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\def\makelabel##1{\upshape ##1}}% } {\end{list}\end{raggedright}} \newenvironment{specHead}[2]% {\vspace{20pt}\hrule\vspace{10pt}% \phantomsection\label{#1}\markright{#2}% \pdfbookmark[2]{#2}{#1}% \hspace{-0.75in}{\bfseries\fontsize{16pt}{18pt}\selectfont#2}% }{} \def\TheFullDate{2017-01-15 (revised: 15 January 2017)} \def\TheID{\makeatother } \def\TheDate{2017-01-15} \title{Incidence and Fetomaternal Outcome of Eclampsia in a Tertiary Medical College Hospital in Bangladesh} \author{}\makeatletter \makeatletter \newcommand*{\cleartoleftpage}{% \clearpage \if@twoside \ifodd\c@page \hbox{}\newpage \if@twocolumn \hbox{}\newpage \fi \fi \fi } \makeatother \makeatletter \thispagestyle{empty} \markright{\@title}\markboth{\@title}{\@author} \renewcommand\small{\@setfontsize\small{9pt}{11pt}\abovedisplayskip 8.5\p@ plus3\p@ minus4\p@ \belowdisplayskip \abovedisplayskip \abovedisplayshortskip \z@ plus2\p@ \belowdisplayshortskip 4\p@ plus2\p@ minus2\p@ \def\@listi{\leftmargin\leftmargini \topsep 2\p@ plus1\p@ minus1\p@ \parsep 2\p@ plus\p@ minus\p@ \itemsep 1pt} } \makeatother \fvset{frame=single,numberblanklines=false,xleftmargin=5mm,xrightmargin=5mm} \fancyhf{} \setlength{\headheight}{14pt} \fancyhead[LE]{\bfseries\leftmark} \fancyhead[RO]{\bfseries\rightmark} \fancyfoot[RO]{} \fancyfoot[CO]{\thepage} \fancyfoot[LO]{\TheID} \fancyfoot[LE]{} \fancyfoot[CE]{\thepage} \fancyfoot[RE]{\TheID} \hypersetup{citebordercolor=0.75 0.75 0.75,linkbordercolor=0.75 0.75 0.75,urlbordercolor=0.75 0.75 0.75,bookmarksnumbered=true} \fancypagestyle{plain}{\fancyhead{}\renewcommand{\headrulewidth}{0pt}} \date{} \usepackage{authblk} \providecommand{\keywords}[1] { \footnotesize \textbf{\textit{Index terms---}} #1 } \usepackage{graphicx,xcolor} \definecolor{GJBlue}{HTML}{273B81} \definecolor{GJLightBlue}{HTML}{0A9DD9} \definecolor{GJMediumGrey}{HTML}{6D6E70} \definecolor{GJLightGrey}{HTML}{929497} \renewenvironment{abstract}{% \setlength{\parindent}{0pt}\raggedright \textcolor{GJMediumGrey}{\rule{\textwidth}{2pt}} \vskip16pt \textcolor{GJBlue}{\large\bfseries\abstractname\space} }{% \vskip8pt \textcolor{GJMediumGrey}{\rule{\textwidth}{2pt}} \vskip16pt } \usepackage[absolute,overlay]{textpos} \makeatother \usepackage{lineno} \linenumbers \begin{document} \author[1]{Kamrun Nessa} \author[2]{Kamrun Nessa} \affil[1]{ } \renewcommand\Authands{ and } \date{\small \em Received: 9 December 2016 Accepted: 1 January 2017 Published: 15 January 2017} \maketitle \begin{abstract} Background: In day to day obstetric practice, the incidence of eclampsia and its complication is high. It is one of the leading causes of maternal mortality in Bangladesh accounting about 20%. This is also associated with poor perinatal outcome.Objectives: To determine the incidence of eclampsia and associated feto-maternal outcome. Materials and Methods:A retrospective study was conducted on the diagnosed patients of eclampsia admitted in Enam Medical College and hospital, Dhaka, Bangladesh, during the period of January 2015 to December 2016. During these years total 2295 patients were admitted in obstetrics unit among them 35 patient were admitted with eclampsia. Analysis done regarding age of women, parity, type of eclampsia, gestational age of delivery, mode of delivery, maternal and fetal outcome. Patients with convulsion and or coma due to other causes were excluded. Study was ethically approved by Ethical Review committee of Enam Medical College and Hospital. All data were entered in SPSS16 and also analyzed through it. \end{abstract} \keywords{eclampsia, perinatal death, preterm delivery.} \begin{textblock*}{18cm}(1cm,1cm) % {block width} (coords) \textcolor{GJBlue}{\LARGE Global Journals \LaTeX\ JournalKaleidoscope\texttrademark} \end{textblock*} \begin{textblock*}{18cm}(1.4cm,1.5cm) % {block width} (coords) \textcolor{GJBlue}{\footnotesize \\ Artificial Intelligence formulated this projection for compatibility purposes from the original article published at Global Journals. However, this technology is currently in beta. \emph{Therefore, kindly ignore odd layouts, missed formulae, text, tables, or figures.