dc.description.abstract | Background: Eclampsia is defined as pre-eclampsia complicated with
convulsions and/or coma. The incidence of eclampsia is 0.2%-0.5% of all
deliveries globally 2. It is a common obstetric emergency in Kenya and it is
associated with adverse maternal and neonatal outcomes. Some of the
documented complications are pulmonary edema, cerebral hemorrhage,
acute renal failure and placental abruptio.
Facilities for intensive care are scarce in low resource settings. Identifying
determinants of maternal and perinatal outcome among eclamptics will
provide insight as to which group of mothers at risk would benefit from
earlier referral.
Objective: To study the determinants of maternal and perinatal outcome
among patients with eclampsia at Kenyatta National Hospital.
Design: This was a Cross-sectional descriptive study.
Methodology: All mothers with eclampsia admitted in labor ward,
ante-natal wards and those reviewed in the postnatal clinic were interviewed
and information collected with respect to age, parity, ANC attendance,
duration of gestation, place of first fit, BP and degree of protenuria at
admission, fit -delivery interval, clinical management, mode of delivery,
perinatal outcome, maternal mortality and duration of hospital stay was
recorded in a questionnaire. Additional was obtained from patient records.
Setting: The study was conducted at Kenyatta National Hospital labor
ward, antenatal wards and post natal clinic. KNH is Kenya's largest referral
hospital.
Data collection analysis: Data collected was entered into a
a database. This data was then analyzed electronically using SPSS widows
statistical software. The chi square test was used to identify factors that were
related to development of complications.
9
Outcome measures: The study variables include age, parity, booking
status, gestational age, location at time of first seizure, number of fits,
seizure to delivery interval, maternal complications and the clinical
management.
Results: During the study 135 patients who developed eclampsia and who
met the inclusion criteria were interviewed. The predictors of outcome were
age, parity, booking status, gestational age, location at time of first
seizure, number of seizures and seizure interval and delivery. There was no
significant relationship between socio-demographic characteristics and
development of complications(p >0.05). The majority of the patients who
had not attended ANC (61.9%) developed complications. The relationship
between the attendance of ANC and non-attendance and the occurrence of
complications was statistically significant. (p=O.OOO1)
There was a statistically significant relationship between the diastolic BP
and development of complications (p=.OOl).The commonest complications
were pulmonary oedema (17.7%), acute renal failure (22.60/0) ,sepsis
(14.5%), postpartum hemorrhage, (1l.3%) and abruptio placenta
(11.3%). Development of complications significantly affected maternal
mortality (p=0.031 ).The incidence of perinatal mortality was 2.8/1 000
deliveries. The case fatality rate was 5.1%.
Conclusion: Development of complications in eclampsia was significantly
influenced by ANC attendance and the diastolic blood pressure on
admission.
Recommendations: From the study findings it is important for health care
workers to review the management of eclampsia to address the rising case
fatality rate. There is also need for increased vigilance of patients who have
had no antenatal care. | en_US |
dc.description.department | a
Department of Psychiatry, University of Nairobi, ; bDepartment of Mental Health, School of Medicine,
Moi University, Eldoret, Kenya | |