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  • Title: Maternal and perinatal mortality due to eclampsia.
    Author: Swain S, Ojha KN, Prakash A, Bhatia BD.
    Journal: Indian Pediatr; 1993 Jun; 30(6):771-3. PubMed ID: 8132257.
    Abstract:
    Forty-four mothers with eclampsia and their newborns managed during the year 1988 at the University Hospital of Banaras Hindu University, Varanasi were analyzed. The incidence of eclampsia was 2.2% of all hospital deliveries. Eclampsia was more common in women (below 20 years) and at gestation of 36 weeks and below, and amongst the mothers deprived of antenatal care. The maternal mortality amongst cases of eclampsia was 31.8% and perinatal loss was 38.6%. A relatively high incidence of eclampsia and maternal and perinatal loss was considered to be related to lack of antenatal care and late referral to the hospital. Our findings suggest that more frequent use of properly timed cesarean section can improve the maternal outcome. 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.
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