Eclampsia

ABSTRACT

To review and critically evaluate the incidence, epidemiology, clinical pattern, management and complications of eclampsia. Design: Study of patients presenting with convulsions in pregnancy or pregnant women who developed convulsions while admitted with a systolic blood pressure [BP] of 140mm Hg or more, or diastolic blood pressure of 90mmHg or more, or both. Department of Obstetrics and Gynaecology, Postgraduate Medical Institute, Services Hospital, Lahore during the period 1.9.95 to 31.8.96. Nineteen [19] pregnant women with obstetric complications. Incidence, clinical features, management and complications of eclampsia. The incidence of eclampsia in our study was 0.75% of all deliveries. None of the patients had any antenatal check up in that pregnancy. Mean age of the patients was 22.95 +/- 4.12 years and the mean parity 1.2 +/- 1.08. The mean gestational age at the time of developing eclampsia was 33.8 +/- 4.43 weeks. Thirteen [68.42%] patients had antepartum fits while the rest had postpartum fits. The mean fit admission interval was 7.21 +/- 9.77 hours and the mean admission delivery interval was 15.87 +/- 13.91 hours making a mean fit delivery interval of 23.08 +/- 20.82 hours. The mean systolic blood pressure was 155 +/- 10 mmHg and the diastolic was 112.5 +/- 9.57. Dependent oedema was seen in78.94% while proteinuria was seen in 89.48% of the patients. The consciousness level was altered in 78.94% of the patients. Intravenous diazepam and a methyldopa were employed as the primary anticonvulsant and antihypertensive respectively in all the patients with 42.1% receiving nifedipine sublingually as an adjuvant to a methyldopa. The labour was spontaneous in 57.89% while the rest required induction. None of the patients underwent abdominal delivery straight away. Caesarean section was however, finally the mode of delivery in 26.31% of the patients. There was only one mortality [5.26%] which resulted from development of acute pulmonary oedema making a maternal mortality rate of 5260 per 100,000 pregnancies. Five patients [26.31%] presented with fetal demise in utero while one [5.26%] perinatal death occurred within twenty-four hours of birth making a perinatal mortality rate of 315.7 per 1000 births. The booking status [100% unbooked] of these patients suggests a need for better antenatal services to ensure prevention rather than cure of eclampsia. The mean fit admission interval of more than seven hours denotes a need for strengthening the primary health services for early recognition of problems and rapid transfer, if required