Application of the new classification of toxemias of pregnancy in 318 fatal cases

Abstract

1.1. Thirty-six per cent of fatal cases of pre-eclampsia were primigravidas.2.2. Sixty per cent of the multiparas had had previous abnormal pregnancies which indicate the importance of some morbid state, usually of the cardiovascular-renal system in the background of toxemia of pregnancy. These facts are brought out particularly in the taking of a detailed medical history. One of every six deaths were certified as due to shock; a diagnosis which in itself needs clarification.3.3. The diagnosis of deaths from severe pre-eclampsia, as certified, are often ambiguous and misleading.4.4. In attempting to classify such material as we have handled, the absence of autopsy findings renders it impossible to deal accurately with the group of pre-eclampsias in which we suspect nonconvulsive eclampsia.5.5. The inadequacy of prenatal care in the eclampsia group reflects the now generally accepted viewpoint that such service and the opportunity for study and early treatment are essential in the prevention of toxemia of pregnancy.6.6. There are probably other causes than hypertension for the convulsions in eclampsia. More than 8 per cent of our cases of convulsive eclampsia had a blood pressure of less than 150/100.7.7. According to the new classification, nonconvulsive eclampsia may not be so grouped without autopsy findings. We were reasonably certain of this diagnosis in three cases which did not come to autopsy.8.8. The unclassified group of toxemias of pregnancy will steadily shrink with more painstaking studies.