Eclampsia

Abstract

Objective: 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 pressure (BP) of 140mmHg or more, or diastolic blood pressure of 90mmHg or more, or both. Setting: Department of Obstetrics and Gynoecology, Postgraduate Medical Institute, Services Hospital, Lahore during the period 1.9.95 to 31.8.96. Subjects: Nineteen (19) pregnant women with obstetric complications. Main Outcome Measures: Incidence, clinical features, management and complications of eclampsia. Results: 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 ± 10mmHg and the diastolic was 112.5 ± 9.57. Dependent oedema was seen in 78.94% 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 was 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.