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BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2015

Open Access 01-12-2015 | Research article

Characteristics and outcomes of patients with eclampsia and severe pre-eclampsia in a rural hospital in Western Tanzania: a retrospective medical record study

Authors: Rob Mooij, Joseph Lugumila, Masumbuko Y. Mwashambwa, Ipyana H. Mwampagatwa, Jeroen van Dillen, Jelle Stekelenburg

Published in: BMC Pregnancy and Childbirth | Issue 1/2015

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Abstract

Background

Eclampsia and pre-eclampsia are well-recognized causes of maternal and neonatal mortality in low income countries, but are never studied in a district hospital. In order to get reliable data to facilitate the hospital’s obstetric audit a retrospective medical record study was performed in Ndala Hospital, Tanzania.

Methods

All patients diagnosed with severe pre-eclampsia or eclampsia between July 2011 and December 2012 were included. Medical records were searched immediately following discharge or death. General patient characteristics, medical history, obstetrical history, possible risk factors, information about the current pregnancy, antenatal clinic attendance and prescribed therapy before admission were recorded. Symptoms and complications were noted. Statistical analysis was done with Epi Info®.

Results

Of the 3398 women who gave birth in the hospital 26 cases of severe pre-eclampsia and 55 cases of eclampsia were diagnosed (0.8 and 1.6 %). Six women with eclampsia died (case fatality rate 11 %). Convulsions in patients with eclampsia were classified as antepartum (44 %), intrapartum (42 %) and postpartum (15 %). Magnesium was given in 100 % of patients with eclampsia and was effective in controlling convulsions. Intravenous antihypertensive treatment was only started in 5 % of patients. Induction of labour was done in 29 patients (78 % of women who were not yet in labour). Delivery was spontaneous in 67 %, assisted vaginal (ventouse) in 14 % and by Caesarean section in 19 % of women. Perinatal deaths occurred in 30 % of women with eclampsia and 27 % of women with severe pre-eclampsia and were associated with low birth weight and prolonged time between admission and birth.

