Clinical management and outcome of eclampsia at Rajavithi Hospital

Abstract

The purpose of this clinical study was to review experience in the management, and outcome of eclamptic patients at Rajavithi Hospital. Standardized treatment for all cases of eclampsia has consisted of magnesium sulfate intravenously and intramuscularly to control convulsions by means of Chesley and Tepper's regimen, intravenous hydralazine intermittently to lower diastolic blood pressure when it exceeds 110 mmHg, and initiation of delivery as soon as the patient has regained consciousness and is stable. During a ten-year period there were 167,200 deliveries and 90 eclamptic patients, yielding an incidence of eclampsia of 1 in 1,857 deliveries. There were three maternal deaths (3.3%) due to intracerebral hemorrhage. Serious adverse maternal outcomes were more frequent in women whose convulsions occurred before delivery. Excluding postpartum cases, perinatal mortality of fetuses weighing 1,000 g or more was 11.7 per cent. Magnesium sulfate is the drug of choice for treatment of eclamptic convulsions. In most situations, clinical assessment of deep tendon reflexes, respirations, and urine output is adequate to monitor maternal magnesium toxicity without the need to determine actual maternal serum magnesium levels.

PIP: Since 1977, all cases of eclampsia at Rajavithi Hospital in Bangkok, Thailand, have been treated with intravenous and intramuscular magnesium sulfate to control convulsions, intermittent intravenous hydralazine to lower diastolic blood pressure, and initiation of labor as soon as the woman is stable. During 1987-96, there were 167,200 deliveries at the hospital and 90 cases of eclampsia, for an incidence of 1 per 1857 deliveries. 50 eclampsias (55.5%) were antepartum, 25 (27.8%) intrapartum, and 15 (16.7%) postpartum. 57 cases (76%) of antepartum and intrapartum eclampsia were delivered by cesarean section. There were 3 maternal deaths (3.3%) in this series, all from intracerebral hemorrhage, and 9 perinatal deaths (11.7%). Serious adverse maternal outcomes were more frequent in women whose convulsions occurred before delivery. These findings document the effectiveness of magnesium sulfate in the prevention and treatment of eclampsic convulsions.