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  • Title: Perinatal mortality in eclampsia in relation to drug therapy.
    Author: Chaudhuri N, Dasgupta P, Pan NR.
    Journal: Indian J Public Health; 1994; 38(1):3-7. PubMed ID: 7883311.
    Abstract:
    Fifty-nine babies were born to eclamptic mothers among 7500 deliveries giving incidence of occurrence of 0.77 percent. The perinatal mortality in eclamptic babies was 32.7%, whereas the total perinatal mortality rate amongst all the deliveries was 10.5%. The mothers were treated within Group I--diazepam, Group II i chlorpromazine (largactil), phenargan and diazepam and Group III--largactil, phethidine and phenargan. The mortality rate was 23.8%, 18.8% and 66.6% respectively. The highest number of still-born i.e. six out of 8 occurred in Group III. Hundred percent still-born was noted in 28-32 weeks of gestation and birth weight less than 1.5 kg irrespective of drug regimes. Iargactil potentiates the respiratory depressant effect of pethidine and may cause high rate of still-birth and death after birth. Between May 1986 and April 1987 in India, 59 infants were born to mothers with eclampsia at the R.G. Kar Medical College and Hospital in Calcutta. The eclampsia rate was 0.77% (59/7500 deliveries). The perinatal mortality rate for eclamptic infants was 32.7%, compared to 10.5% for the total perinatal mortality rate. Pediatricians divided the infants into 3 groups based on the drug used to treat eclampsia: diazepam only (group I); largactil, diazepam, and phenargan (group II); and largactil, pethidine, and phenargan (group III). Group III infants had the greatest mortality rate (66.7%), followed by group I infants (25.8%) and group II infants (18.1%). The still born rate was also highest among group III infants (40.02% vs. 4.76% for group I and 4.52% for group II). Since largactil enhances the respiratory depressant effect of pethidine, it may account for the higher mortality among group III infants. The mode of delivery associated with the highest mortality rate was forceps delivery (35%), largely because forceps were used in very sick mothers and those who were in more intractable convulsion. All infants less than 1.5 kg at 28-32 weeks gestation died. The fact that another study found the mortality rate for this infant group to be 18.28% indicated that the high mortality was due to the effect of the drugs. The mortality rate of the 1.5-2 kg group at 28-32 weeks gestation was 50%. Based on these findings, the pediatric researchers concluded that the combination of pethidine and largactil was responsible for the high mortality rate, especially the still born rate.
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