Magnesium sulphate therapy in eclampsia: a 5 years experience at a teaching hospital

To describe the presentation of eclampsia, its management and associated outcomes using magnesium sulphate [MgSO4], over a five years period at a tertiary care hospital. This descriptive study was conducted at Obstetrics and Gynecology Unit, Hayatabad Medical Complex, Peshawar from January 2004 to December 2008. Data was collected from all patients presenting with eclampsia. A total of 146 patients had eclampsia. Unbooked were 124 [84.93%]. Mean age 23 years +/- 5.3 years [range 18-38 years], primigravida were 69.17% [101 cases]. Antepartum fits in 72.6% [106 cases], intrapartum 14 [9.58%] and 27 [18.49%] postpartum. MgSO4 was used in all except 4 with oliguria, they were given diazepam. Recurrent fit occurred in only 20[13.69%]. MgSO4 toxicity occurred as respiratory depression in 9 cases, depressed tendon reflexes in 10 and decreased urine output in 13 cases Total deliveries were 23021, prevalence of eclampsia was 0.63%. Mode of delivery was Vaginal in 97 [66.43%], instrumental in 29 [19.98%] and cesarean section in 20 [13.69%] cases. There were 26[17.2%] stillbirths and 4 neonatal deaths. Complications included HELLP in 17 [11.64%], pulmonary complications in 17, renal failure in 7 [4.79%], DIC in 16[10.95%] and temporary blindness in 16 cases. Eleven [7.53%] maternal deaths occurred, causes included DIC in 1case, HELLP in 2, renal failure 1, cardiopulmonary failure in 2 and CVA [received deeply unconscious] in 5 cases. All were unbooked cases and with delay in reaching hospital. Eclampsia is common antenatally and in primigravidae, and a major cause of maternal morbidity and mortality in our region. It was effectively controlled with MgSO4, preventing recurrent fits and safe for both mother and fetus

Frequency of eclampsia and maternal complications in a tertiary care facility of Peshawar

Eclampsia is a potentially fatal disorder of pregnancy and an important cause of maternal mortality throughout the world. To find out the frequency of eclampsia and its maternal complications in a public sector hospital. This prospective descriptive study was performed in the gynaecology unit "A" of Lady Reading hospital Peshawar. The study included all patients who presented with eclampsia to this unit in one year. The diagnosis was based on convulsions, hypertension and albuminuria. The list of complications included visual, cerebrovascular, cardiovascular, pulmonary, renal, haemostatic and hepatic. Obstetrical and minor complications were not recorded. During the study period a total of 3090 patients were delivered in the unit with 96 cases being diagnosed as eclamptics [3.1%]. Complications were seen in 46[48%] patients. Of 96 cases 11[11.5%] died. Most of the patients who died had more than one complication. Eclampsia is a serious threat to pregnant females and needs to be picked earlier and treated promptly

Factors that influence morbidity and mortality in sever preeclampsia, eclampsia and hemolysis, elevated liver enzymes, and low platelet count syndrome

To evaluate the prognostic factors affecting morbidity and mortality in severe preeclampsia, eclampsia and hemolysis, elevated liver enzymes, and low platelet count [HELLP] syndrome cases. We retrospectively evaluated, 2245 cases who delivered in the Department of Obstetrics and Gynecology, Faculty of Medicine, Cukurova University, Turkey between January and December 2002. Ninety-three cases had severe preeclampsia, 26 cases eclampsia, 19 cases HELLP syndrome, and 6 cases with eclampsia and HELLP syndrome were included in this study. The pregnancy induced hypertension cases were evaluated retrospectively for socioeconomic status, obstetrical history, biochemical parameters, and maternal complications. The incidence of preeclampsia was 20.1% [453/2245], the incidence of severe preeclampsia, eclampsia, and HELLP syndrome was 6.4% [144/2245]. These ratios are higher than that reported in the English literature. The complication rate was 38% in severe preeclampsia cases. Among the severe preeclampsia cases, 32 had eclampsia [22.1%], and 25 had HELLP syndrome [17.3%]. The most important biochemical marker for maternal mortality is bilirubin levels. Maternal mortality was statistically higher in cases with jaundice. Also, there was a statistically significant relation between maternal complications and liver function tests, lactate dehydrogenase levels, and low platelet levels

