Risk Factors Of Eclampsia And The Effect Of Eclampsia On Maternal And Perinatal Outcome

Objective:To investigate the related risk factors and premonitory clinical manifestations of eclampsia,as well as comparative analysis of the adverse outcome in maternal and perinatal. Further in order to recognize the foreboding of eclampsia early,actively to intervene and control, than to prevent the eclampsia and improve the outcomes of mother and child.Methods:The clinical data of 32 patients with eclampsia were analyzed retrospectively,who being treated at the First Affiliated Hospital of Dalian Medical University during January 2004 to December 2014. By using the method of 1:2 matched case-control study,the relevant date of the 32 patients with eclampsia and 64 controls with severe preeclampsia were collected to analyze the related risk factors by conditional logistic regresstion. Statistics and analysis the two groups of patients for general situation,clinical features,laboratory indexes,as well as the outcome in maternal and perinatal.Results:(1) The incidence of patients with eclampsia and the perinatal mortality showed a descending trend basically nearly 11 years in our hospital.(2) Among the patients with eclampsia,the primiparas accounts for 80.4%,of with that of multiparas makes up 19.6%;the antepartum eclampsia accounts for 75%,intrapartum eclampsia3.1%,postpartum eclampsia 12.5%. About 81.25% of the patients who had occurred seizure outside of our hospital for the first time,the 18.76% of the paitients occurred inour hospital. The 12.5% of the eclampsia patients with regular prenatal examination,while 87.5% of the patients withour regular prenatal examination.(3) There are some major premonitory clinical manifestations with eclampsia,among them,the 71.88%patients with dizziness and headache,the 43.75% with nausea and vomiting,31.25%with visual disturbance,31.25% with aggravation of edema,21.88% with elevation of blood pressure,18.75% with epigastric discomfort. The incidence of placental abruption of eclampsia patients is 66.7%,who with the premonitory clinical manifestations of upper abdominal discomfort and blood pressure elevation,that was significantly higher than who without the premonitory clinical manifestations(0%) of upper abdominal discomfort and blood pressure elevation in eclampsia(P < 0.01).(4) The eclampsia attack were taking place on the basis of severe preeclampsia have 11 cases(34.38%),in addition, 8 cases(25%) were taking place on the basis of mild preeclampsia and gestational hypertension, 4 cases(12.5%) without gestational hypertension disease before eclampsia attack.(5) The laboratory Indicators of the eclampsia patients: The patients of eclampsia with PLT<50g/L accounts for 23.5%,serum Albumin(ALB) <30g/L for 78.13%,Lactic Dehydrogenase(LDH) ≥300IU/L for 81.25%. The incidence of HELLP syndrome is 89.47% in eclampsia patients with ALB(<30g/L) and LDH(≥300IU/L),that is obviously higher than the patients with eclampsia whose ALB and LDH is normal(0%),the difference was statistically significant(P<0.01).(6) By using the method of 1:2 matched,the menarche age of eclampsia patients were older than the severe preeclampsia patients(P < 0.05), while the ecalmpsia patients’ time of hospitalization after postpartum were higher than the controls(P<0.05). The LDH of eclampsia patients were higher than the controls(P < 0.05).(7) Results of univariate logistic regression analysis showed that primipara,menarche age is equal or greater than16,the time of found hypertention(≥37 weeks),irregular antenatal care,worsen edema in the short term,without use of magnesium sulfate,sedative and hypotensor were influencing factors of eclampsia(P<0.05). Results of multivariate conditional logistic regression analysis showed that only the prophylactic use of magnesium sulfate was independent factor for eclampsia(P=0.005,OR=153.027). The rate of occurrence andrecurrence of eclampsia were both low,While used the magnesium sulfate and sedatives simultaneously.(8) The eclampsia group appeared HELLP syndrome and cerebral vascular accident were higher than the control group(P<0.05). The eclampsia group of perinatal appeared premature birth was lower than the severe preeclampsia without attack of convulsion group(P<0.05). Appeared the neonatal asphyxia in case group is higher than the controls(P <0.05).(9) The patients without using magnesium sulfate before seizure of eclampsia account for 84.38%,without using sedavite for 93.75%,while the patients of eclampsia who applicated both magnesium sulfate and sedative before seizure of eclampsia account for 6.25%,the rates of recurrence was 3.13%.(10)Among the 24 patients with antepartum eclampsia,only one case reappeared eclampsia attack after termination of the pregnancy.Conclusions:(1) The primipara,menarche age is equal or greater than 16,the time of found hypertention(≥37 weeks),irregular antenatal care,worsen edema in the short term,without using of magnesium sulfate,sedative and hypotensor may the influencing factors of eclampsia.(2) The premonitory clinical manifestations before the onset of attack are easy to be neglected,we should step up our vigilance.(3) The eclampsia patients complicated with HELLP syndrome and cerebrovascular accident more easily.The fetus of eclampsia cases complicated with fetal death and stillbirth more easily,while the newborn of eclampsia cases complicated with neonatal asphyxia easily. The eclampsia patients with serum albumin(<30g/L) and LDH(≥300IU/L),who more easily complicated with HELLP syndrome.(4) The active application of magnesium sulfate and sedative for patients of preeclampsia and eclampsia,can prevent the onset and recurrence of eclampsia.