Conclusions

2.4 % of women were diagnosed with severe pre-eclampsia or eclampsia. The case fatality rate and overall perinatal mortality were comparable to other reports. Better outcomes could be achieved by better treatment of hypertension and starting induction of labour as soon as possible.
Literature
1.
2.
Say L, Chou D, Gemmill A, Tunçalp Ö, Moller A-B, Daniels J, et al. Global causes of maternal death: a WHO systematic analysis. The Lancet Global Health. 2014;2(6):e323–33.CrossRefPubMed
3.
Tanzania Demographic and Health Survey 2010. Dar es Salaam, Tanzania and Calverton, Maryland: National Bureau of Statistics (NBS) and ICF Macro; 2011.
4.
Zwart JJ, Richters A, Ory F, de Vries JI, Bloemenkamp KW, van Roosmalen J. Eclampsia in the Netherlands. Obstet Gynecol. 2008;112(4):820–7.CrossRefPubMed
5.
6.
Urassa DP, Carlstedt A, Nyström L, Massawe SN, Lindmark G. Eclampsia in Dar es Salaam, Tanzania—incidence, outcome, and the role of antenatal care. Acta Obstet Gynecol Scand. 2006;85(5):571–8.CrossRefPubMed
7.
Ndaboine EM, Kihunrwa A, Rumanyika R, Im HB, Massinde AN. Maternal and perinatal outcomes among eclamptic patients admitted to Bugando Medical Centre, Mwanza, Tanzania. Afr J Reprod Health. 2012;16(1):35–41.PubMed
8.
Altman D, Carroli G, Duley L, Farrell B, Moodley J, Neilson J, et al. Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial: a randomised placebo-controlled trial. Lancet. 2002;359(9321):1877–90.CrossRefPubMed
9.
Zwart JJ, Richters JM, Öry F, de Vries JIP, Bloemenkamp KWM, van Roosmalen J. Severe maternal morbidity during pregnancy, delivery and puerperium in the Netherlands: a nationwide population-based study of 371 000 pregnancies. BJOG. 2008;115(7):842–50.CrossRefPubMed
10.
Ghulmiyyah L, Sibai B. Maternal mortality from preeclampsia/eclampsia. Semin Perinatol. 2012;36(1):56–9.CrossRefPubMed
11.
van Dillen J, Mesman JA, Zwart JJ, Bloemenkamp KW, van Roosmalen J. Introducing maternal morbidity audit in the Netherlands. BJOG. 2010;117(4):416–21.CrossRefPubMed
12.
van Dillen J, Stekelenburg J, Schutte J, Walraven G, van Roosmalen J. The use of audit to identify maternal mortality in different settings: is it just a difference between the rich and the poor? World Health Popul. 2007;9(1):5–13.CrossRefPubMed
13.
Kidanto H, Wangwe P, Kilewo CD, Nystrom L, Lindmark G. Improved quality of management of eclampsia patients through criteria based audit at Muhimbili National Hospital, Dar es Salaam, Tanzania. Bridging the quality gap. BMC Pregnancy Childbirth. 2012;12(1):134.CrossRefPubMedPubMedCentral
14.
van den Akker T, van Rhenen J, Mwagomba B, Lommerse K, Vinkhumbo S, van Roosmalen J. Reduction of severe acute maternal morbidity and maternal mortality in Thyolo District, Malawi: the impact of obstetric audit. PLoS One. 2011;6(6), e20776.CrossRefPubMedPubMedCentral
15.
Armstrong CE, Lange IL, Magoma M, Ferla C, Filippi V, Ronsmans C. Strengths and weaknesses in the implementation of maternal and perinatal death reviews in Tanzania: perceptions, processes and practice. Trop Med Int Health. 2014;19(9):1087–95.CrossRefPubMed
16.
Manual of basic techniques for a health laboratory. Geneva, Switzerland: World Health Organization; 1980.
17.
ACOG Practice Bulletin. Clinical management guidelines for obstetrician-gynecologists. Number 33, January 2002. Diagnosis and Management of Preeclampsia and Eclampsia. Obstet Gynecol. 2002;199(1):159–67.
18.
Standard treatment guidelines & national medicines list–Tanzania mainland. Dar es Salaam, Tanzania: United Republic of Tanzania–ministry of health and social welfare; 2013.
19.
Shepard MD, Penberthy LA. Performance of quantitative urine analysis in Australasia critically assessed. Clin Chem. 1987;33(6):792–5.PubMed
20.
Manual of basic techniques for a health laboratory, 2nd edn. Geneva, Switzerland: World Health Organization; 2003.
21.
Thornton CE, Makris A, Ogle RF, Tooher JM, Hennessy A. Role of proteinuria in defining pre-eclampsia: clinical outcomes for women and babies. Clin Exp Pharmacol Physiol. 2010;37(4):466–70.CrossRefPubMed
22.
Pregnancy. TACoOaGTFoHi: Hypertension in Pregnancy. Washington. DC: the American College of Obstetricians and Gynaecologists; 2013.
23.
Nyamtema AS, Bartsch-de Jong A, Urassa DP, Hagen JP, van Roosmalen J. The quality of antenatal care in rural Tanzania: what is behind the number of visits? BMC Pregnancy Childbirth. 2012;12:70.CrossRefPubMedPubMedCentral
24.
Magoma M, Requejo J, Campbell OM, Cousens S, Filippi V. High ANC coverage and low skilled attendance in a rural Tanzanian district: a case for implementing a birth plan intervention. BMC Pregnancy Childbirth. 2010;10:13.CrossRefPubMedPubMedCentral
25.
Pfeiffer C, Mwaipopo R. Delivering at home or in a health facility? health-seeking behaviour of women and the role of traditional birth attendants in Tanzania. BMC Pregnancy Childbirth. 2013;13(1):55.CrossRefPubMedPubMedCentral
26.
Mselle LT, Moland KM, Mvungi A, Evjen-Olsen B, Kohi TW. Why give birth in health facility? Users’ and providers’ accounts of poor quality of birth care in Tanzania. BMC Health Serv Res. 2013;13:174.CrossRefPubMedPubMedCentral
27.
Villar J, Ba'aqeel H, Piaggio G, Lumbiganon P, Miguel Belizan J, Farnot U, et al. WHO antenatal care randomised trial for the evaluation of a new model of routine antenatal care. Lancet. 2001;357(9268):1551–64.CrossRefPubMed
28.
Trial ACR. Manual for the implementation of the new model. Geneva, Switzerland: World Health Organization; 2002.
29.
Schaap T, Knight M, Zwart J, Kurinczuk J, Brocklehurst P, van Roosmalen J, et al. Eclampsia, a comparison within the International Network of Obstetric Survey Systems. BJOG. 2014.
30.
Committee Opinion no. 514. Emergent therapy for acute-onset, severe hypertension with preeclampsia or eclampsia. Obstet Gynecol. 2011;118(6):1465–8.CrossRef
31.
Kidanto HL, Kaguta MM, van Roosmalen J. Induction of labor with misoprostol or oxytocin in Tanzania. Int J Gynaecol Obstet. 2007;96(1):30–1.CrossRefPubMed
32.
Muganyizi PS, Shagdara MS. Predictors of extra care among magnesium sulphate treated eclamptic patients at Muhimbili National Hospital, Tanzania. BMC Pregnancy Childbirth. 2011;11:41.CrossRefPubMedPubMedCentral
33.
Adegoke A, Utz B, Msuya SE, van den Broek N. SkilledBirth Attendants: who is who? A descriptive study of definitions and roles from nine Sub Saharan African countries. PLoS One. 2012;7(7), e40220.CrossRefPubMedPubMedCentral
34.
Duysburgh E, Zhang WH, Ye M, Williams A, Massawe S, Sie A, et al. Quality of antenatal and childbirth care in selected rural health facilities in Burkina Faso, Ghana and Tanzania: similar finding. Trop Med Int Health. 2013.
35.
Paxton A, Maine D, Freedman L, Fry D, Lobis S. The evidence for emergency obstetric care. Int J Gynaecol Obstet. 2005;88(2):181–93.CrossRefPubMed
36.
World Health Organization U. UNICEF and AMDD: monitoring emergency obstetric care: a handbook. Geneva, Switzerland: WHO Press; 2009.
37.
Maaloe N, Sorensen BL, Onesmo R, Secher NJ, Bygbjerg IC. Prolonged labour as indication for emergency caesarean section: a quality assurance analysis by criterion-based audit at two Tanzanian rural hospitals. BJOG. 2012;119(5):605–13.CrossRefPubMed
38.
Lobis S, Mbaruku G, Kamwendo F, McAuliffe E, Austin J, de Pinho H. Expected to deliver: alignment of regulation, training, and actual performance of emergency obstetric care providers in Malawi and Tanzania. Int J Gynaecol Obstet. 2011;115(3):322–7.CrossRefPubMed
Metadata
Title
Characteristics and outcomes of patients with eclampsia and severe pre-eclampsia in a rural hospital in Western Tanzania: a retrospective medical record study
Authors
Rob Mooij
Joseph Lugumila
Masumbuko Y. Mwashambwa
Ipyana H. Mwampagatwa
Jeroen van Dillen
Jelle Stekelenburg
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2015
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-015-0649-2

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