TMSS Medical College Journal

Background: Pre-eclampsia accounts for the majority of referrals in a tertiary care center as it stands one of the major causes of maternal morbidity and mortality. Maternal outcomes are directly related to the severity of pre-eclampsia. Pre-eclampsia with severe features has remained a serious challenge in obstetric practice. Objective: To observe the maternal outcome in patients having severe pre-eclampsia following early delivery. Materials and methods: In this observational study total 100 pregnant women with severe pre-eclampsia were divided into two groups: Group A- (Deliveries were done < 48 hours after admission and Group B- deliveries were done >48 hours after admission. Antenatal corticosteroid were given in both groups between gestational age >28 weeks and <37 weeks. Data were recorded in a pre-designed questionnaire and analyzed by computer based software SPSS windows version 25 and results were presented in tabulated form. Results: Out of hundred severe pre-eclamptic women, 66 were in group-A and 34 were in group-B. Most of the study subjects were in 20-30 years age group and the mean age were 27.03+4.72 years in group-A and 24.65+4.66 years in group-B, most of them came from low socio-economic family, achieved primary education, unemployed and belonged to rural area in both groups with non-significant difference (p>0.05). Majority of them were pirmigravida, 65.15% in group-A and 70.59% in group-B and mean gestational age were 36.00: 2.456 weeks and 33.44: 2.699 weeks respectively (p<0.001). Most of the study subjects were on regular antenatal care, 63.64% in group-A and 47.06% in group-B. 52.94% in group-B and 36.36% group-A had none or irregular antenatal care . Antenatal corticosteroid was used significantly more in group-B (88.24%) than group-A (30.30%) (p<0.001). Caesarean section was the common mode of delivery in both groups with statistically non-significant difference. The maternal complications were more in group-B than group-A including Eclapmsia (p=0.001). Abruptio placentae (p=0.004), Pulmonary edema (P=0.011), Acute kidney injury (p=0.026), HELLP syndrome (p=0.047), DIC (p=0.047), Maternal mortality (p=0.014) and ICU admission (p<0.001). Conclusion: Proper antenatal care for all pregnant women and screening for pre-eclamsia should be ensured which will help in prevention as well as early diagnosis and treatment of pre-eclampsia.

Hypertensive disorders are among the most common medical disorders during pregnancy which include pre-eclampsia, eclampsia, pregnancy induced hypertension and transient hypertension of pregnancy and continue to be the major cause of maternal morbidity and mortality especially in developing countries." About 10-15% of maternal deaths are directly associated with per-eclampsia and eclampsia.’ According to BMMS-16, in Bangladesh about 24% of maternal deaths are caused by pre-eclampsia and eclampsia.’ Pre-eclampsia complicates 10% of all pregnancies’. Severe pre-eclampsia is characterized by blood pressure >160 mmHg systolic and >110 mmHg diastolic on two occasions at least 6 hours apart while the patient is on bed rest, proteinuria of >5 gm in 24-hours urine specimen, oliguria <500 ml urine in 24-hours and other associated signs and symptoms such as cerebral or visual disturbance, pulmonary edema or cyanosis, epigastric or right upper quadrant abdominal pain, impaired liver function, thrombocytopenia and fetal growth restriction.’