ASSESSMENT OF NEONATAL OUTCOMES IN ECLAMPTIC MOTHERS ADMITTED TO NMCH, PATNA, BIHAR

Hypertension during pregnancy is a highly variable disorder unique to pregnancy and a leading cause of maternal and fetal/neonatal morbidity and mortality. Preeclampsia is a progressive disorder,in some conditions delivery is needed immediately for the benet of mother and fetus. However,need for premature delivery has adverse effects on neonatal outcomes. Eclampsia still remains a signicant risk factor for neonatal morbidities like preterm ,stillbirth ,IUGR, hematological and cerebrovascular anomalies. Hence based on above ndings the present study was conducted for Assessment of Neonatal Outcomes in Eclamptic Mothers Admitted to NMCH, Patna, Bihar. Reviewed is the current literature for neonatal outcomes and potential strategies to optimize fetal outcomes in pregnancies associated with eclampsia. The present study was India. The study was planned from March 2019 to October 2019. In the present study 50 females admitted with eclampsia or with pre-eclampsia but subsequently developing eclampsia were enrolled. Also the control females were also evaluated for comparative evaluation. The mothers were selected after matching the socio-demographic and nutritional prole. Mothers less than 28 weeks of gestation or suffering from chronic illness, giving birth to twin babies or babies with gross congenital malformation were excluded. The data generated from the present study concludes that Prevention of prematurity, treatment of morbidities & prevention of infection among infants should be done to reduce the PMR and improve perinatal outcome. Thus High risk pregnancy should be identied prospectively and then given special care, perhaps a major impact on overall perinatal loss could be reduced.

B) Intrauterine growth retardation-Preeclampsia, a condition with decreased uteroplacental blood ow and ischemia is a signicant risk factor in development of IUGR and represents the most common cause of IUGR in nonanomalous infant. Data has shown that for any gestational age at birth, a weight below 10th percentile increases mortality [11,12]. Pregnancies complicated with severe eclampsia and preeclampsia shows birthweight 12% lower than expected while pregnancies with mild eclampsia and preeclampsia showed no change in weight gain than the normal ones [12,13]. C) Hematological effects-Maternal eclampsia or preeclampsia can result in neonatal thrombocytopenia. In pregnancies complicated by preeclampsia, thrombocytopenia is identied at birth or within rst 2-3 days following delivery [14,15]. The pathogenesis is unknown [16]. One likely mechanism is that eclampsia and the resultant fetal hypoxia, has a direct depressant on megakaryocyte proliferation [17,18]. This is supported by studies showing that growth restricted neonates have signicant megakaryocytopoeitic defects without evidence of increased platelet destruction [18]. D) Bronchopulmonary dysplasia-Evidence suggests that abnormal placentation, characterized by shallow invasion of the maternal arteries,compromises uterine blood ow at expense of growing placenta and fetus [17]. The resulting hypoxia and ischemia may result in fetal angiogenesis [15,16]. however, BPD occurs in infants of mothers with severe eclampsia . E) Neurodevelopmental outcome-The neurodevelopmental outcomes of exposed infants are highly variable [13,14]. Some evidence suggests that preeclamsia and eclampsia is associated with a decreased risk of cerebral palsy [16,17]. Some data suggests infants born to mothers with eclampsia have lower MDI scores at 24 months of age as compared to infants without maternal eclampsia [14].
Therefore, it shows that both eclampsia and preeclampsia leads to a number of adverse neonatal outcomesand is one of the main public health problems. Hence based on above ndings the present study was planned for Assessment of Neonatal Outcomes in Eclamptic Mothers Admitted to NMCH, Patna, Bihar.

METHODOLOGY:
The present study was planned in Department of Pediatrics, Nalanda Medical College and Hospital, Patna, Bihar, India. The study was planned from March 2019 to October 2019. In the present study 50 females admitted with eclampsia or with pre-eclampsia but subsequently developing eclampsia were enrolled. Also the control females were also evaluated for comparative evaluation.
All the patients were informed consents. The aim and the objective of the present study were conveyed to them. Approval of the institutional ethical committee was taken prior to conduct of this study.
Following was the inclusion and exclusion criteria for the present study.
Inclusion Criteria: All pregnant women are at or beyond 28 weeks of gestation, with singleton pregnancy and in the age group between 20-40 years are included.
Exclusion Criteria: Women with chronic hypertension, renal disease,

INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH International Journal of Scientific Research
cardio vascular disease, thyroid disease, liver disease, diabetes mellitus, twin pregnancy, pregnancy with gross congenital malformation and molar pregnancy are excluded. Blood samples were collected with the consent of the patient and centrifuged and analysed immediately for serum calcium and magnesium levels.

