Determinants of Maternal Mortality in Eclampsia in India

Abstract

EDITORIAL COMMENT: We accepted this paper for publication to remind readers of the savage toll on maternal life that can be claimed by eclampsia when there is inadequate antenatal care in the detection and management of cases of preeclampsia. In the 22 years from 1971–1993 there were 108,476 deliveries and 60 cases of eclampsia at the Mercy Hospital for Women, an incidence of 0.06% or 1 in 1,808 deliveries and the maternal mortality rate was 5% (3 of 60). In this large series from India of 271 cases, the maternal mortality rate was 7.8% and the incidence of eclampsia was 1 in 115 deliveries (0.87%). The authors refer to other series of eclampsia in India where the incidences of eclampsia were as high as 4.6% of all deliveries. These high incidences of eclampsia are largely explained by referral of complicated cases to major centres and expectedly the series reported here contains a very high proportion of cases of antepartum eclampsia. Where antenatal care facilities are better most cases of eclampsia occur intrapartum and the distribution of the 60 cases at the Mercy Hospital for Women was 19 (32%) antepartum, 14 (23%) intrapartum and 27 (45%) postpartum whereas in the series from India the distribution was 128 (47%) antepartum, 85 (31%) intrapartum and 58 (22%) postpartum. The causes of death in these cases of eclampsia were similar to those which occur in developed countries. The take‐away message for readers is that we must continue our antenatal vigilance to detect the signs of preclampsia and manage these patients appropriately.Summary: Two hundred and seventy‐one pregnant mothers with eclamptic seizures admitted in a tertiary level teaching institution in South India over a period of 9 years from 1984 to 1992 were critically analysed with a particular reference to maternal mortality. The incidence of eclampsia was 0.87% of the total hospital deliveries (1 in 115 deliveries) and was increasing in consecutive years. Seventy per cent of the patients were primagravidas and more than 95% of them had not received antenatal care and were alarmingly unaware of any kind of examination during pregnancy. Eclampsia accounted for 20.9% of all maternal deaths during the same period and the case mortality rate was 7.8%. There is an urgent need to impart special training in antenatal care to non‐obstetrician doctors as well as paramedical staff working in the community and to provide health education to the community to reduce mortality from eclampsia.