Abstract:
BACKGROUND: The inclusion of Magnesium Sulphate (MgSO4) as a gold standard in the
treatment of eclampsia has substantially reduced incidences of repeated fits,
eclamptic morbidity and deaths. However, despite treatment with MgSO4, a
proportion of patients need extra medical/nursing attention and prolonged stay in
the intensive care unit (ICU). The literature on the underlying factors for the
need of extra care in the MgSO4 era is lacking. This study sought to establish
predictors of extra care in ICU among eclamptic patients after treatment with
MgSO4 at Muhimbili National Hospital (MNH).
METHODS: Data were obtained from hospital records of eclamptic patients who were
admitted at MNH and treated with MgSO4 from January 1st to December 31st, 2008.
Based on set criteria, patients who needed extra care were identified. Analysis
was performed using PASW statistics 18 whereby frequencies, cross-tabulations,
bivariate and multiple logistic regressions were performed.
RESULTS: A total of 366 eclamptic patients were admitted and treated with MgSO4
at MNH during a 12 month study period in 2008. Most of these (76%) were referred
from district hospitals and 132 (36%) met the criteria for extra care in ICU.
After adjusting for other variables, the risk of extra care in ICU for patients
who were admitted with altered consciousness was double (OR = 2.3; 95% CI:
1.3-4.0) that of the ones admitted in alert state. The risk or need of extra care
increased by increasing time to delivery and was doubled (OR = 2.0; 95%
CI:1.1-3.7) if it was between 12 and 24 hours and tenfold elevated (OR = 10.0;
95% CI:4.3-23.6) if beyond 24 hours as compared to when time to delivery was less
than 12 hours.Abdominal delivery was also independently associated with increased
risk compared to vaginal delivery (OR = 2.5; 95%CI: 1.4-4.5). The type of
referral and number of fits were associated with extra care in ICU but this
association was wholly explained by the clinical status of the patient on
admission to MNH and prolonged time lag to delivery.
CONCLUSION: We concluded that even with MgSO4 used as the gold standard in the
treatment of eclampsia, effective pre-referral care and expedited delivery were
crucial in minimizing the need for extra care in ICU.
