Eclampsia in a teaching hospital: incidence, clinical profile and response to magnesium sulphate by zuspan’s regimen

Abstract

Aims and objectives of the study: 1) To study the incidence of eclampsia at Shri Dharmasthala Manjunatheshwara (SDM ) Medical College & Hospital ,Sattur, Dharwad, Karnataka. 2) To study the clinical profile,maternal and perinatal outcome in eclamptic patients. 3)To study the effect of MgSo4 by Zuspan’s regimen in eclampsia which is been used in our hospital. Methods: Analysis of case records of all eclampsia cases from the study period of January 2006 to September 2012, a retrospective study. Results : There were a total of 13740 deliveries and 100 cases of eclampsia during the study period. The incidence of eclampsia was found to be 1% in our hospital. There were a total of 34 maternal deaths during the study period, out of which four were due to eclampsia , giving a case fatality rate of 4% and maternal mortality ratio of 11.7%. Total no of perinatal deaths due to eclampsia was 19, hence the perinatal mortality rate for eclampsia was 184/ 1000.Majority of the patients were unbooked, 95 cases ( 95%). 79 % of patients were primigravidas and 85 % of patients were less than 25 years of age. Antepartum eclampsia was seen in 56 patients (56%) , intrapartum eclampsia in 26 patients(26%) and postpartum eclampsia in 18 patients(18%).Emergency Cesarean section was a common mode of delivery, done in 45 patients( 45.4 %),54 patients had vaginal deliveries ( 54.5%), 1 patient died before delivery.98 patients received MgSO4 by Zuspan’s regimen and only 2 patients had recurrence of convulsion after the start of treatment .Two patients of postpartum eclampsia had features of renal failure and thus did not receive MgSO4 in the study period. Conclusion : Eclampsia continues to be an important cause of maternal and perinatal morbidity and mortality.This is due to lack of proper antenatal care, low socio economic condition and lack of education. MgSo4 is the anticonvulsant of choice and low dose Zuspan’s regimen of Mgso4 is effective in the management of eclampsia.Early presentation and timely decision to terminate pregnancy will improve the maternal and perinatal outcome.