Emine Ahu KOÇ, Nuri DANIŞMAN, Murat ÖZEL

EKLAMPSİ İLE KOMPLİKE GEBELİKLERDE MATERNAL VE FETAL SONUÇLAR

Amaç: Eklampsi vakalarının klinik gidişleri ve maternal -fetal sonuçların analizini yapmak, eklampsiye predispozan durumları ortaya çıkarmak, mortalite nedenlerine açığa çıkarıp yönetimini güncel literatür eşliğinde tartışmak.Materyal- Metot: Refere merkez olan 3. basamak bir Eğitim ve Araştırma Hastanesinde 5 yıllıkdönemde eklampsi tanısıyla takip ve tedavi edilen 151 gebe değerlendirildi. Preeklampsi semptom ve bulgularını gösteren gebede,başka bir patoloji yokluğunda meydana gelen generalize tonikklonik konvülziyonların varlığı eklampsi olarak kabul edildi.Maternal öykü, klink ve laboratuvarbulguları, doğum şekli, eklampsinin yönetimi, maternal ve perinatal komplikasyonlar not edildi.Bulgular: Toplam 151 olgu değerlendirildi. 5 yıllık dönemde eklampsi insidansı 1.44/1000 olarakhesaplandı. Olguların ortalama yaşı 23 (16-43) idi.90 (%59.6) hasta nullipar, 146 (%96.7) hasta tekil gebelik idi. Medyan gebelik yaşı 33 hafta (23-41) idi. Konvülziyon 100(%66.2) hastada antepartum, 29(%19.2) hastada postpartum ve 22(%14.6) hastada intrapartum dönemdeydi. Sezaryenledoğum oranı %70.2 idi. Canlı doğum oranı %82.7 idi. 31 (%19.9) fetus intrauterin dönemde exolmuştu. 21 (%13,5) yenidoğan erken neonatal dönemde ex oldu. Perinatal morbidite %12.8 vemortalite %31.2 oranındaydı. Maternal morbidite %31.7, mortalite %2.6 olarak hesaplandı.Sonuçlar: Eklampsi ile komplike olan gebeliklerde maternal ve perinatal sonuçları iyileştirebilmekiçin yeterli antenatal bakım, gebelerin bilinçlendirilmesi ve erken-uygun yönetim gerekmektedir.Aksi halde eklampsi maternal-peinatal morbidite ve mortalitenin major nedenlerinden biri olmaya devam edecektir.

Maternal and Fetal Results of Pregnancies Complicated with Eclampsia

Aim: Our aim is to analyze the clinical course of eclampsia cases and maternal-fetal outcomes,to elicit eclampsia predisposing conditions,to expose causes of mortality and to discuss management in the light of current literature. Material-method: 151 pregnant women who were followed up and treated with a diagnosis of eclampsia in atertiary education and research hospital for 5 years were evaluated. The presence of generalized tonic clonic convulsions which manifested symptoms and signs of preeclampsia and occured in the absence of another pathology was considered as eclampsia.Maternal history,clinical and laboratory findings,delivery method,management of eclampsia,maternal and perinatal complications were noted. Results: A total of 151 cases were evaluated.The incidence of eclampsia in the 5 year period was calculated as 1.44/1000.The mean age of the cases was 23 (16-43).Ninety patients (59.6%) were nullipar and 146 (96.7%) were singular pregnancies.The median gestational age was 33 (23- 41) weeks.Convulsions were in antepartum in 100 (66.2%) cases,postpartum in 29 (19.2%) cases and intrapartum in 22 (14.6%) cases. Cesarean delivery rate was 70.2%.The live birth rate was 82.7%. 31 (19.9%) fetuses die in intrauterine period. 21 (13.5%) newborns died in early neonatal period. Perinatal morbidity was 12.8% and mortality was 31.2% .Maternal morbidity was 31.7% and mortality was 2.6%. Conclusions: Pregnancies complicated with eclampsia,adequate antenatal care,awareness of the need for gestation and early approriate management are needed to improve maternal and perinatal outcomes. Otherwise eclampsia will continue to be one of the major causes of maternalperinatal morbidity and mortality.

PDF

___

Dukkit K, Harrington D. Risk factors for preeclampsia at antenatal booking: systemic review of controlled studies. BMJ. 2005 Mar; 330(7491):565.
Govt. of lndia (2002),Annual report 2001-2002, Ministry of Health and FamilyWelfare, New Delhi.
ACOG practice bullet in. Diagnosis and management of preeclampsia and eclampsia. Number 33, January 2002. Praveen kumar et al; Eclampsia Annals of International Medical and Dental Research, Vol (3), Issue (2) Page 6 Section: Obstetrics&Gynaecology ACOG Committee on Practice Bulletins—Obstetrics. Obstet Gynecol. 2002 Jan; 99(1):159-67.
Noralhan MN, ShardaP, Jammal AB: Report of 50 cases of eclampsia J Obstet Gynaecol Res. Aug.31(4):302-9;2005
El-Nafaty A.U, Melah GS, Massa AA, Audu BM, Nelda M.Theanalysis of eclamptic morbidity and mortality in the Specialist Hospital Gombe, Nigeria. J Obstet Gynaecol Feb.24(2):142-7;2004
Munro PT: Management of eclampsia in the accident and emergency department. J Accid Emerg Med; 17:7-11;2000
Onuh S, Aisien A: Maternal and fetal outcome in eclamptic patients in Benin City, Nigeria. Journal of Obstet and Gynaecol Oct. 24(7):765-768;2004
Douglas KA, Redman CWG. Eclampsia in the United Kingdom. BrMed J.309:1395;1994
Sibai BM, McCubbin JH, Anderson GD, Eclampsia. I. Observations from 67 recent cases. Obstet Gynecol.58:609;1981
Morriss MC, Twickler DM, Hatab MR, Cerebral blood flow and cranial magnetic resonance imaging in eclampsiaand severe preeclampsia.Obstet Gynecol.89:561;1997
Brown CEL, Cunningham FG, Pritchard JA. Convulsions in hypertensive, proteinuric primipars more than 24 hours after delivery: Eclampsia or some other cause. J Reprod Med 32;1987
Osungbade KO, Ige OK. Public Health Perspectives of Preeclampsia in Developing Countries: Implication for Health System Strengthening. Journal of Pregnancy. 2011; 2011: 481095
Sibai BM. Diagnosis, prevention and management of eclampsia. Obstetrics and Gynecology. 2005 Feb;105(2):402–10.
Mattar F,SibaiBM.Eclampsia-Risk factors for maternal morbidity. Am J Obstet Gynecol 182:307-312;1999
Sibai BM. Eclampsia.VI.Maternal and perinatal outcome in 254 consecutive cases. Am J Obstet Gynecol 163:1049;199
Aabidha PM, Cherian AG, Paul E, Helan J. Maternal and fetal outcome in pre-eclampsia in a secondary care hospital in South India. Journal of Family Medicine and Primary Care. 2015; 4(2):257- 260.
Lopez-Llera M: Main clinical subtypes of eclampsia. Am J Obstet Gynecol 166:4-9;1992
Ade-Ojo IP, Loto OM. Outcome of eclampsia in OAUTH IleIfe. Nig J ClinPract. 2008;11(3):279–284.
Swain S ,Ohha KN, Prakash A. Maternal and perinatal mortality due to eclampsia . Indian Pediatr. 1993;30(6):771-3.
Jain S, Nager S, Monga D. Maternal mortality following Eclampsia; a critical analysis of 693 cases in two teaching hospitals in Northern India. 1998;38:256-60.