RESULTS & DISCUSSION:
Hypertension is one of the most common medical complication of pregnancy. It contributes signicantly to the cause of maternal and perinatal morbidity and mortality. Hypertensive disorders of pregnancy predispose women to acute or chronic uteroplacental insufciency, resulting in ante or intrapartum asphyxia that may lead to fetal death, intrauterine growth retardation and/or preterm delivery. [14] Essential hypertension cases were less in this study, probably because majority of the mothers did not receive antenatal care and were admitted as emergency cases, hence no blood pressure record during the antenatal period was available. Seventy three per cent of the study cases were emergency admissions, the gures being similar to other studies. [15] The perinatal mortality was also higher in them as compared to the booked cases.  Maternal morbidity includes severe bleeding from abruption placentae with its resulting coagulopathy, pulmonary edema, aspiration pneumonia, acute renal failure, cerebrovascular haemorrhage, retinal detachment and PRES. Perinatal mortality and morbidity is another impact factor in eclampsia patients, as the denitive treatment is the only termination of pregnancy irrespective of gestational age. The primary target in eclampsia is achieving control of convulsions, control of blood pressure and terminating pregnancy within optimal time frame. At all health providing levels appropriate use of anticonvulsants, anti-hypertensives along with safe culmination of pregnancy should be encouraged for these patients. If need is felt referral to a well-equipped higher center should be done promptly without wasting time along with by appropriate emergency obstetric care.
The major cause of intra uterine death was placental insufciency producing severe intra uterine growth retardation. The major cause of still birth also is placental insufciency. From our study it is seen that women with severe IUGR had poor neonatal out come. Respiratory distress syndrome was the major neonatal complication followed by sepsis and convulsions. All these complications were seen to decrease with increasing gestational age rather than the birth weight. Steroids when given were denitely seen to help reduce the neonatal respiratory distress syndrome. Expectant management can be undertaken by experienced team offering continuous monitoring and care. It is best that such patients be moved to a tertiary care centre with advanced neonatal care facility before the management is offered.
The frequency of hypertensive disorders of pregnancy continues to remain high and majority are due to toxaemia of pregnancy. Perinatal mortality is signicantly high in mothers with hypertensive disorders. The frequency of both preterm and intrauterine growth retarded babies in higher in these mothers and birth asphyxia is the commonest neonatal complication.
There are limited number of therapeutic options in management of eclampsia with known benet to fetus. Magnesium sulphate , medication for seizure prophylaxis has shown to have a neuroprotective effect on preterm neonates leading to decreased incidence of cerebral palsy. Antenatal administration of corticosteroids,12-24 hours before delivery has been shown to decrease morbidity and improve survival rates of infants born before 34 weeks of gestation.
The nurse midwife plays a signicant role in providing care for high risk pregnant women. She should recognize that the mainstay of treatment for pre-eclampsia remains ending the pregnancy by delivering the fetus (and the placenta). This can be a signicant problem for the baby if pre-eclampsia occurs at 24-28 week of gestation. Thus, many strategies have been proposed to delay the need for delivery. The nurse midwife could assist with early recognition of the symptomless syndrome. She should also be aware of the serious nature of the condition in its severest form, adhere to agreed guidelines for admission to hospital, and have a great knowledge of investigations and the use of antihypertensive and anticonvulsant therapy. In addition, she can provide postnatal follow up and counselling for future pregnancies (Yoder et al., 2009). [18] Eclampsia is associated with signicant maternal and perinatal morbidity and mortality. The higher death is due to high percentage of the patient being unbooked; majority receive no therapeutic intervention until admission. The delay in the diagnosis, and early detection of warning symptoms is preceding eclampsia, like, edema, headache, nausea, vomiting, epigastric pain, blurring of vision and thereby delay in management, leading to various complications and resulting high mortality and morbidity. Maternal and newborn deaths due to preeclampsia/ eclampsia are preventable: by increasing community awareness about the condition, improving antenatal care quality, and scaling up proven best practices to prevent mild preeclampsia's escalation to severe pre-eclampsia and eclampsia. By detecting and managing pre-eclampsia, judiciously, thus preventing eclampsia, can improve the survival rate of women and babies in developing countries.

CONCLUSION:
There has been a lack of consideration earlier to the complications of premature delivery. However , the potential of eclampsia to disrupt mechanisms regulating fetal growth and development, a better understanding of pathophysiology of disorder will allow us to develop strategies to prevent morbidities and mortalities of neonates . The data generated from the present study concludes that Prevention of prematurity, treatment of morbidities & prevention of infection among infants should be done to reduce the PMR and improve perinatal outcome. Thus High risk pregnancy should be identied prospectively and then given special care, perhaps a major impact on overall perinatal loss could be reduced.

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