Criteria based audit in the management of eclampsia at a public sector tertiary care hospital in Karachi, Pakistan.

OBJECTIVE: To evaluate the practice of Eclampsia management at a tertiary care public sector hospital.

PATIENTS & METHODS: We conducted criteria based audit of 93 Eclampsia patients admitted in Gynae unit III, Civil hospital and Dow University of Health Sciences Karachi, between 1st January 2016 and 31st December 2016. Management practices were assessed using evidence-based criteria for care. A clinical criteria for standards of care were developed from Royal College of Obstetrician & Gynecologist (RCOG/NICE) guidelines, World Health Organization (WHO) manual, twelve criteria were identified for the audit purpose.

RESULT: Total deliveries during study periods were 5323,with 93 cases were of Eclampsia, giving prevalence of 1.7%. Majority were antepartum (67%), followed by postpartum (21%) cases. Mean age of patients was 25 years while mean parity was 1.4. Majority 48% were un-booked and 36% were referred. Cesarean section was the main mode of delivery (53%) while 24% delivered vaginally. Live birth rate was 65%. History and examination was performed in 98% of patients. MgSO4 loading dose was given in 81%, antihypertensive labetalol/hydralazine were given in 29% of cases with acute severe hypertension. Initial investigation were sent in 84% of patients and repeat investigations within 12 h were done in 74% of cases. Reflexes were monitored in 12% of cases, consultant was informed in 37% of cases, management plan was made in 74% of cases, 98% patients were delivered within 12 h of admission.

CONCLUSION: Suboptimal care was observed in monitoring of patients after magnesium sulphate, and in the management plan of patients.