Introduction
A modest amount of all pregnancies are convoluted by hypertension. Eclampsia and toxemia represent about portion of these cases worldwide and have been perceived and portrayed for quite a long time in spite of the overall absence of comprehension of the disease.1 In the fifth century, Hippocrates noticed that migraines, spasms, and tiredness were inauspicious signs related with pregnancy. In 1619, Varandaeus begat the term eclampsia in a composition on gynecology.1, 2
Eclampsia, which is viewed as a complexity of serious toxemia, is normally characterized as new beginning of amazing mal seizure movement or potentially unexplained unconsciousness during pregnancy or post pregnancy in a lady with signs or manifestations of preeclampsia.3 It commonly happens during or after the twentieth seven day stretch of incubation or in the post pregnancy time frame. Regardless, eclampsia without hypertension with proteinuria has been shown to happen in 38% of cases announced in the United Kingdom.3 Similarly, hypertension was missing in 16% of cases investigated in the United States.4
The clinical signs of maternal toxemia are hypertension and proteinuria with or without existing together fundamental irregularities including the kidneys, liver, or blood. There is additionally a fetal appearance of toxemia including fetal development limitation, decreased amniotic liquid, and unusual fetal oxygenation.3 HELLP condition is an extreme type of toxemia and includes hemolytic iron deficiency, raised liver capacity tests (LFTs), and low platelet tally.
Most instances of eclampsia present in the third trimester of pregnancy, with about 80% of eclamptic seizures happening intrapartum or inside the initial 48 hours following conveyance. Uncommon cases have been accounted for before 20 weeks' incubation or as late as 23 days' post pregnancy. Other than early discovery of toxemia, no solid test or manifestation complex predicts the improvement of eclampsia. In created nations, many announced cases have been delegated inevitable.
Hereditary inclination, immunology, endocrinology, nourishment, unusual trophoblastic attack, coagulation irregularities, vascular endothelial harm, cardiovascular maladaptation, dietary lacks or overabundance, and disease have been proposed as etiologic elements for toxemia/eclampsia.5 Imbalanced prostanoid creation and expanded plasma antiphospholipids have additionally been involved in eclampsia.2, 6
Materials and Methods
The present study was carried out in the Department of Obstetrics and Gynaecology, it is a prospective study.
The patients were selected from patients who were admitted to as emergency cases in labour room patients were irrespective of age and parity. On a specially designed proforma for this study, the patient particulars like detailed obstetric history, examination and laboratory findings were recorded; were studied.
Method
Blood pressure recording: Blood pressure was recorded in lateral recurrent position. The point of muffing of Korotkoff's sound was taken as diastolic pressure when the sound failed to disappear till zero, otherwise the point of disappearance of Korotkof'fs sound was taken as diastolic BP. At least two recording six hours apart were taken.
Family history of PIH - All possible effects were made to get a detailed family history as regards to affected sisters, mothers and mother in-law and most of the data is based on the verbal account given by the patient or attendants.
Proteinuria - A test tube was two third filled with a midstream sample of urine. The top 2 cm of the urine was boiled over a flame. Turbidity of urine which did not disappear even on addition of 10% acetic acid was considered to be indication of proteinuria. For practical purposes the amount of protein was exposed as a haze (+), cloud (++) or granular precipitate (+++).
