ABSTRACT
BACKGROUND: Eclampsia is a major cause of maternal and perinatal morbidity and mortality. The objectives of this study were to determine pregnancy outcome in women with eclampsia especially the maternal and perinatal deaths and the various contributory factors. MATERIALS AND METHOD: A retrospective analysis of demographic and clinical data of patients with eclampsia over a ten-year period (2000-2009) with particular reference to fetal and maternal outcome. Statistical analysis was by Epi- info computer package while test of significance between proportions was done using chi square. Ap value less than 0.05 was considered significant. RESULTS: 23,266 deliveries were conducted and 1027 cases of eclampsia were managed within the 10-yr period giving an incidence of 4.4%. The patients were mainly primigravidae (76%, N=778) with no antenatal care (93.4%, N=959); mean age was 21 years. Intrapartum eclampsia accounted for 62.6%, (N=643). About 45% (N=643) delivered spontaneously, 28.7% (N=277) had instrumental delivery while 19.6% (N=189) had caesarean section. Of the 621 maternal deaths for the period, eclampsia contributed to 29.4% (184) with a case fatality rate of 17.9%. Case fatality in the two years (2006/2007) when magnesium sulphate was used only on eclamptics with repeat fits (because of limited supply) was 18.2% which was not significantly different from the 20.0% fatality recorded in the two years (2008/2009) the drug was used routinely as the sole anticonvulsant agent P > 0.05. Maternal deaths were significantly more amongst the multiparous women with eclampsia (23.3%) than the primigravidae (16%); mortality was also more in eclamptics who had no antenatal care (18.7%) than those with care (5.9%), p <0.05. Major maternal complications were aspiration pneumonitis (23.9%) and pulmonary oedema (16.3%), hyperpyrexia (17.9%), acute renal failure (11.4%), and cerebrovascular accidents 9.8%. Total perinatal deaths were 392 with 81.1% (318/392) still births and 18.9% (74/392) early neonatal deaths mainly from severe birth asphyxia. Perinatal mortality ratio was 406/1000. CONCLUSION: The incidence of eclampsia in the study group was high. It was a major direct cause of maternal and perinatal deaths. Maternal outcome was also poor even with the introduction of magnesium sulphate. Interventions for reduction of maternal and perinatal mortality must emphasize on strategies that prevent the occurrence of eclampsia since outcome in some settings is still not very favorable when it does occur.
