Factors that predict very severe maternal morbidity among eclanptic mothers managed at Muhimbili national hospital

Abstract

Background: Eclampsia is a condition known to be associated with serIOUS obstetric complications including severe maternal morbidity and mortality. Although eclampsia as an entity causes severe morbidity, from a practical point of view and literature, most eclamptic patients clinically recover within 72 hours of childbirth. A proportion of mothers, however, , develop very severe morbidity as indicated by the need for prolonged admission in ICU, and extra medical! nursing care measures. This study focuses on predictors of very severe morbidity among eclamptic mothers.

Objectives: To identify factors that independently predict very severe maternal morbidity outcome among eclamptic patients admitted at Muhimbili National Hospital (MNH).

Materials and Methods: A retrospective, cross sectional-analytical study was conducted at MNH and eclamptic mothers with very severe morbidity (VSM) were identified. Using Multiple Logistic Regression, the odds of factors that predict VSM and their 95% Confidence Interval were calculated.

Results: A total of 366 eclamptic patients were studied. Out of these, 132 (36.1 %) had VSM. From all the eclamptic mothers, 121 patients needed duration of stay in ICU of more than three days, 20 patients needed insertion of naso-gastric tube for feeding, 14 patients needed physiotherapy, and 49 patients needed resuscitation drugs. Factors that independently predicted VSM were, mode of delivery [OR 2.80, 95% C I (1.50 - 5.10)], time interval from admission to delivery [OR 2.25,95% Cl (1.23 - 4.10)], and number of fits [OR 1.81, 95% Cl (1.04 - 3.14)].

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Conclusions: These results underscore the importance of prompt, timely and less invasive delivery in prevention of VS M among eclampsia patients.

Recommendations: More efforts are needed to improve and strengthen the municipal hospitals to be able to provide standard care for eclamptic mothers in order to avoid VSM and death.