Maternal and perinatal outcome in Patients with eclampsia at Kenyatta national hospital

Abstract

Background: Eclampsia is defined as pre-eclampsia complicated with convulsions and/or coma. The incidence of eclampsia is 0.2%-0.5% of all deliveries globally 2. It is a common obstetric emergency in Kenya and it is associated with adverse maternal and neonatal outcomes. Some of the documented complications are pulmonary edema, cerebral hemorrhage, acute renal failure and placental abruptio. Facilities for intensive care are scarce in low resource settings. Identifying determinants of maternal and perinatal outcome among eclamptics will provide insight as to which group of mothers at risk would benefit from earlier referral. Objective: To study the determinants of maternal and perinatal outcome among patients with eclampsia at Kenyatta National Hospital. Design: This was a Cross-sectional descriptive study. Methodology: All mothers with eclampsia admitted in labor ward, ante-natal wards and those reviewed in the postnatal clinic were interviewed and information collected with respect to age, parity, ANC attendance, duration of gestation, place of first fit, BP and degree of protenuria at admission, fit -delivery interval, clinical management, mode of delivery, perinatal outcome, maternal mortality and duration of hospital stay was recorded in a questionnaire. Additional was obtained from patient records. Setting: The study was conducted at Kenyatta National Hospital labor ward, antenatal wards and post natal clinic. KNH is Kenya's largest referral hospital. Data collection analysis: Data collected was entered into a a database. This data was then analyzed electronically using SPSS widows statistical software. The chi square test was used to identify factors that were related to development of complications. 9 Outcome measures: The study variables include age, parity, booking status, gestational age, location at time of first seizure, number of fits, seizure to delivery interval, maternal complications and the clinical management. Results: During the study 135 patients who developed eclampsia and who met the inclusion criteria were interviewed. The predictors of outcome were age, parity, booking status, gestational age, location at time of first seizure, number of seizures and seizure interval and delivery. There was no significant relationship between socio-demographic characteristics and development of complications(p >0.05). The majority of the patients who had not attended ANC (61.9%) developed complications. The relationship between the attendance of ANC and non-attendance and the occurrence of complications was statistically significant. (p=O.OOO1) There was a statistically significant relationship between the diastolic BP and development of complications (p=.OOl).The commonest complications were pulmonary oedema (17.7%), acute renal failure (22.60/0) ,sepsis (14.5%), postpartum hemorrhage, (1l.3%) and abruptio placenta (11.3%). Development of complications significantly affected maternal mortality (p=0.031 ).The incidence of perinatal mortality was 2.8/1 000 deliveries. The case fatality rate was 5.1%. Conclusion: Development of complications in eclampsia was significantly influenced by ANC attendance and the diastolic blood pressure on admission. Recommendations: From the study findings it is important for health care workers to review the management of eclampsia to address the rising case fatality rate. There is also need for increased vigilance of patients who have had no antenatal care.