Clinical Profile of Acute Neurological Emergencies in Postpartum Mothers: A Hospital-based Descriptive Study

Abstract

Introduction: Neurological disorders in pregnancy pose a major diagnostic challenge as they are a significant contributor to mortality and morbidity in pregnancy. Neurological complications may manifest at any time during pregnancy or puerperium even after what seemed to be a normal pregnancy. A thorough understanding of the patterns of these diseases is essential for prediction and early identification. Aim: To study the aetiology, clinical profile, morbidity and mortality patterns of acute neurological emergencies in postpartum women. Materials and Methods: This hospital- based descriptive study was conducted in the Department of Obstetrics and Gynaecology at Government Vellore Medical College and Hospital, Vellore, Tamil Nadu, India between February 2021 and August 2022. A total of 76 postnatal mothers who met the inclusion criteria were selected using consecutive sampling. Details pertaining to personal, demographic, antenatal risk factors, labour/delivery and postnatal events were recorded using a pretested semi-structured questionnaire. The data were entered into Microsoft Excel and analysed using Statistical Package for the Social Sciences (SPSS) 21.0, with the data expressed as frequency and proportion. Results: Among the 76 women included in the study, more than half were multiparous women 42 (55%) and the majority were young adults aged <25 years 48 (63.1%). The majority belonged to a low socioeconomic status (57, 75%), with headache 46 (60.5%) being the most common presenting complaint followed by seizures 45 (59%). The most common diagnosis observed was postpartum eclampsia 37 (48%). Around 34 (44.7%) of the women had associated anaemia, followed by hypertensive disorders of pregnancy including Gestational Hypertension (GHTN) and severe pre-eclampsia together 33 (42%). Long-term residual morbidity was observed only in five of the survivors, two with fine motor weakness, two with remote amnesia and one with speech defects mainly attributable to irreversible damage to motor nuclei and hypoxic ischaemic encephalopathy. Seven out of the 76 affected individuals succumbed to death during the hospital stay, all within seven days of admission. Conclusion: Neurological disorders in the postpartum period are a major contributor to maternal mortality, with eclampsia topping the list as the most common cause of seizures in the postpartum period.

Keywords

• cortical vein thrombosis
• headache
• posterior reversible encephalopathy
• postpartum eclampsia
• seizures