Eclampsia-management and outcome with magnesium sulpate as the anticonvulsant

To study the maternal outcome in terms of morbidity and mortality with the use of magnesium sulphate in eclampsia for seizure control and prophylaxis. A quasi experimental study. This study was conducted in Obstetrics and Gynaecology Unit of Hayatabad Medical Complex, Peshawar, from 1st September 2002 to 31st December 2003. All the patients admitted with eclampsia during this period were included in the study. A detailed history and clinical examination were recorded. Patients were monitored for number of fits, rise in blood pressure [BP], dose of magnesium sulphate administered and its side effects, development of complications of eclampsia, duration of labour, mode of delivery and use of other medications as well as maternal and perinatal outcome. During this period, 52 patients were admitted with eclampsia. Majority were unbooked. Primigravida were 31 [59.6%]. Common age group was between 21 and 30 years having 34 [65.4%] patients while 16 [30.7%] patients were 20 years or less than 20 years of age. Thirty-three [63.4%] patients had antenatal fits, 9 [17.3%] intrapartum fits and 11 [19.2%] had postpartum eclampsia. Twenty-six patients had term pregnancy, 22 patients with 28-36 weeks gestation while 4 patients developing eclampsia before 28 weeks gestation. Eighteen patients had spontaneous vaginal delivery; labour was induced in 21 patients while 6 patients underwent cesarean section. Maternal complications included pulmonary oedema, tongue bites, HELLP syndrome, placental abruption and coagulopathy. Side effects of magnesium sulphate were low. There were 4 [7.6%] maternal deaths due to eclampsia. Perinatal outcome was good with 33 [63.4%] live births, 3 IUDs and 10 still births, mostly due to prematurity. Magnesium sulphate was found to be an effective anti-convulsant both for control and prophylaxis of seizures in eclampsia and improved maternal and fetal outcome

Proteinúria nas síndromes hipertensivas da gestação: prognóstico materno e perinatal / Proteinuria in hypertensive syndrome of pregnancy: maternal and perinatal outcome

OBJETIVO: Avaliar o valor prognóstico da proteinúria nas gestantes com síndromes hipertensivas nos desfechos maternos e perinatais. MÉTODOS: Estudo transversal retrospectivo de 334 gestantes com síndromes hipertensivas que pariram no Hospital São Paulo na disciplina de Obstetrícia da UNIFESP/EPM, no período de 1° de janeiro de 1999 a 31 de dezembro de 2002. RESULTADOS: Após a revisão dos prontuários, as pacientes foram divididas em quatro grupos: I sem proteinúria (n-203), II com proteinúria de 0,3 a 1g (n-39), III de 1 a 2g (n-45) e grupo IV de 2g ou mais (n-47). Na ausência da proteinúria houve um caso de descolamento prematuro da placenta. Com proteinúria observou-se desfechos maternos adversos, com a presença das complicações, proporcional à elevação da proteinúria, sendo a síndrome HELLP a mais freqüente com 30,5 por cento (40/131) seguida da eclâmpsia com 3,8 por cento (5/131), DPP 3,01 por cento (4/131) e insuficiência renal 0,7 por cento (1/131). Foi constatado um óbito materno nesse grupo, perfazendo-se o CMM de 763100.000/n.v. Em relação aos desfechos perinatais, no grupo sem proteinúria não houve elevação dos efeitos adversos. Na presença da proteinúria e a elevação dos seus níveis observou-se pior prognóstico perinatal com os seguintes indicadores: aumento da prematuridade (62,2 por cento vs 11,5 por cento), recém-nascidos com peso < 2500g (6,5 por cento vs 1,5 por cento), Apgar < 7 no 5° minuto (30,4 por cento vs 3,5 por cento), restrição de crescimento intra-útero (41,9 por cento vs 6,5 por cento), cuidados intensivos na unidade neonatal (59,8 por cento vs 15,5 por cento), natimortos (14,4 por cento vs 1,4 por cento), e óbitos neonatais (6,1 por cento vs 0,98 por cento). O coeficiente de mortalidade perinatal foi maior com proteinúria (175 vs 19,7) e, quando > 2g (297,8 vs 19,7). CONCLUSÕES: A presença da proteinúria e a elevação dos seus níveis, aumentaram as complicações maternas, principalmente a síndrome HELLP e eclâmpsia. Observou-se incidência de complicações perinatais com elevação significativamente maior da prematuridade, recém-nascidos com Apgar < 7, peso < 2500g, CIUR, natimortos e óbitos neonatais.

