Hypertensive disorder during pregnancy represents a significant public health problem throughout the world and pre-eclampsia is most common of these disorders [1]. In developing countries incidence of preeclampsia is reported to be 4-18% [2], with hypertensive disorders being second most common obstetric cause of still birth and early neonatal deaths in these countries [3]. Preeclampsia, with or without severe features, is a disorder of pregnancy associated with new-onset hypertension, usually with accompanying proteinuria, which occurs most often after 20 weeks of gestation and frequently near term. The parameters for initial identification

of hypertension in the context of pregnancy-induced hypertension constituting the "mild range" are specifically defined as a systolic blood pressure (SBP) of 140 mm Hg or more or diastolic blood pressure (DBP) of 90 mm Hg or more on 2 occasions at least 4 hours apart; or shorter interval timing in cases of "severe range" hypertension with SBP of 160 mm Hg or more or DBP of 110 mm Hg or more, all of which must be identified after 20 weeks of gestation. Such criteria identified before 20 weeks of gestation would be defined as pre-existing essential hypertension or "chronic hypertension."[4]

 This disease represents a spectrum of hypertensive disease in pregnancy, beginning with gestational hypertension and progressing to develop severe features, ultimately leading to its more severe manifestations, such as eclampsia and HELLP syndrome.[5] This disease encompasses 2% to 8% of pregnancy-related complications, more than 50,000 maternal deaths, and over 500,000 fetal deaths worldwide.[6] Early diagnosis and prompt management are essential to preventing both maternal and neonatal complications through symptomatic management and delivery planning..

Fetal complications are mainly due to uteroplacental Insufficiency leading to IUGR (Intrauterine growth Restriction), Stillbirth, Low birth weight babies, IUFD (Intrauterine fetal death), and prematurity. Delivery is the ultimate cure for severe preeclampsia & eclampsia, because of the worsening of fetal & Maternal status. Proper obstetric care is one of the Cornerstones of the management, undue delay in the Delivery of the fetus & placenta may adversely affect fetal & maternal outcomes, hence, the abdominal route of delivery when the vaginal route is not imminent will help in improving the Maternal/fetal outcome.

The present study is a prospective study carried out on 74 pregnant women of severe preeclampsia who are admitted in our tertiary care Centre.

Patients with known case of preexisting hypertension, epilepsy, diabetes mellitus, heart disease, multiple pregnancy, were excluded from the study. The outcome of each pregnancy was obtained by examining the patient in labour ward and neonatal intestine care unit. On admission, detailed history regarding age, parity of gestation, signs and symptoms, obstetrics and family history was recorded from the patient or patient’s attended as appropriate. General physical examination, systemic, abdominal and pelvic examination were carried out. Investigations like complete blood count with absolute platelet count, liver function tests, renal function tests, coagulation profile, fundoscopy, urine examination were performed for all patients. Ultrasound was done at the time of admission after the patient stabilization. Obstetrics management was carried out as per department protocol and the decision regarding timing and mode of delivery was individualized. Eclamptic patients were given magnesium sulphate by Pritchard’s regimen; antihypertensive drugs were nifedipine and labetalol singly or in combination. Obstetric management was done (spontaneous/ induced labour) as per the unit protocols and patients were delivered either by vaginal route or by caesarean section. Neonatal care was provided by pediatrician from delivery onwards. The patients with uncontrolled hypertension were managed in collaboration with physician and anesthetist. All the mothers were followed up for evidence of change in blood Pressure and to look for other complication of eclampsia for 6 weeks. All the babies delivered were followed up during early neonatal period for complications. At the end of the study, data was collected and analyzed.

Table 2: Age distribution

Table 3: Parity

Table 4: Gestational Age

Table 5:  Pregnancy outcome

Table 6: Indications for LSCS

Table 7: Maternal complication

Table 8: Perinatal outcomes

Pre eclampsia and eclampsia still remains a major problem in developing countries. It is one of the important causes of maternal and perinatal morbidity and mortality, probably resulting from inadequate antenatal care and lack of awareness amongst people belonging to low socio economic status. This situation demands extension of medical services in rural areas for the benefit of both mother and baby (Both maternal and perinatal). Early detection of high risk individuals by well trained personals, timely referral to tertiary care center, early initiation of treatment of pre eclampsia, training of mothers about fertility, age and importance of care during pregnancy and strengthening of the neonatal intensive care may lead to improved maternal and fetal outcome.

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