Liver enzyme patterns in maternal deaths due to eclampsia: A South African cohort

Abstract

Eclampsia is an obstetric emergency and a major cause of maternal mortality in low and middle-income countries such as South Africa. Despite years of research, there is no single test for the prediction of eclampsia, however liver function tests have been effective in monitoring the prognosis of this disorder. This was a retrospective study of patients in whom the final cause of death was eclampsia in South Africa between the years 2014-2016. Of 109 cases who died from eclampsia, the highest prevalence was found among primigravidae (42.1%: n = 45) of whom 26.6% (n = 29) were between 20 and 24 years of age. Twenty-six (23.9%) eclamptics did not receive antenatal care and of these 80.7% (n = 21) had the first eclamptic seizure at home. The first level of health care was used by 63.3% (n = 69) of patients; liver function test results were documented in 56.9% (n = 57). An association was found between eclampsia and elevated aspartate aminotransferase levels. Primigravidae especially teenagers are at risk of eclampsia. These women in particular must be informed of the warning signs of preeclampsia and requested to attend for antenatal care frequently especially in the third trimester so that early signs of preeclampsia are detected and timeous delivery is carried out to prevent eclampsia. Furthermore, liver function tests and platelet counts should be done in all women with the preeclampsia-eclampsia syndrome during antenatal and in the immediate postpartum period to prognosticate progression of the disorder and or timing of discharge from hospital.