Management of pre - eclampsia / Eclampsia

Preclampsia/eclampsia affects only a small proportion of all pregnancies, yet it is associated with significant morbidity and mortality for mother and baby, with post partum resolution. The disorder is triggered by a placental pathology followed by a wide spectrum of maternal systemic response. However, there remains controversy in practically every aspect of the condition. A full understanding of the condition, its variable presentation allows the consulting anesthetist to optimize a plan for anesthetic management

Late postpartum eclampsia without prodroma.

Late postpartum eclampsia is an increasingly recognized entity. We describe a patient who developed postpartum eclampsia on the 6th day of delivery without any preceding pre-eclampsia. A high index of suspicion and close follow-up will help in the early detection of this condition. Awareness of this condition will also save the patient from unnecessary investigations. This may be all the more relevant in developing countries where eclampsia contributes to one-third of maternal mortality and the resources for patient investigation and management are limited.

Mola hidatiforme completa e eclâmpsia: relato de caso / Complete hydatidiform mole and eclampsia: a case report

O desenvolvimento de pré-eclâmpsia ou eclâmpsia antes da 20ª semana deve levar à suspeita de mola hidatiforme. Descrevemos um caso de mola hidatiforme completa (MHC) e eclâmpsia concomitante em paciente com 20 anos que apresentava sangramento genital, anemia, tamanho uterino excessivo e cistos de ovário, associados a hipertensäo arterial e proteinúria. Os níveis de b-hCG estavam elevados e a funçäo tiroidiana, alterada. A ultra-sonografia mostrou-se compatível com MHC. Após o esvaziamento uterino apresentou cefaléia e alteraçöes visuais, seguidas por convulsöes tônico-clônicas que cessaram com sulfato de magnésio hepta-hidratado a 50 por cento. No seguimento pós-molar foi diagnosticado tumor trofoblástico gestacional (TTG) prontamente tratado com quimioterapia. A associaçäo de MHC e eclâmpsia determina esvaziamento uterino imediato e seguimento pós-molar rigoroso, pelo risco aumentado de desenvolvimento de TTG

The neurology of eclampsia : some observations.

Nineteen patients admitted with diagnosis of eclampsia in a large general hospital between 1996 - 1999, were analyzed. Eight patients were referred to neurologists for assessment and management. All these patients had recurrent generalized seizures. Five patients developed visual disturbance. Neuroimaging (CT and/or MRI) revealed symmetrical occipital lesions in all. One patient had a large pontine lesion. Seizure control was achieved in all with intravenous phenytoin. All patients recovered fully without any residual neurological deficit and their radiological brain lesions resolved completely, in all except one case. The neurological manifestations and neuroimaging features in cases of eclampsia have been reviewed. A brief note on the pathogenesis of the cerebral lesions is included and the controversial aspect of seizure control in eclampsia highlighted.

Reversible posterior leukoencephalopathy syndrome: a report of 2 cases.

Reversible posterior leukoencephalopathy syndrome (RPLE) is an increasingly recognised disorder, most commonly associated with malignant hypertension, toxaemia of pregnancy or the use of immunosuppressive agents. Two cases of RPLE syndrome occurring in the setting of accelerated hypertension and eclampsia are described. Both patients had seizures, altered sensorium and typical findings on neuroimaging. They had complete clinical and radiological recovery. The clinical course, pathophysiology and neuroimaging features of RPLE syndrome are discussed.

