Maternal and perinatal mortality due to eclampsia
Swain, S.; Ojha, K.N.; Prakash, A.; Bhatia, B.D.
Indian Pediatrics 30(6): 771-773
1993
ISSN/ISBN: 0019-6061 PMID: 8132257 Document Number: 337998
In 1988, in India, 44 cases of eclampsia were admitted to the University Hospital Institute of Medical Sciences of Banaras Hindu University in Varanasi. The eclampsia incidence was 22/1000 (44/2051 deliveries). This was much higher than that in developed countries (1/1150). This eclampsia rate had not changed in 10 years, suggesting that poor maternal and child health (MCH) services were operating. It decreased as the gestational age increased (29 weeks, 10%; 30-33 weeks, 7.3%; 34-36 weeks, 5.5%, and 37 weeks, 1.5%; p 0.001). 84% of eclampsia cases developed eclampsia after delivery. 84% were primigravidae. Eclampsia was more common in adolescent mothers than in older mothers (5.2% vs. 1.5-1.6%; p 0.001). 43 eclampsia cases received no prenatal care. During 1988, there were a total of 45 maternal deaths. Eclampsia accounted for 13 deaths (28.9%). The case fatality rate for eclampsia stood at 29.5%. Maternal death was more common among cases who delivered vaginally than those who delivered via cesarean section (39.1% vs. 15%). One eclampsia case died undelivered. 23 newborns suffered severe birth anoxia (1-minute Apgar, 3). Six of these newborns died within one week. There were 11 fetal deaths, indicating delayed referral. Total perinatal mortality rate was 386/1000. Eclampsia-related deaths was much higher if the mother had more than 15 convulsions (63.6% vs. 26.1% for 6-15 convulsion and 0 for 5 convulsions; p 0.001). These findings suggest that delayed referral and lack of prenatal care contributed to a high rate of eclampsia and of maternal and perinatal mortality. Thus, MCH services need to improve prenatal care, monitor blood pressure, refer eclamptic cases to a higher level to minimize the interval between first convulsion to delivery, and effectively control convulsions so as to increase maternal and perinatal survival.