Tayyiba Wasim, Marryam Gull, Saqib Siddiq.
Eclampsia, a major cause of maternal & perinatal morbidity and mortality.
Professional Med J Jan ;11(3):328-33.

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.

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