depending on the gestational period, tendency for postpartum resolution, presence of proteinuria or convulsion. Hypertension in pregnancy affects about 5-22% of pregnancies especially in developing countries. Though preeclampsia and eclampsia seems to create more concern than others, evidence abound that any form of hypertension in pregnancy places women at increased risk of adverse outcomes

Blood Uric Acid Level as a Marker of Increased Risk of Eclampsia in Severe Pre-Eclamptic Patients: A Cross-Sectionnal Study in two Tertiary Hospitals in Yaounde; Cameroon

BACKGROUND. Eclampsia is the most dangerous maternal complication in hypertensive disorders of pregnancy (HDP). Hyperuricemia is a sign of poor prognosis for both the mother and the fetus. We investigated the relationship between uricemia and the occurrence of eclampsia in cases of severe pre-eclampsia.MATERIALS AND METHODS. This was a three-month' cross-sectional study carried out in two tertiary hospitals in the city of Yaounde; Cameroon. All patients attending the hospitals with evidence of severe pre-eclampsia or eclampsia and willing to participate in the study were enrolled. Socio-epidemiology data and blood were collected as soon as the diagnosis was made; uricemia were measured using a spectrophotometric method. Statistical analyses were performed using SPSS 18.0 and significance was observed when P was 0.05.RESULTS. Ninety five pregnant women; aged between 15 to 41 years; with evidence of severe pre-eclampsia (60) or eclampsia (35) were enrolled during the months of January to march 2015. While age below 20 years increased the risk of eclampsia (OR

Training-of-Trainers of Nurses and Midwives as a Strategy for the Reduction of Eclampsia-Related Maternal Mortality in Nigeria

Background: Preeclampsia and eclampsia (PE/E) are major contributors to maternal and perinatal mortality in Nigeria. Despite the availability of current curriculum at Nigerian schools of nursing and midwifery; the knowledge on the management of PE/E among the students has remained poor. In order to reduce maternal and perinatal mortality in developing countries; targeted training and supportive supervision of frontline health care providers have been recommended. Methodology: A total of 292 tutors from 171 schools of nursing and midwifery participated in the training of the trainers' workshops on current management of PE/E across the country. Pre- and post-test assessments were administered. Six months after the training; 29 schools and 84 tutors were randomly selected for follow-up to evaluate the impact of the training. Results: Significant knowledge transfer occurred among the participants as the pretest/posttest analysis showed knowledge transmission across all the 13 knowledge items assessed. The follow-up evaluation also showed that the trained tutors conducted 19 step-down trainings and trained 157 other tutors in their respective schools. Subsequently; 2382 nursing and midwifery students were properly trained. However; six of the monitored schools (24.2) lacked all the essential kits for teaching on PE/E. Conclusion: Updating the knowledge of tutors leads to improved preservice training of the future generation of nurses and midwives. This will likely result in higher quality of care to patients and reduce PE/E-related maternal and perinatal mortality. However; there is need to provide essential training kits for teaching of student nurses and midwives

A retrospective analysis of eclampsia as a major cause of maternal and perinatal mortality in Sagamu

Background: While eclampsia remains a leading cause of maternal death in the developing world, the prevalence and case fatality of the condition in the developed world has reduced due to early detection and prompt treatment. The understanding of the factors associated with eclampsia may reduce the burden and enhance the quality of foeto-maternal outcome.Objective: To determine the prevalence of eclampsia and the associated foeto-maternal outcome. Methods: A retrospective study of patients who presented with eclampsia at the Olabisi Onabanjo University Teaching Hospital (OOUTH) between January 2008 and December 2012 was carried out. The hospital records were retrieved and the data extracted included the age, parity, gestational age at presentation, booking status, mode of delivery, outcome of baby and mother, and the total delivery in the hospital over the period.Results: The prevalence of eclampsia over the period was 1.1%. Eclampsia was common among women aged 25years and below (64.3%), nulliparous women (78.6%) and unbooked (100.0%). Caesarean section was carried out on 63.0% of the patients on account of unfavourable cervix, while 22.2% of patients had spontaneous vagina delivery. Most (96.4%) received magnesium sulphate (MgSO4) therapy but 22.2% convulsed while receiving it. Maternal mortality was 7.1% while perinatal mortality rate was 250/1000 live birth.Conclusion: Eclampsia remains a cause of maternal morbidity and preventable death in the understudied community. Early antenatal booking and the use of MgSO4 are effective in reducing the burden

Pattern and Outcome of Eclampsia Managed at a General Hospital in North-West Nigeria

Hypertensive disorders of pregnancy constitute major threats to maternal health during pregnancy; labour and the post-partum period. Eclampsia is a leading cause of maternal morbidity and mortality especially in low income and middle-income countries.Method: A retrospective review of the clinical records of women managed for eclampsia during a two-year period from December 2004 to November 2006 at the General hospital Aliero was undertaken.Results: Fifty-eight patients were managed for eclampsia during the 2-year period of study. Eclampsia occurred before and during labour in 47 patients while 11 patients had post-partum eclampsia.Conclusion: The reorientation of caregivers and the community in order to enhance awareness of eclampsia is recommended. The promotion of early presentation; routine antenatal care; and prompt referral to secondary center's as well as the provision of the resources for adequate management of eclampsia is advocated