}} \end{textblock*} \let\tabcellsep& \section[{Incidence and Fetomaternal Outcome of Eclampsia in a Tertiary Medical College Hospital in Bangladesh}]{Incidence and Fetomaternal Outcome of Eclampsia in a Tertiary Medical College Hospital in Bangladesh}\par Kamrun Nessa ? , Sanjida khan ? , Selina Begum ? , Ferdowsi Sultana ? \& Tania Akbar ¥ Abstract-Background: In day to day obstetric practice, the incidence of eclampsia and its complication is high. It is one of the leading causes of maternal mortality in Bangladesh accounting about 20\%. This is also associated with poor perinatal outcome.\par Objectives: To determine the incidence of eclampsia and associated feto-maternal outcome. Keywords: eclampsia, perinatal death, preterm delivery. \section[{Materials and Methods}]{Materials and Methods} \section[{I. Introduction}]{I. Introduction}\par ow a days Eclampsia is one of the leading cause of maternal and perinatal mortality as well as morbidity throughout the world \hyperref[b0]{1,}\hyperref[b1]{2} . Pre-eclampsia when complicated with generalized tonic-clonic convulsions and/or coma is called eclampsia \hyperref[b2]{3} . Since eclampsia is a severe form of pre-eclampsia, early detection of risk factors, symptoms and signs by good antenatal checkup and initiation therapy will prevent occurrence of eclampsia. Unfortunately, eclampsia still complicates much larger number of pregnancies in the world. It is estimated that every year eclampsia is associated with about 50, 000 maternal death worldwide, most of which occur in developing countries \hyperref[b3]{4} . The incidence of eclampsia has been reduced to. 2\%-.5 \% of all deliveries in developed countries. But in Bangladesh about 5\% of the total pregnancies develop eclampsia \hyperref[b4]{5} . There are approximately 3.6 million births per year in Bangladesh and over 10,000 women develop eclampsia each year \hyperref[b5]{6} . It is one of the common cause of maternal mortality and responsible for 20\% of maternal death \hyperref[b6]{7} . Incidence of eclampsia varies inversely with the quality of antenatal care. \section[{II. Methodology}]{II. Methodology}\par This retrospective study was conducted on the diagnosed patients of eclampsia admitted in Enam medical college hospital, Savar, Dhaka, Bangladesh, during the period of January 2015 to December 2016. During these months total 2295 patients were admitted in obstetric ward and among them 35 patients were eclampsia. Age of patients, parity, type of eclampsia, gestational age, mode of delivery, maternal and fetal outcome were noted from medical records of patients. Patients with diagnosis of convulsion and coma of other causes were excluded.\par All patients of eclampsia were followed up thoroughly from admission to discharge. Study was ethically approved by Ethical Review committee of Enam Medical College and Hospital. All data were entered in SPSS16 and also analyzed through it. 35 cases of eclampsia were recorded out of 2295 obstetric patients admitted during the study period which gives an incidence of 1.52\%. 19(54.28\%) cases were in between age of 21 to 30 years, while 12(34.28\%) were less than 21 years and 4(11.42\%) were more than 30 years as illustrated in Table \hyperref[tab_1]{1}. Majority (60\%) were nulliparous, while 40\% were multiparous which is shown in Fig \hyperref[fig_1]{1}. Table {\ref 2}: Distribution of study subjects according to fetal outcome \section[{IV. Discussion}]{IV. Discussion}\par Antepartum eclampsia accounted for 42.85\% in this study is higher than 36.8\% reported in Lagos but lower than 61.6\%,84\% and 85\% reported in Ethiopia, Enugu and Ibadan respectively \hyperref[b11]{11,}\hyperref[b13]{[13]}\hyperref[b14]{[14]}\hyperref[b15]{[15]} . In our study post partum eclampsia was more common, about 57.14\% which correlate with another study on similar topic \hyperref[b16]{16} .\par The majority of antepartum cases in our study had eclampsia before term and caesarean section was a leading mode of delivery, which is comparable to other studies \hyperref[b17]{17,}\hyperref[b18]{18} . In this study patients underwent caesarean section due to an unfavourable cervix remote from delivery, but the decision to perform a caesarean delivery was based on multiple factors which included gestational age, foetal condition, stage of labour and Bishop scoring of cervix \hyperref[b19]{19} .\par Maternal mortality rate of 8.57\% reported in this study was higher than 7.9\%, 8\% and 9\% reported respectively from Tanzania, India and Ibadan, Nigeria \hyperref[b14]{14,}\hyperref[b24]{20,} {\ref 21} .