ABSTRACT
Background: Eclampsia remains a leading cause of maternal and perinatal morbidity and mortality often in settings of poor health seeking behaviour and services. Objective of this study was to determine the incidence, investigate the risk factors, obstetric outcomes and suggest ways of improving the impact of eclampsia.Methods: An analytical observational study on consecutive cases of eclampsia managed in a tertiary hospital setting from 2014 to 2019. For each case of eclampsia recruited the next gestational hypertensive and normotensive cases managed in the period were recruited to serve as controls. Computer statistical software, Chi square for test of associations were used for analysis with statistical significance set at p<0.05.Results: Among 3625 deliveries within the study period were 57 cases of eclampsia; an incidence of 1.57%. Most (74.4%) were antepartum eclampsia. Majority of the eclamptic mothers were unbooked (81.4%), of lower social class (86.0%), poorly educated (81.4%) and nulliparous (58.1%). Eclamptic mothers were more likely to be youth ≤24 years (39.5%), teenagers (25.6%), and unmarried. Twenty-four (55.8%) had abdominal delivery, anaemia (23.3%) and were transfused. Three women died from eclampsia; a case fatality of 6.98%. Twenty-four (55.8%) neonates were preterm, low birth weight (48.8%), intrauterine growth restriction (25.6%), special care baby unit admission (32.6%) and perinatal mortality 13 (30.2%).Conclusions: Eclampsia is still an un-mitigating malady in this study settings with increased maternal and perinatal complications. Nulliparity, low social status, young age and lack of prenatal care appeared significant risk factors. Quality prenatal care, early detection and management of pre-eclampsia will mitigate eclampsia occurrence and severity. Women empowerment is proffered.
ABSTRACT
Background: Delivery following a previous caesarean section is associated with the fear of increased maternal and perinatal morbidity and mortality. The optimal mode of such delivery remains critical with increasing rate of caesarean births in the contemporary obstetric care. The intended choice of mode of delivery for the woman and her clinician remains between trial of vaginal birth after caesarean and elective repeat caesarean section. This study was therefore designed to appraise the obstetric outcomes of the two main modes of delivery after a primary caesarean delivery. Objective: This study assessed the feto-maternal implications of trial of vaginal birth and elective caesarean section after a prior caesarean in order to contribute data to the increasing volume of evidence for expeditious management of increasing caesarean section rates. Specifically the maternal and perinatal outcomes of trial of vaginal birth after caesarean (TVBAC) and elective repeat caesarean delivery (ELRCD) were estimated and compared. Methodology: This was a comparative analytical observational study of 245 and 57 women who respectively had Trial of vaginal birth after caesarean (TVBAC) and elective repeat caesarean section (ELRCS) in their subsequent delivery following a primary caesarean section. EPI-INFO statistical package was used for data collation and analysis. Results: Trial of vaginal birth was associated with 1.22% risk of hysterectomy, 0.82% of uterine rupture and 1.6% long hospital stay unlike elective repeat caesarean section that had no recorded incidence of any of these morbidities. The women who had TVBAC were twice at increased risk of blood transfusion and more than 50% increased risk of postpartum hemorrhage compared to those who had ELRCS. The differences were however not statistically significant. Composite perinatal morbidity was thrice higher among TVBAC (5.3% vs. 1.8%, OR 3.14 P=0.48) mainly 3.3%, 1.2% and 1.6% of Apgar scores less than7 at 5 minute, fresh stillbirths and perinatal deaths respectively. Again none of the differences was statistically significant. The morbidities associated with TVBAC seemed to increase when it failed and the need for emergency caesarean arose. Conclusion: There appeared to be subtle but insignificant increased likelihood of both maternal and perinatal adverse outcomes in trial of vaginal birth after caesarean. We recommend TVBAC in well selected cases since the feto-maternal outcome appeared similar in the two modes of delivery.