Results & Discussion
Table 1
Distribution of cases according to diagnosis
|
Diagnosis on admission |
No. of Cases |
Percent |
No. of Death |
Percentage mortality |
|
Preeclampsia |
120 |
31.58 |
12 |
12 |
|
Eclampsia |
260 |
68.42 |
23 |
8.84 |
|
Total |
380 |
100% |
35 |
9.21% |
Table 2
Distribution of pre-eclapmsia & eclampsia in relation to Booked/Unbooked status
Table 3
Distribution of cases showing lactate dehydrogenase level (LDH) on admission
Table 4
Statistical study
|
LDH |
Case |
Mean |
SD |
P value |
|
Preeclampsia |
725.81 |
195.92 |
0.181 |
|
|
Eclampsia |
758.77 |
234.80 |
0.154 |
Table 5
Distribution of cases showing serum creatinine on admission
|
Serum Creatinine (mg/dl) |
Preeclampsia |
Eclampsia |
||
|
No. |
% |
No. |
% |
|
|
<1.5 |
97 |
80.83 |
201 |
77.31 |
|
>1.5 |
23 |
19.17 |
59 |
22.69 |
|
Total |
120 |
100% |
260 |
100% |
Table 6
Distribution of cases on the basis of total serum Bilirubin (mg/dl) on admission
|
Total Bilirubin (mg/dl) |
Preeclampsia |
Eclampsia |
||
|
No. |
% |
No. |
% |
|
|
< 1.2 |
93 |
77.50 |
196 |
75.38 |
|
> 1.2 |
27 |
22.50 |
64 |
24.62 |
|
Total |
120 |
100% |
260 |
100% |
Incidence of eclampsia varies from country to country. In general eclampsia is preventable and it less common in the developed countries (UK, USA) of 11625, 120 and 260 patients were diagnosed as preeclampsia and eclampsia respectively. This indicates a frequency of 1.03% for preeclampsia and 2.23% for eclampsia.
Swains et al reported the incidence of eclampsia as 2.2% of all hospital deliveries.7 Choudhary P (mid April 2000 to mid April 2001) in a retrospective study observed the incidence of eclampsia as 2.9 per 1000 deliveries.8
Dr. Tayyiba Wasim et al. reported the incidence of eclampsia at Lahore General Hospital (2002) as 2.2%.9 In our study it is found that that serum Lactate Dehgydrogenase were > 600 IU/L in 77.50% of Preeclampsia and 78.46% of eclampsia patients.
Demir et al. (2006)10 had found that in complicated cases of Preeclampsia and eclampsia, LDH level were significantly higher. Qublan HS et al. (2005)11 had found abnormally that LDH as a biochemical marker of adverse pregnancy outcome in severe Preeclampsia patients.
LDH level > 600 IU/L in 54.8% of severe Preeclampsia and 12.2% of mildly Preeclampsia. Lactate dehydrogenase is a useful marker that reflect the severity of and occurrence of complication of preeclampsia. Sever preeclampsia is frequently accompanied by evidence of hemolysis, which is semiquanitfied. By elevated serum lactate dehyrogenase levels.
Rinehart reported the rate of change of platelet count and LDH level in preeclampsia for LDH, values increased at a rate of approximately 1400 IU/l per day, 600 IU/l per day, 300 IU/l per day and 200 IU/l per day for patients with classes 1, 2 and 3 and for non-HELLP severe Preeclampsia, respectively.12
In this study 80.83% of preeclampsia and 77.31% of eclampsia patient had their serum creatinine level within the normal range that is 0.6-1.2 mg/dl.
Martin Jn evaluated clinical and research facility profile in serious toxemia with or without HELLP condition. He found that lactate dehydrogenase level >1400 IU/L, aspartate aminotransferase level >150 IU/L, alanine aminotransferase level >100 IU/L, uric corrosive level >7.8 mg/dL, serum creatinine level >1.0 mg/dL, and 4+ urinary protein by dipstick can be utilized to separate the patient at high danger for critical maternal bleakness. Convergences of lactate dehydrogenase, aspartate aminotransferase, and uric corrosive over these cut focuses have the most grounded prescient worth and are hazard added substance with deteriorating thrombocytopenia.13
Conclusion
Eclampsia is associated with significant maternal and perinatal morbidity and mortality. The higher mortality is due to high percentage of the patient being unbooked and majority received no therapeutic intervention until admission. Among the cases studied 76% preeclampsia and 96% eclampsia patient were unbooked case and most of them resided in rural areas while the remaining were from urban slums.
Hyperbilirubinemia was seen in small groups of pre-eclampsia and eclampsia patients. Deranged level of liver enzyme were also found in small group of pre-eclampsia and eclampsia patients. LDH level was found significant higher (more than 600 IU/L) in pre-eclampsia and eclampsia patients.
