CLINICAL ARTICLE
a r t i c l e
i n f o
Article history:
Received 1 April 2011
Received in revised form 11 October 2011
Accepted 23 November 2011
Keywords:
Eclampsia
Intensive care unit
Magnesium sulfate
Nifedipine
a b s t r a c t
Objective: To evaluate the protocol used for management of eclampsia at Assiut University Hospital, Assiut,
Egypt. Methods: In a prospective cross-sectional study, data were collected from 1998 women treated for
eclampsia at Assiut University Hospital between January 1990 and January 2010, including 1594 cases of
prepartum eclampsia, 75 of intrapartum eclampsia, 16 of intercurrent eclampsia, and 313 of postpartum
eclampsia. The treatment regimen included use of nifedipine as an antihypertensive, magnesium sulfate as
an anticonvulsant, rapid interruption of pregnancy, and admission to the ICU. Data were evaluated for control
of blood pressure, prevention and control of convulsions, and maternal and perinatal outcomes. Results:
Magnesium sulfate was effective in controlling convulsions in 98.1% of women. Nifedipine initiated a smooth
decline in blood pressure (P > 0.0001). There were 79 maternal deaths (3.95%). Maternal morbidity occurred
in 439 (22%) women. Twenty-seven percent of women delivered vaginally (most of these women were
admitted postpartum). Perinatal mortality occurred in 7.9% of cases. Conclusion: A combination of nifedipine
as an antihypertensive drug, magnesium sulfate as an anticonvulsant, rapid interruption of pregnancy, and
managing the patients in the ICU resulted in a marked improvement in the outcome for both mother and
fetus at Assiut University Hospital.
2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.
1. Introduction
In low-resource countries, annually 150 maternal deaths per
100 000 births are related to hypertensive disorders of pregnancy, as
compared with 4 maternal deaths per 100 000 births in high-income
countries [1]. Hypertensive disorders of pregnancy signicantly
increase fetal and neonatal morbidity and mortality [1].
Administration of calcium ion channel blockers such as nifedipine
is an ideal approach to the treatment of patients with hypertensive
disorders of pregnancy. The resulting vasodilator effect of nifedipine
is pronounced in vessels with high vasoconstrictor tone without
diminishing cardiac output. Nifedipine is effective in postpartum control of blood pressure among women with eclampsia [2].
Both the American Congress of Obstetricians and Gynecologists
[3,4] and the Royal College of Obstetricians and Gynecologists [5] recommend the use of magnesium sulfate for treatment of eclampsia,
and good results have been obtained with its use [6]. Management
of affected patients in the intensive care unit (ICU) is strongly recommended by all centers.
The aim of the present study was to evaluate the current protocol
used for management of women with eclampsia in a women's health
0020-7292/$ see front matter 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.
doi:10.1016/j.ijgo.2011.10.018
D.E.M. Abd El Aal, A.Y. Shahin / International Journal of Gynecology and Obstetrics 116 (2012) 232236
233
Age, y
Mean SD
25.1 6.4
Range
1645
Parity
Mean SD
1.7 2.3
Range
09
Duration of pregnancy, wk
Mean SD
37.1 2.8
Range
3640
a
Signicant at P b 0.05.
25.5 6.8
1845
23.5 6.0
1835
25.0 6.3
1745
2.0 2.5
08
1.0 2.2
06
1.6 2.3
09
37.8 2.6
3540
36.6 3.4
3539
39 2.2
3641
234
D.E.M. Abd El Aal, A.Y. Shahin / International Journal of Gynecology and Obstetrics 116 (2012) 232236
Table 2
Changes in blood pressure after use of nifedipine among the different groups of
patients.
Group
Prepartum eclampsia
(n = 1594)
Intrapartum eclampsia
(n = 75)
Intercurrent eclampsia
(n = 16)
Postpartum eclampsia
(n = 313)
a
Before
After
163.2 22.2
140.2 14.2
113.8 14.9
Before
After
96 9.8
168.5 20.2
139.1 12.3
114.2 13.7
95.2 9.5
157.2 20.4
142.7 11.9
117.3 10.1
95 4.7
165.1 21.4
140.5 15.9
113.1 14.2
96.5 9.8
Signicant at P b 0.0001.
