Feto-maternal Outcomes in Cesarean Section Compared to Vaginal Delivery in Eclamptic Patients in a Tertiary Level Hospital

Abstract

Background: Over  half-a-million women die each year  from pregnancy-related  causes, and  99 percent of these occur in developing countries. In Bangladesh though maternal mortality  rate (MMR) declined  significantly  around 40% in  the  past  decade,  still  eclampsia  accounts  for 20% of maternal deaths. Eclampsia is uniquely a disease of pregnancy, and the only cure  is  delivery  regardless  of  gestational  age.  A  rational  therapy  for  general  management  of  hypertension and convulsion has been established in Bangladesh by the Eclampsia Working  Group.  But  controversy  still  exists  regarding  obstetric  management.

Objective: To  evaluate  the  feto-maternal  outcome  in  cesarean  section  compared  to  vaginal  delivery  in  eclamptic  patients.

Materials  and  Methods: This  prospective  cohort  study  was  conducted  in  the  department of Obstretics & Gynecology, Dhaka Medical College & Hospital (DMCH), from  January to December 2011. A total 100 eclamptic women with term pregnancy and live foetus  were purposively included in the study (Group I, 50 patients with vaginal delivery and Group  II, 50 with cesarean section).

Results: Out  of these 100 patients 56% were aged <20 years,  71%  were  primigravida  and  77%  were  from  low  socioeconomic  status.  Sixteen  percent  patients from vaginal delivery group and 18% from cesarean section group had no antenatal  care. The mean gestational age was about 38 weeks in two groups. No significant difference  was found between the two groups regarding blood pressure, proteinuria, consciousness level  and convulsion. Recurrence of convulsion occurred in 30% patients of vaginal delivery group  compared  to  6%  in  cesarean  section  group.  Maternal  complications  such  as  postpartum  hemorrhage,  cerebrovascular  accident,  renal  failure,  obstetric  shock  and  abruptio  placenta  were  higher  among  vaginal  delivery  group  patients  (46%)  than  cesarean  section  patients  (16%).  Maternal  mortality  was 6% in  the  vaginal  delivery  group  and  none  in  the  cesarean  section  group.  Regarding  fetal  outcome,  stillbirth  was  20%  after  vaginal  delivery  and  6%  after cesarean section,  the result was statistically  significant.  Birth asphyxia was less  in  the  cesarean  section  group  (23.4%)  than  in  vaginal  delivery  group  (60%)  and  this  was  statistically  significant.

Conclusions:  The  result  of  the  present  study  shows  a  better  feto- maternal outcome in the cesarean section group than in the vaginal delivery group.

Journal of Enam Medical College; Vol 3 No 2 July 2013; Page 77-83

DOI: http://dx.doi.org/10.3329/jemc.v3i2.16128