Assessment of clinical outcomes and prescribing behavior among inpatients with severe preeclampsia and eclampsia: An Indian experience

Abstract

Objectives:The study aims to evaluate the management, maternal-fetal outcomes, and prescription behavior among inpatients with severe preeclampsia and eclampsia.Materials and Methods:This prospective cohort study in a tertiary referral center was conducted in 164 inpatient pregnant women who fulfilled the inclusion criteria. The study was conducted between November 2005 and February 2007. The patients were followed-up till delivery. Antepartum and intrapartum care and maternal and perinatal outcome were noted. Chief outcome measures were maternal and perinatal mortality and drug use indicators.Results:Median age at delivery of the women was 25 (22-28) years. Majority were suffering from antepartum eclampsia (52.5%), followed by preeclampsia (31%) and postpartum eclampsia (16.5%). Nulliparity (61.6%) was more common in eclampsia, while multiparity in preclamptic group. A total of 48% had preterm delivery. Most presented with headache (50%) and hyperreflexia (29%). Only 15% presented with all three prodromal symptoms and 86% had hypertension. There was increased morbidity, operative intervention, and admission to intensive care unit. Most babies (67%) weighed <2.5 kg and had poor outcome. The maternal mortality was 0.4/1000. Average number of drugs prescribed in patients of preeclampsia, antepartum eclampsia, and postpartum eclampsia were 13.2, 14.9, and 14.2, respectively. Antibiotics (24.6%) were the most common class of the drugs prescribed in all the groups, followed by vitamin and calcium supplements (22.7%) and antihypertensives (13.5%). Most common antihypertensive used were calcium channel blockers and anticonvulsant magnesium sulphate.Conclusions:There was increased maternal and perinatal morbidity. Protocols for the management of eclampsia, including antihypertensive and anticonvulsant therapies, should be available and reviewed regularly to improve the standard of care and reduce the prevalence of this dangerous condition.

Maternal and Perinatal Outcome in Patients With Eclampsia: A Study Done at a Tertiary Care Centre

“…It was seen that in the present study, the incidence of eclampsia was found to be 0.34% of total deliveries studied. These findings were much lower and in contrast with the studies from Tanzania, Nigeria, Eastern India, Uttar Pradesh, and Karnataka, where the incidence was reported to be 1.37%, 7.8%, 3.2%, 2.2%, and 1.82% by Ndaboine et al [ 8 ] in 2012, Efetie et al [ 9 ] in 2007, Kumar et al [ 10 ] in 2014 and Yaliwal et al [ 11 ] in 2011.…”

Antibiotic Prescribing to Patients with Infectious and Non-Infectious Indications Admitted to Obstetrics and Gynaecology Departments in Two Tertiary Care Hospitals in Central India

“…Prescribing antibiotics as treatment is indicated only in cases of postoperative or concomitant infections for procedures such as caesarean sections and hysterectomies [ 31 ]. Comparable prescription patterns have previously been presented in two Indian studies where patients were treated with antibiotics for multiple days after caesarean section instead of receiving a single-dose prophylaxis [ 30 , 32 ]. Prescribing antibiotics as a treatment and for extended durations to non-infectious, nonsurgical cases is not recommended and increases not only the risk of the ABR development, but also the treatment cost.…”

“…This number is comparable with a study in an Indian hospital, where nearly 70% of women with severe pre-eclampsia or eclampsia, which is not an indication for antibiotic use, were prescribed antibiotics. However, most of these women underwent emergency LSCS, which can justify the high use of antibiotics [ 30 ]. On the other hand, in our study, only 23% of patients had LSCS, which points towards a high percentage of women with unindicated antibiotic use.…”

Generating evidence on screening, diagnosis and management of non-communicable diseases during pregnancy; a scoping review of current gap and practice in India with a comparison of Asian context

“…Overall findings show MgSO4 as the most common anticonvulsant for prevention and treatment of eclampsia and Nifedipine as the most common anti-hypertensive agents [ 40 , 42 ]. However, a high prescription rate of rapid acting Nifedipine was strongly criticized and suggested a periodic review of the treatment protocols to improve pregnancy outcome [ 41 ]. A single loading dose, the only regime, may be an effective alternative to the standard 24-hour therapy for seizure prevention in severe preeclampsia cases [ 43 ].…”

“…However, the study criticised the high prescription rate of rapid-acting sublingual Nifedipine; given the fact that it is associated with adverse maternal and foetal outcome. Also the fact that labetalol, which is known for its efficacy and safety in treating acute PIH, was prescribed in a very small proportion of cases [41]. A retrospective analysis of case records of 5991 eclamptic patients admitted to the tertiary care hospital from Jan 1999 to Dec [43] compared the efficacy of two drug regimens, the Dhaka regime vs. the loading dose only regime as prophylaxis for seizures in severe pre-eclamptic cases.…”