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      Eclampsia in Rural Nigeria: The Unmitigating Catastrophe

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          Abstract

          Introduction:

          Eclampsia is one of the most dreaded causes of adverse outcomes of pregnancy worldwide. It is one of the greatest causes of maternal and perinatal morbidity and mortality world over. We do not know the prevalence, management outcome, and the devastation caused by this dreaded disease in our center hence the need for this work.

          Materials and Methods:

          This is a 7-year retrospective review of all cases of eclampsia managed in Mater Misericordiae Hospital Afikpo, a rural secondary cum referral Catholic Mission Hospital in Afikpo, Ebonyi State in Southeastern Nigeria.

          Results:

          The prevalence of eclampsia in our center is 1.12% or one case of eclampsia for every 89 women that delivered in our facility. The majority of the women that had eclampsia in our center 56 (71.8%) were primigravidae. Seventeen women (21.8%) had various antenatal complications with 4 or 23.6% presenting with intrauterine fetal deaths and two (11.8%) each with intrauterine growth restriction, and domestic violence, respectively. Thirty-five or 44.9% of the women were delivered by emergency lower segment cesarean section. Fifteen or 17.9% babies were dead giving a perinatal mortality rate of 174 per 1,000After delivery, and 3 (3.8%) of the women had postpartum hemorrhage. Two women (2.6%) died giving a maternal mortality ratio of 2564 per 100,000 deliveries.

          Conclusion:

          Eclampsia is a dreaded obstetric disease with adverse fetal and maternal consequences that are not mitigating, and no effort should be spared in managing it effectively including public enlightenment.

          Résumé

          Introduction:

          L’éclampsie est l’une des causes les plus redoutées des effets néfastes de la grossesse dans le monde entier. C’est l’une des principales causes de morbidité et de mortalité maternelle et périnatale dans le monde entier. Nous ne connaissons pas la prévalence, les résultats de la gestion et la dévastation causée par cette maladie redoutée dans notre centre, donc le besoin de ce travail.

          Matériaux et méthodes:

          une revue rétrospective de 7 ans de tous les cas d’éclampsie administrés dans l’hôpital Mater Misericordiae, Afikpo, un hôpital de mission catholique secondaire secondaire secondaire à Afikpo, État d’Ebonyi dans le sud-est du Nigéria.

          Résultats:

          La prévalence de l’éclampsie dans notre centre est de 1,12% ou d’un cas d’éclampsie pour les 89 femmes qui ont été livrées dans notre établissement. La majorité des femmes ayant eu une eclampsie dans notre centre 56 (71,8%) étaient des primigraphères. Dix-sept femmes (21,8%) ont eu diverses complications prénatales avec 4 ou 23,6% présentant des décès fœtus intra-utérins et deux (11,8%) chacune avec une restriction de croissance intra-utérine et une violence domestique, respectivement. Trente-cinq ou 44,9% des femmes ont été livrées par une césarienne de segment inférieur d’urgence. Quinze ou 17,9% de bébés étaient morts, ce qui donnait un taux de mortalité périnatale de 174 par 1000 après l’accouchement, et 3 (3,8%) des femmes avaient une hémorragie post-partum. Deux femmes (2,6%) sont mortes, ce qui donne un taux de mortalité maternelle de 2564 pour 100 000 accouchements.

          Conclusion:

          L’éclampsie est une maladie obstétrique redoutable avec des conséquences défavorables de la foetus et de la mère qui ne sont pas atténuantes, et aucun effort ne devrait être épargné pour la gérer efficacement, y compris l’illumination du public.

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          Most cited references30

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          Risk Factors of Pre-Eclampsia/Eclampsia and Its Adverse Outcomes in Low- and Middle-Income Countries: A WHO Secondary Analysis

          Background Pre-eclampsia has an immense adverse impact on maternal and perinatal health especially in low- and middle-income settings. We aimed to estimate the associations between pre-eclampsia/eclampsia and its risk factors, and adverse maternal and perinatal outcomes. Methods We performed a secondary analysis of the WHO Global Survey on Maternal and Perinatal Health. The survey was a multi-country, facility-based cross-sectional study. A global sample consisting of 24 countries from three regions and 373 health facilities was obtained via a stratified multi-stage cluster sampling design. Maternal and offspring data were extracted from records using standardized questionnaires. Multi-level logistic regression modelling was conducted with random effects at the individual, facility and country levels. Results Data for 276,388 mothers and their infants was analysed. The prevalence of pre-eclampsia/eclampsia in the study population was 10,754 (4%). At the individual level, sociodemographic characteristics of maternal age ≥30 years and low educational attainment were significantly associated with higher risk of pre-eclampsia/eclampsia. As for clinical and obstetric variables, high body mass index (BMI), nulliparity (AOR: 2.04; 95%CI 1.92–2.16), absence of antenatal care (AOR: 1.41; 95%CI 1.26–1.57), chronic hypertension (AOR: 7.75; 95%CI 6.77–8.87), gestational diabetes (AOR: 2.00; 95%CI 1.63–2.45), cardiac or renal disease (AOR: 2.38; 95%CI 1.86–3.05), pyelonephritis or urinary tract infection (AOR: 1.13; 95%CI 1.03–1.24) and severe anemia (AOR: 2.98; 95%CI 2.47–3.61) were found to be significant risk factors, while having >8 visits of antenatal care was protective (AOR: 0.90; 95%CI 0.83–0.98). Pre-eclampsia/eclampsia was found to be a significant risk factor for maternal death, perinatal death, preterm birth and low birthweight. Conclusion Chronic hypertension, obesity and severe anemia were the highest risk factors of preeclampsia/eclampsia. Implementation of effective interventions prioritizing risk factors, provision of quality health services during pre-pregnancy and during pregnancy for joint efforts in the areas of maternal health are recommended.
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            Global burden of maternal death and disability.

