MATERNAL CHARACTERISTICS, FETO-MATERNAL OUTCOME AND SEASONAL VARIATION IN PRE-ECLAMPSIA WITH SEVERE FEATURES AND ECLAMPSIA

Abstract

Aims&objectives:- To study prevalence of pre-eclampsia, co-relation of severe pre-eclampsia and eclampsia with maternal characteristics,feto-maternal outcome,seasonal variation and sex of the fetus, if any. Materials&Methoods- It was prospective observational study, carried out in obstetrics and gynecology department, MMIMSR, Mullana, Ambala, a tertiary care rural hospital in North India, from 1st June,2020 to 31st December,2020. Maternal characteristics, risk factors, sex of fetus, adverse maternal and fetal outcomes were recorded and data analyzed. Retrospective analysis of patients with severe pre-eclampsia and eclampsia, for a period of 3 years from January,2018 to December,2020 was done to see seasonal variation. Results:- A total of 1275 births were recorded from 1st June,2020 to 31st Dec,2020. 114 women were diagnosed with Hypertensive disorders of pregnancy with a prevalence of 8.94%. An increased incidence(75%) of severe pre-eclampsia/eclampsia in unbooked patients was seen. 87.5% patients were less than 30 years. 55% patients were primigravida. Severe preeclampsia-eclampsia was more in rural population(80%) with low literacy level(45%) and low socio-economic status(70%). Signicantly increased incidence(72.5%) of pre-eclampsia in women with dark complexion. 52.5% cases were seen in BMI range of 30.0-34.9. 42.5% patients presented before 34 weeks, 47.5% beyond 34 weeks and 10% within 48 hours post-partum. Singleton pregnancy was seen in 92.5% cases. Anemia was contributing factor in 42.5% and. 12.5% had APS. Caesarean rate was very high. Increased risk of severe pre-eclampsia has been observed while carrying a male fetus(67.5%). Patients with severe pre-eclampsia had increased risk of eclampsia(27.5%) and placental abruption(17.5%). FGR seen in 20%, with oligohydramnios in 15% cases. ICU admission with ventilator support needed by 10% while 5% had maternal deaths. Fetal complications, like pre-maturity seen in 50%, NICU admission required in 57.5% and intra-uterine death in 27.5%. Peak incidence recorded in summers(June-July). Conclusion-Unbooked/referred-in pregnancy, illiteracy, low socio-economic status, undiagnosed maternal risk factors, anemia pose a challenge for early diagnosis and management of severe pre-eclampsia&eclampsia. Severe disease is usually early onset, more in dark complexion with male fetus in-utero with peak incidence in summer. Regular antenatal check-up with diagnosis of high-risk factors in rst trimester, to implement preventive measures should be universal guideline.