Characteristics and outcomes of patients with eclampsia and severe pre-eclampsia in a rural hospital in Western Tanzania: a retrospective medical record study

Abstract

BackgroundEclampsia and pre-eclampsia are well-recognized causes of maternal and neonatal mortality in low income countries, but are never studied in a district hospital. In order to get reliable data to facilitate the hospital’s obstetric audit a retrospective medical record study was performed in Ndala Hospital, Tanzania.MethodsAll patients diagnosed with severe pre-eclampsia or eclampsia between July 2011 and December 2012 were included. Medical records were searched immediately following discharge or death. General patient characteristics, medical history, obstetrical history, possible risk factors, information about the current pregnancy, antenatal clinic attendance and prescribed therapy before admission were recorded. Symptoms and complications were noted. Statistical analysis was done with Epi Info®.ResultsOf the 3398 women who gave birth in the hospital 26 cases of severe pre-eclampsia and 55 cases of eclampsia were diagnosed (0.8 and 1.6 %). Six women with eclampsia died (case fatality rate 11 %). Convulsions in patients with eclampsia were classified as antepartum (44 %), intrapartum (42 %) and postpartum (15 %). Magnesium was given in 100 % of patients with eclampsia and was effective in controlling convulsions. Intravenous antihypertensive treatment was only started in 5 % of patients. Induction of labour was done in 29 patients (78 % of women who were not yet in labour). Delivery was spontaneous in 67 %, assisted vaginal (ventouse) in 14 % and by Caesarean section in 19 % of women. Perinatal deaths occurred in 30 % of women with eclampsia and 27 % of women with severe pre-eclampsia and were associated with low birth weight and prolonged time between admission and birth.Conclusions2.4 % of women were diagnosed with severe pre-eclampsia or eclampsia. The case fatality rate and overall perinatal mortality were comparable to other reports. Better outcomes could be achieved by better treatment of hypertension and starting induction of labour as soon as possible.

Preeclampsia management modalities and perinatal death: a retrospective study in Woldia general hospital

“…In three studies, usage of magnesium sulfate in preeclamptic women to prevent seizures ranged from 74.1 to 100% [12,14,17] similar to our finding of (91.7%). In addition to this, this study revealed that anti-convulsant medication was continued for 24 h postpartum for 177 (73.4%) patients.…”

“…Rates of labor induction vary a great deal across studies. Similar to a rural hospital in Western Tanzania, in this study labor was induced in 38.1% of the patients [17]. In contrast, 47.9% of patients were induced at the Mettu Karl Referral Hospital [12] and 23.4% in governmental hospitals of Addis Ababa [14].…”

“…The median duration for women with severe preeclampsia between admission and labor was 24 h (IQR 10.25-48) which was shorter than other study conducted among patients with severe preeclampsia and eclampsia [17]. Shorter hospital stay for severe preeclamptic women at term was stated as a supported management option in studies and management protocols [16,19].…”

Prevalence of Eclampsia and its Maternal-fetal outcomes at Ghandi Memorial Hospital, Addis Ababa Ethiopia, 2019. Retrospective study

“…In this study the proportion of mothers delivered with cesarean section is 47.8%. This is in-line with the study conducted in Aminu Kano Teaching Hospital, Kano, Nigeria(19) which showed 55.8% patients were delivered by cesarean section, in a rural hospital in Western Tanzania (20) 19% women delivered by Caesarean section, in Amhara Regionreferral hospitals, North West Ethiopia(10) showed 27.9% delivered by cesarean section. This might be due to the fact that eclamptic disorder causes seizure/convulsion which highly associated with fetal distress related placental-insu ciency and causes feto-maternal complications.…”

Severe maternal outcomes and quality of care at district hospitals in Rwanda– a multicentre prospective case-control study

“…A high coverage of those interventions alone does not avoid the occurrence of SMO as shown in our study. Different studies have highlighted that high coverage of essential interventions is not sufficient to reduce maternal morbidity and mortality; they suggest that universal coverage of life-saving interventions needs to be matched with comprehensive emergency care and overall improvements in the quality of maternal health care [ 19 , 27 , 28 ]. Case fatality for hypertensive disorders in pregnancy and/or labour was also high in other studies, illustrating that better treatment of hypertension and starting induction of labour as soon as possible is needed to improve health outcomes [ 15 , 21 , 24 , 29 ].…”