Suyog Tannirwar¹, Pooja Daramwar^2*

^1,2Assistant Professor, Department of Paediatric, Dr Ulhas Patil Medical College, Jalgaon khurd, Jalgaon, Maharashtra, INDIA.

Email: sbtannirwar@gmail.com

Table 1: Maternal characteristics

In present study, 1501-2500 gms (60%) birth weight group was most common followed by >2500 gms (18%) and 1001-1500 grams (17%). In present study stillbirths were 13% while early neonatal death was noted in 14%. Out of 110 live births APGAR score at 5 minutes was ≥7 in 67%,3-6 in 12% and 1-2 in 9%. 24 % neonates required resuscitation while NICU admission was required in 46% neonates. Complications were noted in 51 neonates. Respiratory distress (31%), Clinical Sepsis (29%), Meconium-stained liquor (25%), Severe birth asphyxia (22%), Hypocalcemia (16%) were common complications.

Table 2: Perinatal outcome in eclamptic patients

DISCUSSION

Antenatal magnesium sulphate is commonly used in obstetric practice. Systematic reviews and clinical practice guidelines support its use when given for maternal neuroprotection in preeclampsia or eclampsia⁶ and for neuroprotection of the fetus in women at risk of preterm birth (for cerebral palsy prevention).⁷ Neonatal outcome in eclamptic mothers is dependent upon multiple factors such as birth weight of the baby, gestational age, birth asphyxia, presence or absence of meconium aspiration and Apgar score at birth. Maternal Eclampsia is one of the prominent etiological factors for neonatal morbidity and mortality. Prematurity, growth restriction and low birth weight are the common neonatal complications seen in babies born to mothers with eclampsia.⁸ In study by Jagjit S,⁸ there were 113 cases of eclampsia mothers (0.96%). Majority of newborn were born to unbooked mother (95.57%). 57% babies were born by Caesarean section. 80.5% babies were live born and 19.5% were still born. Perinatal deaths due to eclampsia was 23%. Out of 91 live births, 45 (49.4%) babies admitted to Neonatal intensive care unit. The common reasons for admission were small for gestational age (43.9%) and low birth weight, hypoglycemia (5.4%), respiratory distress (15.3%), severe birth asphyxia (7.6%) and 4 (4.3%) babies had neonatal death. 87/91 (95.6%) newborns were discharged. In present study >80% of eclamptic patients had babies with birth weight less than 2500 g. Similar results were observed in other studies conducted by Dhananjaya et al..⁹ and Rajesri et al..,¹⁰ with 89% and 78% of babies respectively with birth weight less than 2500g. This may be because of higher number of preterm deliveries (spontaneous and induced) as well as intrauterine growth restriction which is a known complication of preeclampsia. Eclampsia in the rural population is an important cause of significant neonatal morbidity in terms of prematurity, LBW, IUGR, and birth asphyxia. It is a significant risk factor for late preterm births as well.¹¹Tejaswi Nandan¹² conducted a comparative study of new-born babies born to 100 consecutive mothers admitted with eclampsia with those born to 100 consecutive non-eclamptic mothers (considered as control) with normal BP. The majority of eclamptic mothers were primigravida (88%), <20 years of age (65%), having body weight of mean 41.22±5.12 kg, height of mean 147.28±6.27cm, and socioeconomic status of Class IV (90%). There was no significant difference observed in respect of age, weight, height, religion, caste, parity, and socioeconomic status between eclamptic and control mothers and thus, the two groups were statistically matched. Outcome in new-borns of eclamptic mothers was significantly more adverse (p<0.001) than in non-eclamptic mothers. In this study, four significant neonatal outcomes of eclamptic mothers were observed as preterm, LBW, IUGR, and birth asphyxia while other outcomes as hypoxic- ischemic encephalopathy (HIE), early-onset sepsis (EOS), early neonatal death (END), and stillbirth were not significant. They concluded that the eclampsia is an important cause of significant neonatal morbidity in terms of prematurity, LBW, IUGR, and birth asphyxia. It is a significant risk factor for late preterm births as well. Madhu Sinha¹³ studied 298 cases of eclampsia, (3 died undelivered) 104 fetus died. Perinatal mortality rate was 39.5% Intrauterine death were 56 (53.8%). Stillbirth accounted for 19.2% of perinatal mortality and 26.9% of neonatal death. 124 newborn got admitted in the nursery, of which 28 (26.9%) died, 96 (60%) were live. There were 28 (26.9%) neonatal deaths. 63 (39.6%) babies were shifted to mother side after observation. Reasons for admission were preterm (21.1%), Intrauterine growth restriction (IUGR) (15.1%), low birth weight (69.4%), meconium aspiration, low Apgar score. Most common causes of perinatal death were birth asphyxia, prematurity, meconium aspiration and neonatal sepsis. In the study conducted by Kamat DJ¹⁴ and Edgar et al.., ¹⁵ the stillbirth rate was found to be 11.5% and 12.2% respectively. Also, the neonatal death rate in studies by Kamat DJ¹⁴ and Anuja et al..¹⁶ was 5.3% and 5.4% respectively.17,21 Perinatal mortality was 68.2% and 40% when the convulsion to delivery interval was more than 12 hours noted in the studies by Anuja et al. and Rajesri et al., respectively. But due to more liberal use of caesarean sections and better NICU facilities available, reduction in perinatal mortality is expected. Although all cases of eclampsia are not preventable but we can improve maternal and fetal outcome by good antenatal care, early detection of sign and symptoms of preeclampsia, prompt treatment and timely termination of pregnancy.

CONCLUSION

Eclampsia requires early delivery, high risk of neonatal morbidity and mortality, should be delivered at a tertiary institute. Prematurity, growth restriction and low birth weight are neonatal complications noted in mothers with eclampsia. A good neonatal intensive care unit will help improve neonatal outcomes.

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