Complicaciones materno fetales más frecuentes asociados a eclampsias en la unidad de cuidados intensivos del Hospital Bertha Calderón Roque, en el período enero a septiembre del 2000 / Most frequent maternal and fetal complications associated to eclampsias in the intensive care unit of the Hospital Bertha Calderon Roque, in the period y of january to september of 2000

El presente trabajo es de tipo descriptivo de corte transversal y prospectivo en relación al de forma de recolección de la información realiazado en el hospital Bertha Calderón Roque en la unidad de cuidados intensivos de enero-septiembre del 2000. El universo del estudio lo constituyeron todas las pacientes ingresadas con el diagnóstico de eclampsia y la muestra fue de 36 pacientes. Los grupos etáreos que predominan fueron en primer lugar las pacientes15-20 años con 20 casos (55 porciento) seguido del grupo de 26-30 añso con 7 casos (19.4 porciento). El nivel de escolaridad fue primaria incompleta con 18 casos (50 porciento) seguida secundaria incompleta con 11 casos (30.5 porciento). Elestado civil que predominó fue el de las acompañadas con 19 casos (52.7 porciento)seguido de las casadas de 10 casos (22.7 porciento) cuya ocupación primordial era ama de casa con 26 casos (72.2 porciento) seguida de las domésticas con 4 casos(11.1 porciento). Según los datos obstetricos generales obtenidos prevalecieron las primigestas con 22 casos (61.1 porciento) seguidas por las multigestas con 7 casos (19.4 porciento) con unas semanas de gestación de 28-36 con 20 casos (55.5porciento, la cuales no se realizarón ningún control prenatal. En 25 casos (69.45 porciento)seguido de las que se realizaron de 2-3 controles prenatales en 7 casos (19.4 porciento). Las complicaciones materna que mayormente se presentaron en orden de frecuencia son las siguientes: Edema Cerebral,IRA, Anemia,Trastorno de Coagulación, SD, Hellps, DPPNI y otras. La complicaciones fetales son las siguientes: prematurez, asfixia, muerte fetal y RCIU. Las condiciones de ingresode las pacientes fue muy grave con 17 casos (47.2 porciento) seguida de las graves con 10 casos (27.7 porciento). La evolución de la paciente fue satisfactoria en 33 casos (91.6 porciento) e insastifactoria con 3 casos (8.3 porciento). Las condiciones de egresos encontradas fue sastifactoria (sin secuelas) en 27 casos (75.0 porciento) y con secuelas 6 casos (16.6 porciento) fallecidas con 3 casos (8.3 porciento)

Medición de la fuga capilar en la preeclampsia-eclampsia / Measurement of capillary fuge in pre-eclampsia-eclampsia

Introducción: se proponen dos parámetros para estimar la fuga capilar que se presenta en pacientes con preeclampsia grave y eclampsia, cuando se alteran las fuerzas de Starling.Objetivo: reportar los valores de la PCOc y el IB en mujeres con preeclampsia grave y eclampsia, asimismo compararlo con embarazo normal.Pacientes y método: se estudiaron prospectivamente los valores de la PCOc y el IB en 87 pacientes con preeclampsia grave y eclampsia (grupo A); comparandolo con 50 pacientes con embarazo normal (grupo B). La PCOc se calculó de acuerdo con la fórmula de Landis-Pappenheimer y el IB se obtuvo de dividir el resultado entre la PCOc y la PAM.Resultados: la PCOc fue de 15.3 ñ 4.5; el IB de 0.11 ñ 0.03 en el grupo A, 24.0 ñ 4.4 y 0.27 ñ 0.03 en el grupo B, (p < 0.005 y p = 0.300 respectivamente).Conclusiones: la PCOc y el IB disminuyen significativamente en la preeclampsia-eclampsia y se propone su utilización como índices cuantitativos de fuga capilar.

