Rajarajeswari, K S (2010) CT Scan Findings in Eclampsia. Masters thesis, Madras Medical College, Chennai.
|
Text
200200110rajarajeswari.pdf Download (2MB) | Preview |
Abstract
INTRODUCTION: Hypertensive disorders are one of the most common medical complications of pregnancy. These disorders continue to be a major cause of maternal and perinatal morbidity and mortality worldwide. Pre-eclampsia is a multisystem disorder affecting the cardiovascular, haematological, renal, hepatic and the central nervous system, of which CNS involvement is the most serious complication. Cerebrovascular involvement is the direct mechanism of death in 40% of these patients. When promptly recognised and treated, symptoms and radiological changes can be reversed. In some women it can progress to ischemia, massive infarction and death. Besides clinical presentation, Neuroimaging is the only mode to assess the CNS involvement. Neuroimaging gives a more accurate assessment of the degrees of CNS involvement in these cases. Vascular changes in organs that occur during pregnancy have been the subject of intense study. Understanding how pregnancy and the postpartum state affect the structure & function of the cerebrovascular bed may provide important clues as to how eclampsia develops and to potential treatments of this devastating condition. To identify the prevalence of neurovascular complications and neurovascular changes in Eclampsia a prospective descriptive study was conducted in Institute of Obstetrics and Gynaecology, Madras Medical College, Chennai. CT scan Brain was done for 100 patients of eclampsia and the findings were analysed. AIM OF THE STUDY: 1. To analyse the findings of CT scan of brain in eclampsia. 2. To determine if these findings can be of value in determining the prognosis of this disorder and whether it adds to the understanding of the pathogenesis of this disorder. 3. To identify the prevalence of neurovascular complications in these cases. MATERIALS AND METHODS: Type of Study: Prospective descriptive study. Period of Study: August 2008 to August 2009. Setting: The study was conducted at Institute of Obstetrics and Gynaecology, Egmore, Chennai. The study was approved by the Board of Ethical committee. SAMPLE SIZE: Sample size – 100. METHODOLOGY: All patients in intensive care unit with a provisional diagnosis of Eclampsia were screened for enrolment into the study. Inclusion criteria:Patients with ec lampsia. Exclusion criteria: Patients with known history of • Chronic hypertension alone, • Epilepsy, • Cerebral tumours, • Renal disorders. SUMMARY: 100 patients with eclampsia between August 2008 to August 2009 at the Institute of Obstetrics and Gynaecology, Madras Medical College, Chennai were selected according to the inclusion and exclusion criteria already stated in the methodology were taken for this prospective descriptive study. Computed Tomography scan of brain was done for these patients within 1 week of postpartum period. Patients with positive CT findings were followed up at 1 to 2 months interval. The results obtained were tabulated, analysed and summarised as follows: 1. Out of the 100 patients 15% had pathological findings in the Computed Tomography scan of brain taken. 2. Majority of the patients (78%) were in the age group of 20-30 yrs. 3. Majority of the patients (68%) were primigravida. 4. Majority of the patients (69%) had normal body mass index of 19.8 - 26. 5. Most of patients around 70% were in the antepartum period at the time of presentation. 6. Majority of the patients (75%) had diagnosed hypertension only at the time of presentation. 7. Most of the patients (73%) had imminent symptoms. 8. Most of the patients (69%) had antepartum eclampsia. 9. Only in positive CT finding group 13.3% had past history of either eclampsia or thrombocytopenia. p value is 0.04 hence statistically significant. 10. Only in positive CT finding group 33.3% were unconscious at the time of presentation. p value is 0. 000, hence statistically significant. 11. Most common blood pressure was systolic 140-160mm of Hg in around 60% and diastolic 90-100mm of Hg in both groups. 12. Only in the positive CT finding group 13.3% had Grade–3 hypertensive retinopathy changes. p value is 0.000, hence statistically significant. 13. All patients had proteinuria. In the positive CT findings group 73.3% had proteinuria of 2+. p value is 0.015, hence statistically significant. 14. Only in the positive CT findings group 20% had thrombocytopenia. p value is 0.000, hence statistically significant. 15. 20% of patients in positive CT findings group had altered liver function test. p value is 0.001, hence statistically significant. 16. Cerebral odema 46% was the most common positive CT finding. Parietal region 40% was the most common area of the brain affected. 17. Maternal mortality was high 46.7% in the positive CT finding group. p value is 0.000, hence statistically significant. 18. 85.7% of patients with cerebral odema recovered and in all of them the lesion resolved completely. 100% of patients with cerebral haemorrhage expired. 19. 100% of patients with diffuse involvement recovered. 100% of patients with frontotemporal or brainstem involvement expired. p value is 0.000 hence statistically significant. CONCLUSION: 1. 15% of patients with eclampsia had pathological abnormalities of brain detected through Computed Tomography scan of brain. 2. Maternal mortality was high in patients with positive CT scan brain findings. 3. Patients with altered liver function, retinal changes, and thrombocytopenia are more prone for developing cerebral lesions. 4. Cerebral odema was the most common pathological abnormality detected. In all but one of these patients recovery and resolving of the lesions were complete. 5. Maternal mortality was high in patients with cerebral haemorrhage, involvement of frontotemporal region or brainstem region. Hence prognosis in these patients is poor. 6. Since majority of patients had hypertension diagnosed only at the time of presentation the need for effective screening of hypertension and its management is emphasised. 7. Thus it is emphasised that CT scan of brain should be included in the investigation protocol for eclampsia if not for all at least for those patients with complications.
| Item Type: | Thesis (Masters) |
|---|---|
| Uncontrolled Keywords: | CT Scan findings ; eclampsia. |
| Subjects: | MEDICAL > Obstetrics and Gynaecology |
| Depositing User: | Subramani R |
| Date Deposited: | 25 Nov 2017 12:05 |
| Last Modified: | 09 Dec 2017 12:44 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/4099 |
Actions (login required)
 |
View Item |
