Neurological disorders during pregnancy and puerperium-still a significant cause of maternal morbidity and mortality in Rural India

Authors : C. S. Madkar, Garima Sinha, Shankar Burute, Mangal S. Puri, Pankaj Salvi

DOI : 10.18231/2394-2754.2018.0026

Volume : 5

Issue : 1

Year : 0

Page No : 118-123

Introduction: A variety of neurological disorders may be encountered during pregnancy and puerperium. These disorders may be unrelated to the pregnant state (e.g., tuberculous meningitis) or peculiar to or more prevalent during pregnancy which are still a cause of significant maternal morbidity and mortality in rural India (e.g., eclampsia and cortical venous thrombosis).
Aim: To study the clinical profile of patients presenting with primary and secondary neurological disorders during pregnancy and puerperium and their outcome. 
Materials and Methods: This study was carried out at the Mamata Medical College between january 2009 and december 2013. All antenatal patients, postabortal or postpartum period requiring neurological consultation were included in this study. Women with eclampsia were excluded. 
Results: There were 75 women included in this study, with 45 cases of primary and 30 of secondary neurological disorders. The former included epilepsy,²¹ CNS infections,¹² cerebrovascular disorders,⁹ intra cranial tumour,¹ post traumatic paresis¹ and encephalomyelitis.¹ The latter included hepatic encephalopathy,²⁸ enteric encephalopathy¹ and polyneuropathy.¹ In patients of epilepsy, the seizures had an equal distribution in all the trimesters and post-partum period, they were mainly of generalized type (77.27%) and were controlled in the majority (90.9%). No fetal congenital malformations were seen. Tubercular meningitis,⁸ pyogenic meningitis³ and viral encephalitis¹ were the CNS infections encountered and pregnancy outcome was good in most cases. All cases of CVT presented in the postpartum period with fever and neurological signs following delivery. Among them 2 patients recovered completely, one patient had residual deficits, another had persistent seizures. We had one maternal death. HE affected patients mainly during the latter half of pregnancy or the post-partum period and was associated with 64.3% mortality.
Conclusion: The incidence of neurological disorders in pregnancy and puerperium was very high especially in our hospital since it is a tertiary care referral centre. Epilepsy and hepatic encephalopathy were the commonest primary and secondary neurological disorders respectively found in our study.

Keywords: Cerebrovascular disorders, CNS infections, Pregnancy, Seizures.

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