الفهرس 
Introduction
DefinitionsOnly 14 pages are availabe for public view
 |  | from | 32 |  |  |
| | | from | 32 | | |
Abstract
Clinical audit is a quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the review of change.
In our study we select to audit management of severe preeclampsia and eclampsia at WHH , Assiut university . 454 cases were enrolled (404 cases of severe preeclampsia and 50 cases of eclampsia ) over the period of 6 months from 1-1-2014 to 30-6-2014.
The main results of the study were identifying areas with nearly optimal care and areas with substandard care in management of cases with antepartum severe preeclampsia and eclampsia at WHH , Assiut university .
As regarding good practice in our hospital :
There was good involvement of senior obstetric and senior anaesthetic staff in assessment and management of all eclamptic patient ,metting the international guidelines regarding laboratory assessment by (CBC,LFTs,RFTs ) ,there was good BP monitoring to all cases of severe preeclampsia and eclampsia ,close fluid balance with charting of input and output with fluid restriction was done to all eclamptic patient ,most cases with severe preeclampsia was initially assessed by CTG, antihypertensive medications were started to those with severe hypertension , using Nifedipine orally not sublingually as primary antihypertensive for acute management of severe hypertension as the international guidelines recommened , corticosteroids given for most cases of severe preeclampsia with gestational age less than 34 weeks gestation ,Mgso4 was the therapy of choice to control seizures with loading dose of 4 mg taken over 5-10 mins and maintenance dose for 24 hours following delivery or after the last seizures for all eclamptic patients with good clinical monitoring for mgso4 toxicity, following the basic principles of ABC in the management of seizures, in all eclamptic patients the decision to deliver was made once the women was stable with appropriate senior personal present ,antihypertensive medications were continued after delivery as dicated by BP.
As regarding areas with sub-standard care in the management of severe preeclampsia and eclampsia at WHH, Assiut university include the following :
Lack of our department documented guidelines,missing routine and direct assessment of clinical symptoms indicating severity, inaccuracy of BP measurement in some cases , lack of 24 hours protein collection as a more accurate test to diagnose significant proteinuria ,lack of documented involvement of consultant obstetrician and anaesthetist , lack of close fluid balance with charting of input and output with no fluid restriction in cases with severe preeclampsia, the initial fetal assessment by CTG in eclamptic patientswas deficient , no continuous electronic fetal monitoring in cases in labour , no documented serial US assessment of fetal size and liquor volume , no usage of Umbilical artery Doppler study , maintenance dose of mgso4 for only 12 hours after delivery in cases with severe preeclampsia instead of 24 hours , vaginal delivery was not the preferable method of delivery as evidenced by high rate of C.S. without presence of fetal or maternal indications in 41.6% in cases with severe preeclampsia , sub-optimal postnatal inpatient care of patient after delivery , absence of 6 weeks postnatal follow up , absence of aformal postnatal review with no preconceptional counseling.
As regarding Maternal outcome the mortality rate was 1.2% in cases with sever preeclampsia (5cases),the causes were pulmonary oedema in two cases,pulmonary embolism in one case,cerebral haemorrhage due to development of post partum eclampsia in one case and one case of acute fatty liver.
In cases with eclampsia the mortality rate was 4% (2cases).the causes were cardiac arrest on one case and cerebral haemorrage with acute renal failure in another case.
As documented from the status of discharge there were no residual morbidity with complete recovery at the time of discharge for the majorty of cases of both groups.
As regarding neonatal outcome Perinatal loss representing 14.2%in cases with severe preeclampsia and 6.3% in cases with eclampsia. Neonatal resuscitation was done to (44.2% and 59.2% of newborn fetuses of both groups respectively).
Main causes of resuscitation were respiratory distress followed by preterm labour.
More infants in eclamptic group were admitted to NICU (63.3% versus 44.2%) and the main indications for admission to NICU were respiratory distress followed by neonatal jaundice and preterm labour in both groups.