UNASSIGNED: West Bengal is experiencing an unanticipated risk of eclampsia among pregnant women and it persists as the leading cause of maternal mortality. This study aimed to investigate the predictors for maternal deaths due to eclampsia in West Bengal.
UNASSIGNED: The study adopted retrospective mixed methods covering facility and community-based maternal death review approaches. Facility-based data were used for 317 deceased cases wherein the community-based review approach was used in 40 cases. An in-depth interview was also performed among 12 caregivers.
UNASSIGNED: One-third of maternal deaths occurred due to eclampsia, and this accounted for the leading cause of maternal deaths in West Bengal. A younger age, a primigravida or nulliparous status, absence of antenatal care (ANC), and residence in rural areas appeared to have the highest risk of developing eclampsia. The majority of pregnant women had an irregular antenatal check-up history, particularly during the second trimester of pregnancy. The rate of eclampsia-related maternal death was higher in women residing more than 49 km from the studied hospitals. Most of the deceased women were referred to three or more hospitals before their death. Gravidity, the number of ANC visits, the mode of delivery, and delays at different levels were significant confounders of death due to eclampsia. The risk of death due to eclampsia was two times higher among women without ANC and those who had a cesarean section than that in their counterparts.
UNASSIGNED: Women in West Bengal have a high risk of preeclampsia and eclampsia resulting in maternal mortality and morbidity. Gravidity, the number of ANC visits, the mode of delivery, and delays in recognition of eclampsia contribute to the risk of maternal deaths. The establishment of separate eclampsia units, enhanced screening, and preventive and treatment procedures may optimize managing eclampsia.

Eclampsia spectrum disorders are a set of serious complications of pregnancy that commonly present after 20 weeks of gestation. There is an association between molar pregnancy, a gestational trophoblastic disease resulting from abnormal fertilisation and gametogenesis, and eclampsia spectrum disorders which can result in manifestation of pre-eclamptic symptomatology earlier than 20 weeks of gestation. We report a case of a gravida 1 para 0 in her mid 20s at 16-weeks gestation presenting with partial hydatidiform mole who developed eclampsia, haemolysis, elevated liver enzymes and low platelets syndrome and posterior reversible encephalopathy syndrome. Ultrasound findings were consistent with molar pregnancy and pathology confirmed partial molar pregnancy with triploid 69, XYY karyotype. This case highlights the early onset potential of eclampsia spectrum disorders in molar pregnancies while suggesting screening such patients for hypertensive disorders.

BACKGROUND: In low-resource settings, magnesium sulphate (MgSO4) for preeclampsia is administered majorly through an injection into the gluteal muscles 4-hourly for 24 hours. The repeated injections are very painful and may lead to infection, abscess formation, and reduced compliance.
OBJECTIVE: To determine the acceptability of Springfusor® pump for the administration of Magnesium Sulphate in preeclampsia and eclampsia.
METHODS: Randomized Open Label Clinical Trial.
METHODS: The study was conducted at Kawempe National Referral Hospital. Eligible women had a systolic blood pressure of ≥140mmHg and or diastolic blood pressure >90mmHg, proteinuria ≥+1, and the physician\'s decision to start on MgSO4. Four-hundred-ninety-six participants were randomized to a Springfusor® pump group (n = 248) or control (standard of care) (n = 248) administration of MgSO4. Intervention group had a loading dose (4gm of 50% MgSO4 intravenously over 20 minutes) and maintenance therapy (1gm of 50% MgSO4 intravenously per hour for 24 hours) administered using the Springfusor®. The standard of care (SOC) group received a loading dose of 4gm of 20% MgSO4 IV over 15-20 minutes, followed by 10gm of 50% MgSO4 intramuscular (5gm in each buttock) and a maintenance dose of 5gm of 50% MgSO4 was administered IM every 4 hours for 24 hours. Both arms received the rest of the care for preeclampsia/eclampsia as per the hospital guidelines. Acceptability of the method of administration was assessed using a Likert scale (1-5; 1 and 2: acceptable and 3-5: unacceptable). Pain at the site of MgSO4 administration was assessed using a Visual Analogue Scale 1-7, (1 minimal pain and 7 worst pain). Comparisons were assessed with the Chi-square test, Mann Whitney-Wilcoxon test, and Students\' t-test.
RESULTS: Intervention arm; was more acceptable than the standard of care arm, (95.3% vs70.3%; p<0.001), had a lower median pain score, (2(CI: 2-2), vs 4(CI: 4-5) p<0.001), and fewer side effects. Maternal mortality was comparable between groups (0.8% in the intervention arm vs 1.2% in the IM arm).
BACKGROUND: Trial No PACTR201712002887266 (https://pactr.samrc.ac.za/).