            Sound information is the prerequisite for health action: without data on the dimensions, impact and significance of a health problem it is neither possible to create an advocacy case nor to establish strong programmes for addressing it. The absence of good information on the extent of the burden of maternal ill-health resulted in its relative neglect by the international health community for many years. Maternal deaths are too often solitary and hidden events that go uncounted. The difficulty arises not because of lack of clarity regarding the definition of a maternal death, but because of the weakness of health information systems and consequent absence of the systematic identification and recording of maternal deaths. In recent years, innovative approaches to measuring maternal mortality have been developed, resulting in a stronger information base. WHO, UNICEF and UNFPA estimates for the year 2000 indicate that most of the total 529,000 maternal deaths globally occur in just 13 countries. By contrast, information on the global burden of non-fatal health outcomes associated with pregnancy and childbearing remains patchy and incomplete. Nonetheless, initial estimates based on systematic reviews of available information and confined to the five major direct pregnancy-related complications indicate a problem of considerable magnitude.
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              Hypertensive Disorders of Pregnancy: A Systematic Review of International Clinical Practice Guidelines

              Background Clinical practice guidelines (CPGs) are developed to assist health care providers in decision-making. We systematically reviewed existing CPGs on the HDPs (hypertensive disorders of pregnancy) to inform clinical practice. Methodology & Principal Findings MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register, Health Technology Assessments, and Database of Abstracts of Reviews of Effects (Ovid interface), Grey Matters, Google Scholar, and personal records were searched for CPGs on the HDPs (Jan/03 to Nov/13) in English, French, Dutch, or German. Of 13 CPGs identified, three were multinational and three developed for community/midwifery use. Length varied from 3–1188 pages and three guidelines did not formulate recommendations. Eight different grading systems were identified for assessing evidence quality and recommendation strength. No guideline scored ≧80% on every domain of the AGREE II, a tool for assessing guideline methodological quality; two CPGs did so for 5/6 domains. Consistency was seen for (i) definitions of hypertension, proteinuria, chronic and gestational hypertension; (ii) pre-eclampsia prevention for women at increased risk: calcium when intake is low and low-dose aspirin, but not vitamins C and E or diuretics; (iii) antihypertensive treatment of severe hypertension; (iv) MgSO4 for eclampsia and severe pre-eclampsia; (v) antenatal corticosteroids at <34 wks when delivery is probable within 7 days; (vi) delivery for women with severe pre-eclampsia pre-viability or pre-eclampsia at term; and (vii) active management of the third stage of labour with oxytocin. Notable inconsistencies were in: (i) definitions of pre-eclampsia and severe pre-eclampsia; (ii) target BP for non-severe hypertension; (iii) timing of delivery for women with pre-eclampsia and severe pre-eclampsia; (iv) MgSO4 for non-severe pre-eclampsia, and (v) postpartum maternal monitoring. Conclusions Existing international HDP CPGs have areas of consistency with which clinicians and researchers can work to develop auditable standards, and areas of inconsistency that should be addressed by future research.
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                Author and article information

                Journal
                Ann Afr Med
                Ann Afr Med
                AAM
                Annals of African Medicine
                Medknow Publications & Media Pvt Ltd (India )
                1596-3519
                0975-5764
                Oct-Dec 2017
                : 16
                : 4
                : 175-180
                Affiliations
                [1]Department of Obstetrics and Gynaecology, Federal Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
                [1 ]Department of Obstetrics and Gynaecology, Abia State University Teaching Hospital, Aba, Abia State, Nigeria
                [2 ]Mile 4 Maternity Hospital, Abakaliki, Ebonyi State, Nigeria
                Author notes
                Address for correspondence: Dr. Chidi Ochu Uzoma Esike, Department of Obstetrics and Gynecology, Federal Teaching Hospital, Abakaliki, Ebonyi State, Nigeria. E-mail: drchidiesike@ 123456yahoo.com
                Article
                AAM-16-175
                10.4103/aam.aam_46_16
                5676407
                29063901
                502a1f26-7fe8-42e0-ac42-86cedb1430f4
                Copyright: © 2017 Annals of African Medicine

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

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                Original Article

                eclampsia,rural nigeria,unmitigating catastrophe,éclampsie,nigeria rurale,catastrophe sans compromis

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