Enclampsia at the University Teaching Hospital

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Mukosa, Phillimon J.M
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During 1997, there were 41,449 deliveries in Lusaka. Of these 29, 991 (72.4%) were at nine Lusaka maternity clinics, 878 (2.1%) were from Chainama maternity clinic, while 10,580 (25.5%) were University Teaching Hospital (UTH) deliveries. During the same period, (January 1^' to December 3 T' 1997) a total number of 101 eclamptic patients were treated at UTH, giving an incidence of eclampsia at UTH of 0.96% of deliveries. Overall incidence of eclampsia taking all Lusaka deliveries was 0.24% in 1997. The incidence of eclampsia in multiple pregnancy was 1.21% (compared to 0.23% in singletons). This incidence is comparable to figures from other developing countries. It was found in this study that eclampsia occurred more often in the primigravidae (59.4% of all eclamptics, mean parity 1.1) with the highest number of cases occurring in those aged between 17 and 19 years of age (mean age 22.2 years, SD 5.6).Treatment of eclampsia, invariably was delivery. This was achieved soon after the blood pressure and seizures were controlled. If delivery was feasible within hours after presenting to UTH, induction or argumentation with oxytocin was carried out to achieve spontaneous vaginal delivery (SVD) as long as there were no obstetrical contraindications to the use of oxytocin. Nevertheless, 73.3% of all cases were delivered by caesarean section.There were 144 maternal deaths in UTH during the study period of 1997. Five maternal deaths (3.5%) were due to eclampsia, (mean parity 2.6). Four of the five maternal deaths were found to have had pulmonary edema as a complication. One of these maternal deaths occurred in a patient with moderate hypertension while four of the five had severe hypertension. One of the deaths occurred in a case that had a caesarean section, two after instrumental delivery and two after spontaneous vaginal delivery. Four of the deaths were clinic referrals and had marked proteinuria. One had been unbooked. No maternal deaths were observed in those booked at UTH. A perinatal loss (stillbirths and early neonatal deaths - within one week of birth) of 17.8% was recorded in cases of eclampsia. The perinatal loss was inversely proportional to parity. 68.4% of fetuses delivered by caesarean section resulted in perinatal deaths, whereas 26.3% and 5.3% were perinatal losses recorded after SVD and instrumental delivery, respectively. Illustrating the severity of the eclampsia, 79% of these perinatal deaths were from eclamptic mothers who received diazepam more than once and 57.9% were from eclamptic mothers who received hydralazine intravenous boluses more than once.The incidence of eclampsia in Lusaka and at UTH has remained the same at 2.4 cases per 1000 deliveries since the early 1980s (Thakkar and Wacha, 1982). Maternal case-fatahty was 5% in this study compared to 6.5% in 1982, but believed to be higher in the immediate past years (closer to 10%). The perinatal death rates in the corresponding years has dropped from 30.4% to 17.8% in this study. Improved antepartum care, and good case management of pre-eclampsia and eclampsia are important to reduce the incidence and case fatality associated with eclampsia.
Eclampsia -- University Teaching Hospital -- Lusaka