Survived
Died
Morbidity
a
Prepartum
eclampsia
(n = 1594)
Intrapartum
eclampsia
(n = 75)
Intercurrent
eclampsia
(n = 16)
Postpartum
eclampsia
(n = 313)
1543 (96.9)
51 (3.1)
324 (20.3)
71 (94.7)
4 (5.3)
15 (20.0)
16 (100.0)
0 (0.0)
2 (12.5)
289 (92.3)
24 (7.7)
98 (31.3)
Table 4
Liver function tests among the different groups of patients.a
Bilirubin, mg/mL
b1
12
>2
SGOT, U/mL
20
>20
SGPT, U/mL
16
>16
Prepartum
eclampsia
(n = 1594)
Intrapartum
eclampsia
(n = 75)
Intercurrent
eclampsia
(n = 16)
Postpartum
eclampsia
(n = 313)
513 (32.2)
972 (61.0)
109 (6.8)
46 (61.3)
20 (26.7)
9 (12.0)
9 (56.3)
6 (37.5)
1 (6.2)
229 (73.2)
68 (21.7)
16 (5.1)
821 (51.5)
773 (48.5)
34 (45.3)
41 (54.7)
9 (56.3)
7 (43.7)
162 (51.8)
151 (48.2)
834(52.3)
760 (47.7)
29 (38.7)
46 (61.3)
9 (56.3)
7 (43.7)
176 (56.2)
137 (43.8)
Table 5
Kidney function tests among the different groups of patients.a
Prepartum
eclampsia
(n = 1594)
Blood urea, mg/dL
b25
972
>25
622
Serum creatinine, mg/dL
1.4
954
>1.4
640
Serum uric acid, mg/dL
6
1083
>6
511
Creatinine clearance, mL/min
100
1076
>100
518
a
Intrapartum
eclampsia
(n = 75)
Intercurrent
eclampsia
(n = 16)
Postpartum
eclampsia
(n = 313)
(61.0)
(39.0)
19 (25.4)
56 (74.6)
7 (43.8)
9 (56.2)
176 (56.2)
137 (43.8)
(59.8)
(41.2)
24 (32.0)
51 (68.0)
7 (43.8)
9 (56.2)
170 (54.3)
139 (45.7)
(67.9)
(32.1)
30 (40.0)
45 (60.0)
6 (37.5)
10 (62.5)
187 (59.7)
126 (40.3)
(67.5)
(32.5)
35 (46.7)
40 (53.3)
7 (43.8)
9 (56.2)
193 (60.7)
120 (39.3)
D.E.M. Abd El Aal, A.Y. Shahin / International Journal of Gynecology and Obstetrics 116 (2012) 232236
Table 6
Changes in arterial blood gases and acidbase status among all patients.a
Time at sample taking
pH
PaCO2, mm Hg
PaO2, mm Hg
Base E
Bicarbonate
O2 saturation
Table 8
Fetal outcome among the different groups of patients.a
T + 30 min
7.34 0.01
33.70 0.61
116.20 6.30
1.81 2.04
18.90 0.34
97.47 0.33
7.37 0.30
31.60 0.56
106.90 4.70
1.85 1.32
20.30 1.40
97.54 0.25
T + 24 h
c
e
7.41 0.01
31.10 0.46
98.10 3.50
0.56 1.50
21.20 1.16
97.58 0.27
d
c
7.41 0.01
30.30 0.49
96.30 2.10
1.75 1.44
17.80 0.28
97.65 0.35
d
c
e
Table 7
Mode of delivery among the different groups of patients.a
Mode of delivery
Prepartum
eclampsia
(n = 1594)
Intrapartum
eclampsia
(n = 75)
Intercurrent
eclampsia
(n = 16)
Postpartum
eclampsia
(n = 313)
Vaginal delivery
Cesarean delivery
109 (6.8)
1485 (93.2)
35 (46.7)
40 (53.3)
6 (37.5)
10 (62.5)
295 (94.2)
18 (5.8)
Prepartum
eclampsia
(n = 1594)
Intrapartum
eclampsia
(n = 75)
Intercurrent
eclampsia
(n = 16)
Postpartum
eclampsia
(n = 313)
Survived
Died
Apgar score at 1 minute
03
37
710
Apgar score at 5 minutes
03
37
71
1496 (93.5)
98 (6.5)
66 (88)
9 (12)
15 (93.8)
1 (6.2)
289 (92.3)
24 (7.7)
4 (6.1)
11 (16.7)
51 (77.2)
1 (6.6)
3 (20)
11 (73.4)
NA
NA
NA
0 (0)
2 (3)
64 (97)
0 (0)
0 (0)
15 (100)
NA
NA
NA
Fetal outcome
T + 48 h
c
235
184 (12.4)
492 (32.8)
820 (54.8)
3 (0.2)
106 (7.1)
1359 (90.8)
236
D.E.M. Abd El Aal, A.Y. Shahin / International Journal of Gynecology and Obstetrics 116 (2012) 232236
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