Despite advances in obstetric care, postpartum eclampsia continues to be a major cause of morbidity and mortality among mothers. Although the most common treatment for eclampsia during the postpartum phase is magnesium sulfate (MgSO4), a small percentage of individuals show resistance to this approach. Clinical challenges arise from MgSO4 resistance, which calls for different approaches to care to avoid unfavorable consequences for mothers. In this case study, we provide a thorough clinical description of a 19-year-old primigravida who gave birth at 37 weeks and developed postpartum eclampsia and did not improve with MgSO4 treatment. This case thus highlights the significance of accurate clinical diagnosis of patients and prompt use of alternative therapy modalities. We also discuss possible approaches to treating this uncommon but serious illness.

UNASSIGNED: Pre-eclampsia and eclampsia are medical conditions that can cause severe complications, such as maternal and foetal morbidity and mortality. This study aimed to assess the incidence and characteristics of pre-eclampsia and eclampsia.
UNASSIGNED: From July 2021 to July 2022, the authors conducted a retrospective, cross-sectional, descriptive study in the Department of Obstetrics and Gynaecology of a tertiary care hospital in the Democratic Republic of the Congo (DR Congo). Out of 1236 total deliveries, 40 patients aged 18-35 years with pre-eclampsia and/or eclampsia with complete data in medical records were studied.
UNASSIGNED: In the studied group, 3.23% of women (40 cases) experienced pre-eclampsia or eclampsia, with the majority (75%, 30 cases) occurring before childbirth. Among these, 62.5% (25 cases) were first-time mothers. The main complications observed in the mothers included HELLP syndrome and placental abruption, whereas their newborns frequently exhibited delayed in-utero growth. Caesarean delivery was the prevalent birthing method, and the treatments most often used for effective management were magnesium sulfate and nicardipine.
UNASSIGNED: The research highlights the common occurrence of eclampsia among patients in the DRC and stresses the critical need for prompt detection of hypertensive complications during pregnancy, aiming to reduce negative health impacts on both mothers and their children.

Eclampsia is one of the most dangerous complications of pregnancy and has a high incidence in developing countries. It is characterized by coma and the occurrence of generalized tonic-clonic seizures in pregnant women with hypertension. Deep bites on the tongue and other orofacial injuries have been described as consequences of these seizures. We present a case of death associated with eclampsia in which the bite during the seizure episode caused almost total amputation of an enlarged tongue (macroglossia). The medico-legal value of this finding and the situation due to antecedent pathological conditions and lack of routine screening in pregnant women who may migrate legally or illegally to give birth with better medical care are discussed.

BACKGROUND: Preeclampsia, a hypertensive disorder in pregnancy, is a multisystem disease of unknown etiology and is associated with an increased risk of maternal mortality and morbidity. Infants from preeclampsia mothers have significantly higher incidence of prematurity, somatic growth retardation, thrombocytopenia, low birth weight, respiratory distress syndrome, and long duration of admission to neonatal intensive care (NICU).
OBJECTIVE: This study was done to study the maternal mortality and morbidity and foetal outcome in pregnant women with severe preeclampsia.
METHODS: This observational study was done in the Department of Obstetrics and Gynaecology, of a tertiary care centre, from the period October 2015 to October 2017. Data was collected from all 130 women attending the antenatal clinic of tertiary care hospital and ward admission and all details such as demographic details, obstetrics examination, and all clinical findings were noted and from that made results.  Result: After applying inclusion and exclusion criteria all 130 women were observed in this study. Among 130 women 47 were diagnosed with preeclampsia. Mainly primigravida women were diagnosed with preeclampsia in the 21-25 years group. Among 47 preeclampsia women, 39 women had a BMI of 19-25 kg/m2. Thirty-two of 47 (68.09%) women were diagnosed with preeclampsia around 36-39 weeks. Among all preeclampsia, 28 women out of 47 (59.5%) women delivered babies vaginally, 18 of 47 (38.3%) women delivered through cesarean section, and one of 47 (2.13%) underwent preterm vaginal delivery. In preeclampsia, women\'s babies were delivered mostly (25/47, 53.19%) ≤2.5 kg weight and only one baby was shifted to NICU because of low birth weight. Preeclampsia increases maternal mortality and morbidity but in this study mortality was not done because our hospital is a tertiary care center with all ICU (intensive care unit) and NICU setup.
CONCLUSIONS: Preterm births and cesarean deliveries were the mild to severe outcomes that were noted. ICU and NICU hospitalizations as a result of severe complications place a heavy demand on medical facilities. There are firm guidelines for the management of pregnancy-induced hypertension and its complications. For appropriate management, there is careful consideration of various factors, and individual case studies are required.

