title: Assessment of clinical outcomes and prescribing behavior among inpatients with severe preeclampsia and eclampsia: an Indian experience.
abstract: OBJECTIVE
  The study aims to evaluate the management, maternal-fetal outcomes, and prescription behavior among inpatients with severe preeclampsia and eclampsia.
  
  
  METHODS
  This prospective cohort study in a tertiary referral center was conducted in 164 inpatient pregnant women who fulfilled the inclusion criteria. The study was conducted between November 2005 and February 2007. The patients were followed-up till delivery. Antepartum and intrapartum care and maternal and perinatal outcome were noted. Chief outcome measures were maternal and perinatal mortality and drug use indicators.
  
  
  RESULTS
  Median age at delivery of the women was 25 (22-28) years. Majority were suffering from antepartum eclampsia (52.5%), followed by preeclampsia (31%) and postpartum eclampsia (16.5%). Nulliparity (61.6%) was more common in eclampsia, while multiparity in preclamptic group. A total of 48% had preterm delivery. Most presented with headache (50%) and hyperreflexia (29%). Only 15% presented with all three prodromal symptoms and 86% had hypertension. There was increased morbidity, operative intervention, and admission to intensive care unit. Most babies (67%) weighed <2.5 kg and had poor outcome. The maternal mortality was 0.4/1000. Average number of drugs prescribed in patients of preeclampsia, antepartum eclampsia, and postpartum eclampsia were 13.2, 14.9, and 14.2, respectively. Antibiotics (24.6%) were the most common class of the drugs prescribed in all the groups, followed by vitamin and calcium supplements (22.7%) and antihypertensives (13.5%). Most common antihypertensive used were calcium channel blockers and anticonvulsant magnesium sulphate.
  
  
  CONCLUSIONS
  There was increased maternal and perinatal morbidity. Protocols for the management of eclampsia, including antihypertensive and anticonvulsant therapies, should be available and reviewed regularly to improve the standard of care and reduce the prevalence of this dangerous condition.
authors.affiliation: Department of Pharmacology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
authors.forename: Shefalika
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Department of Pharmacy Practice, Clinical Research Unit, National Institute of Pharmaceutical Education and Research, Mohali, India.
authors.forename: Dipika
authors.initials: D
authors.lastname: Bansal
authors.affiliation: Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Debasish
authors.initials: D
authors.lastname: Hota
authors.affiliation: Department of Obstetrics and Gynecology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
authors.forename: Madhu
authors.initials: M
authors.lastname: Jain
authors.affiliation: Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Pawan
authors.initials: P
authors.lastname: Singh
authors.affiliation: Department of Pharmacology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
authors.forename: B L
authors.initials: BL
authors.lastname: Pandey
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000927:Anticonvulsants / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D017723:Drug Utilization Review; D004461:Eclampsia / Q000188:drug therapy / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007194:India; D011225:Pre-Eclampsia / Q000188:drug therapy / Q000503:physiopathology*; D011247:Pregnancy; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D000927:Anticonvulsants; D000959:Antihypertensive Agents
keywords: Eclampsia; hypertension; magnesium sulphate; preeclampsia; pregnancy