Eclampsia in Enugu, eastern Nigeria

Abstract

A retrospective analysis of 83 cases of eclampsia managed at the University of Nigeria Teaching Hospital over a ten year period was carried out. Incidence of eclampsia was 1.7/1000 deliveries. Antepartum eclampsia constituted 84% of the cases managed. The incidence of eclampsia among unbooked cases was 14.3/1000 births and of these, the maternal mortality was 15.6% while the incidence of eclampsia for the booked patients was 1.1/1000 births of which the maternal mortality was 7.8%. Selection of high risk cases for hospital confinement, early referral of cases of eclampsia and careful use of drugs to control eclamptic fits are recommended to reduce morbidity and mortality from eclampsia.

PIP: Eclampsia is one of the leading causes of maternal mortality in Nigeria. The etiology of the condition may be genetic, and treatment regimens differ. It is agreed, however, that adequate prenatal care can reduce the occurrence of eclampsia. Researchers analyzed the 83 cases of eclampsia which were treated at the University of Nigeria Teaching Hospital in Enugu from January 1977 to December 1986. The 49,883 deliveries during this decade led to an eclampsia rate of 1.7/1000. Of the 47,638 women who received prenatal care at the hospital (booked women), 51 experienced eclampsia (1.1/1000); the 2245 referred deliveries included 32 cases of eclampsia (14.3/1000). This difference is significant (p .0.05). Some booked patients, however, had only 1 prenatal consultation. The mean parity of eclampsia patients was 1.6, and median age was 27 years. Eclampsia occurred at or= 28 weeks gestation in 4, at 29-36 weeks in 37, at term in 38, and postpartum in 13 women. Blood pressure at time of occurrence ranged from 130/95-250/160 mmHg. Most of the complications and 7 of the 9 deaths occurred with systolic pressure 200 mmHg. The comparatively high 10.8% maternal deaths of these patients included 15.6% of referred and 7.8% of the booked patients. This difference was not significant. The perinatal mortality rate was 33% for referred patients and 11% for booked (not statistically significant), for a combined rate of 18.5%. Diazepam was most often used in treatment because it was available; however, the Cesarean rate was highest with this drug. (Magnesium sulfate, well-regarded for eclampsia treatment in the US, was not available). The perinatal mortality rate is in line with the experience of others; Cesarean sections led to the most perinatal deaths. Postpartum eclampsia led to 2 deaths of women after they left the hospital. High-risk cases should receive early referral and hospitalization. It would also be useful to monitor the efficiency of the drugs used for treatment.