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

摘要

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