\par Hypertensive disorders are a common cause of preterm labour, perinatal death and intrauterine growth restriction \hyperref[b20]{22} . The 20\% perinatal mortality rate in this study is higher than 10\% reported from Ibadan, but lower than 29\% and 40.9\% reported from Ethiopia and Kaduna, Nigeria respevtively \hyperref[b21]{23,}\hyperref[b14]{14,}\hyperref[b22]{24} . A significant percentage (37.14\%) of low birth weight neonates might have been the result of the high number of preterm deliveries among the eclamptic patients. Similar findings have been reported in the literature that links the incidence of low birth weight infants with preterm deliveries in eclamptic patients \hyperref[b17]{17,}\hyperref[b23]{25,} {\ref 26} . \section[{V. Conclusion}]{V. Conclusion}\par The incidence of eclampsia remains high in our hospital. Fetomaternal morbidity and mortality are in alarming rate. Hence, eclampsia remains a continuing problem in developing countries and leading cause of fetal-maternal mortality and morbidity. Careful antenatal supervision, early detection and management of high risk cases can reduce this dreadful disease. After meticulous treatment 18(51.42\%) patients improved in eclampsia ward, while 14 (40\%) patients needed ICU support and 3(8.57\%) died. Among the babies only 6(17.14\%) were term and healthy. Most (37.14\%) of the babies were preterm low birth weight, 9 (25.71\%) were IUGR and 7 (20\%) were perinatal death which is shown in Fig 5 {\ref and Table 2}. \section[{Global}]{Global}\par The incidence of eclampsia in our hospital was 1.52\% of total obstetric admission.. Onuh in Benin Nigeria reported 1.32\% and Okafor recently reported an incidence of 0.82\% in Abujia, Nigeria \hyperref[b7]{8} . A high incidence of eclampsia is common in developing countries where most patients have no antenatal care which would allow for early recognition and treatment of eclampsia. Majority of the patients were between age 21 to 30 years in this study which is contrary to the report in the developed world where severe preeclampsia with severe features and eclampsia is significantly commoner among women older than 40 years \hyperref[b8]{9} . Nulliparity strongly associated with eclampsia in this study is supported by previous reports in other centres \hyperref[b10]{[10]}\hyperref[b11]{[11]}\hyperref[b12]{[12]} \begin{figure}[htbp] \noindent\textbf{1}\includegraphics[]{image-2.png} \caption{\label{fig_1}Fig. 1 :}\end{figure} \begin{figure}[htbp] \noindent\textbf{2345}\includegraphics[]{image-3.png} \caption{\label{fig_2}Fig. 2 :Fig. 3 :Fig. 4 :Fig. 5 :}\end{figure} \begin{figure}[htbp] \noindent\textbf{}\includegraphics[]{image-4.png} \caption{\label{fig_3}E}\end{figure} \begin{figure}[htbp] \noindent\textbf{1} \par \begin{longtable}{P{0.4138157894736842\textwidth}P{0.15657894736842104\textwidth}P{0.27960526315789475\textwidth}} Age\tabcellsep Frequency\tabcellsep Percentage\\ < 21 Years\tabcellsep 12\tabcellsep 34.28\\ 21 to 30 years\tabcellsep 19\tabcellsep 54.28\\ > 30 years\tabcellsep 4\tabcellsep 11.42\end{longtable} \par \caption{\label{tab_1}Table 1 :}\end{figure} \begin{figure}[htbp] \noindent\textbf{} \par \begin{longtable}{P{0.85\textwidth}} Volume XVII Issue II Version I\\ D D D D ) E\\ (\\ Medical Research\\ Global Journal of\end{longtable} \par \caption{\label{tab_2}}\end{figure} \footnote{© 2017 Global Journals Inc. (US)} \footnote{© 2017 Global Journals Inc. (US)Year 2017} \backmatter \begin{bibitemlist}{1} \bibitem[Okogbenin et al. ()]{b8}\label{b8} \textit{}, S A Okogbenin , J O Eigbefoh , F Omorogbe , F Okogbo , P I Okonto , A G Ohihoin . 2010. \bibitem[Sibai ()]{b18}\label{b18} ‘Diagnosis, prevention and management of eclampsia’. B M Sibai . \xref{http://dx.doi.org/10.1097/01.AOG.0000152351.13671.99}{10.1097/01.AOG.0000152351.13671.99}. \textit{Obstet Gynaecol} 2005. 105 (2) p. . \bibitem[Onwuhafua et al. ()]{b20}\label{b20} ‘Eclampsi in Kaduna state of Nigeria. A proposal for better outcome’. P I Onwuhafua , A Onwuhafua , J Adze , Z Mairami . \textit{Niger J Med} 2001. 10 (2) p. . \bibitem[Urassa et al. ()]{b22}\label{b22} ‘Eclampsia in Dar es Salaam, Tanzania-incidence, outcome, and the role ofantenatal care’. 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