Factores asociados a eclampsia en pacientes ingresados en el Servicio de Unidad de Cuidados Intensivos del Hospital Bertha Calderón Roque, enero - septiembre 2000 / Factors associated to eclampsia in patients admitted in the Intensive Care Unit Service of the Hospital Bertha Calderon Roque, january - september 2000

Se realizo un estudio asociado a la eclampsia en pacientes ingresados en la unidad de cuidados intensivos del Hospital Bertha Calderon Roque en el período de enero a septiembre 2000. La muestra fue constituída por 36 pacientes, el tipo de estudio fue retrospectivo y de corte transversal. La información fue ordenada, clasificada y agrupados los resultados conforme a criteriosdel estudio analizando todas las variables, utilizando el programa EpI Info 6.0.Se encontró que la mayoría de las pacientes estaban comprendidas en el grupo de 14 a 20 años, tenían algún grado de escolaridad, de unión acompañada y amas de casa. La mayoría de ellas no se había realizado ningún control prenatal. Un gran procentaje tenían antecedentes de infección de vías urinarias, la mayoría había presentado una convulsión, en su hogar y durante el embarazo. La mayoría de las pacientes que habían presentado su primera convulsión ingresado en condición muygrave, pero evolucionaron satisfactoriamente. Es necesario mejorar la cobertura de control prenatal y principalmente en los grupos de riesgo...

Alteraçöes cerebrais na eclampsia / Cerebral evaluation in patients with eclampsia

Gestantes que desenvolvem eclampsia apresentam altos indices de mortalidade e morbidade materna e perinatal. Neste artigo de revisao discutimos a fisiopatologia da convulsao eclamptica e descrevemos os exames complementares relacionados ao cerebro que podem ser solicitados a fim de auxiliar na avaliacao diagnostica e conduta terapeutica

Protocolo de manejo en la preeclampsia eclampsia. Estudio comparativo / Management protocol in the preclampsia eclampsia. Comparative study

Introducción: El curso del evento obstétrico en pacientes con preeclampsia eclampsia, requiere de manejo médico-quirúrgico protocolizado basado en el conocimiento de su fisiopatología. Objetivo: presentar un mismo protocolo de manejo y los resultados en forma comparativa en las poblaciones estudiadas en dos Unidades de Cuidados Intensivos Obstétricos. Pacientes y métodos: evaluamos retrospectivamente los expedientes de 190 pacientes que ingresaron consecutivamente al HGO-DIF durante 45 meses (enero 94 a septiembre 97), así como 1,800 pacientes que recibieron atención en HGO-2-CMN IMSS durante 13 años (1973 a 1985). Incluimos pacientes que reunieron criterios de preeclampsia eclampsia (hipertensión arterial, proteinuria, edema y/o pérdida del estado de alerta o crisis convulsivas tónico-clínicas). Resultados: observamos baja mortalidad, causada ésta principalmente por falla orgánica múltiple y hemorragia cerebral, y las complicaciones que más frecuentemente se asocian son: el de síndrome de HELLP y la insuficiencia renal aguda, con arriba de 90 por ciento de los pacientes recuperados. Conclusiones: nuestros resultados nos permiten proponer este protocolo como prototipo de manejo para hospitales que apoyan a pacientes obstétricas con preeclampsia eclampsia

Alteraciones cerebrovasculares en la eclampsia: rol de la tomografía axial computarizada: TAC / Cerebrovascular disorders in eclampsia: role of computarized axial tomography, ACT

Se analizan los casos con diagnóstico de eclampsia, registrados en el Servicio de Obstetricia y Ginecología del Hospital San Juan de Dios, entre los años 1995 y 1998 (junio). Se destacan los aspectos clínicos y terapéuticos, así como el aporte de la tomografía axial computarizada (TAC), como método de estudio. De la serie presentada, el 68,7 por ciento contó con TAC. De estos, el 63,6 por ciento presentaba una TAC alterada. Las lesiones más frecuentes objetivadas por este examen fueron la isquemia y el edema (tres casos cada una), seguidas por el infarto y la hemorragia con un caso cada una. Se concluye que la TAC es un examen necesario en la evaluación de las pacientes con eclampsia, ya sea en la pesquisa de alteraciones cerebrales, en el control de la evaluación de ellas y sus eventuales secuelas y como método de ayuda en el diagnóstico diferencial con otras patologías que pueden manifestarse con convulsiones