Introduction Obstetric emergencies, like eclampsia, need a quick and accurate response from the treating physician coming into first contact with the patient. Therefore, all doctors, even primary care physicians, interns, and resident doctors, need training to handle such cases proficiently, leaving minimal chances of error. Providing training for the management of these critical conditions on actual patients is not practically feasible. Clinical simulation in obstetrics can be used for the improvement of these skills for undergraduate and postgraduate students. We conducted a non-blinded randomized controlled trial with the primary aim of developing and implementing a module for training undergraduate medical students on the assessment and management of eclampsia and to evaluate and compare it with traditional didactic lectures or case-based learning. Methods The present randomized controlled educational trial was conducted in the Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, India. The undergraduate medical students (Phase 3, Part 1) posted in the department during their clinical postings or tutorials were randomized into two groups. A total of 62 students were randomly divided into two groups, Group A and Group B, each consisting of 31 students. However, only 24/31 (77.42%) in Group A and 19/31 (61.3%) in Group B finally agreed to participate in the study. One group (Group A, with 24 participants) was taught the diagnosis and management of antepartum eclampsia through simulation-based training, and the other group (Group B, with 19 participants) was taught the same topic through conventional teaching, which consisted of didactic lectures through PowerPoint presentations and case-based discussion. Learning objectives were kept identical for both groups. Pre- and post-test scores were compared for both groups. Results The mean pre-test score of the simulation group was 6.13 ± 1.39, and that of the conventional teaching group was 6.05 ± 1.54. The post-test score of the simulation group was 9.17 ± 1.34, and that of the conventional teaching group was 7.37 ± 1.70. The simulation group showed an extremely significant (two-tailed p < 0.0001) improvement in their post-test scores when compared to their scores before the module was taught. The difference in the scores of simulated teaching (Group A) and conventional teaching (Group B) was also statistically significant (p = 0.005). Simulation-based learning was found to be more interactive, helpful in providing real-life-like experiences, led to better retention and understanding, and motivated the students for self-directed learning. Conclusion Although both conventional and simulation-based teaching were useful, simulation-based training was more effective in teaching undergraduate medical students regarding the diagnosis and management of eclampsia. Simulation-based learning is more interactive, provides real-life-like experiences, leads to better retention and understanding, and motivates the students for self-directed learning.

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UNASSIGNED: Hypertensive disorders during pregnancy are a major cause of severe morbidity, long-term disability, and death. Appropriate pharmacological treatment is essential in the management of these disorders.
UNASSIGNED: Synthesize the recommendations developed by the World Health Organization (WHO) to improve the quality of care and health outcomes of adults with high blood pressure, and address aspects of how to implement these recommendations.
UNASSIGNED: A synthesis was conducted of WHO recommendations: drug treatment for severe hypertension in pregnancy and WHO recommendations: drug treatment for non-severe hypertension in pregnancy. The WHO recommendations follow the GRADE methodology (Grading of Recommendations, Assessment, Development, and Evaluation) for the preparation of guidelines, as described in the WHO Handbook for Guideline Development. In addition, a systematic search for studies carried out in the Region of the Americas was conducted in PubMed, Lilacs, Health Systems Evidence, Epistemonikos, and gray literature to identify barriers, facilitators, and implementation strategies.
UNASSIGNED: Four recommendations were formulated for women with hypertensive disorders. Implementation barriers and facilitators were identified, and indicators were created to assess adherence and outcomes.
UNASSIGNED: The formulated recommendations provide guidance on how to approach drug treatment of hypertension in pregnancy, with considerations for implementation in Latin America and the Caribbean.
UNASSIGNED: Os distúrbios hipertensivos na gravidez são uma das principais causas do alto índice de morbidade grave, morte e incapacidade de longo prazo. Um dos principais procedimentos para manejo desses distúrbios é o tratamento farmacológico adequado.
UNASSIGNED: Apresentar uma síntese das recomendações elaboradas pela Organização Mundial da Saúde (OMS) para melhorar a qualidade da atenção e dos desfechos de saúde em gestantes com distúrbios hipertensivos e abordar aspectos da implementação dessas recomendações.
UNASSIGNED: Foi elaborado um resumo das recomendações feitas em duas diretrizes da OMS (uma para tratamento farmacológico da hipertensão grave na gestação e outra para tratamento farmacológico da hipertensão não grave na gestação). As diretrizes elaboradas pela OMS seguem os métodos de elaboração da Classificação de Análise, Desenvolvimento e Avaliação de Recomendações (GRADE, na sigla em inglês) do manual de elaboração de diretrizes da OMS. Além disso, foi realizada uma busca sistemática de estudos desenvolvidos na Região das Américas nas bases de dados PubMed, LILACS, Health Systems Evidence e Epistemonikos e na literatura cinzenta, a fim de identificar barreiras, facilitadores e estratégias de implementação, bem como indicadores.
UNASSIGNED: Foram formuladas quatro recomendações para mulheres com distúrbios hipertensivos. Identificaram-se barreiras e facilitadores para a implementação e criaram-se indicadores de adesão e de resultados.
UNASSIGNED: As recomendações formuladas visam orientar a abordagem do tratamento farmacológico da hipertensão na gestação e incluem considerações de implementação na América Latina e no Caribe.