ECLAMPSIA, A MAJOR CAUSE OF MATERNA L & PERINA TA L MORBIDITY AND MORTALITY

Abstract

Eclampsia is a serious obstetric complication, particularly in
developing countries. Objectives: The objective of our study was to highlight the high incidence of eclampsia
at our institution and to determine the maternal and perinatal morbidity and mortality associated with it.
Setting: Lahore General Hospital, Lahore, Period: January, 2001 to December, 2002. Patients and Methods:
136 eclamptic patients among a total of 6173 deliveries during this two year period. Results: The incidence of
eclampsia at our institution was 22 per 1000 deliveries or 2.2%. Most of the patients were less than 21 years old
(51.4%) and were primigravida (59.6%).The majority of patients were uneducated (85%) and belonged to the
lower socioeconomic class (90%). 94% were unbooked and only 6% were booked. Most of the patients
presented with antepartum eclampsia (63.2%) and were at 28 to 36 weeks of gestation (50%). 15% were at less
than 28 weeks of gestation, while 35% were at more than 36 weeks of gestation. The commonest mode of
delivery in eclamptics was spontaneous vaginal delivery (71.6%) followed by lower segment caesarean section
in 18.7% and forceps delivery in 9.7%. The mean hospital stay was 8 days. The maternal complications were
septicemia (69.85%), pulmonary complications (66.18%), urinary tract infection (41.18%) and cerebrovascular
accidents (11.03%). HELLP syndrome occurred in 2.94 %. There were 11 maternal deaths, the case fatality rate
being 8%. The maternal mortality rate among eclamptics was 89.5 per 100,000 live births. The commonest cause
of maternal mortality in our series was cerebrovascular accident (54.55%). Other causes of maternal mortality
were pulmonary complications (27.27%) and renal failure (18.18%). The perinatal mortality rate was 47.77%
including 31 stillborns (47.7% of perinatal deaths) and 34 early neonatal deaths (52.3 % of perinatal deaths). The
early neonatal mortality rate was 32.38%. The causes of perinatal mortality were prematurity (30.77%), birth
asphyxia (33.85%), meconium aspiration syndrome (18.46%) and intrauterine growth retardation (15.38%).
Conclusion: The incidence of eclampsia is very high. The case fatality rate in our series is lower than most
developing countries. Eclampsia is associated with significant maternal morbidity and perinatal mortality. The
major avoidable contributing factor is lack of antenatal care. Hence, improvement in antenatal care services is
required to reduce the incidence of eclampsia as well as the morbidity and mortality associated with it.