Abstract
Aim: Eclampsia is one of the important preventable causes of maternal mortality.This study aims to review the clinical profile of eclamptic women and compare thematernal mortality, recurrence of convulsions, other morbidities including the neonataloutcome with Magnesium Sulphate versus Phenytoin used for its management.Material and Methods: Prospective study was carried out in all the eclamptic patientadmitted in Gynae ward from April 2000 - April 2001 (Baisak 2057 to Chaitra 2057).Results: There were total of 30 patients.Most of the them (53.3%) were of the 15-20years of age group and three fourth (73%) were primigravidas. More than half (56%)were unbooked and one fourth were nonimmunised and illiterate .Blood pressure hadnever been measured in 63% of the patient . In the Phenytoin Group 68.75% hadrecurrences of fits where as in the Magnesium Sulphate Group only 21.43 % hadreccurence. In the Magnesium Sulphate group, 50% delivered normally whereas 42.5%needed caesarean section in the Phenytoin group Only 6.2% delivered normally andin 37.5 % forceps had to be applied. There were 37.50% admission to NeonatalIntensive Unit (NICU) for various complications in Phenytoin group whereas therewere only 14.2% NICU admission in Magnesium Sulphate group. There were twocases of neonatal deaths out of 16 neonates in the Phenytoin group whereas only oneout of 14 cases in Magnesium Sulphate group. There was only one maternal death inthese thirty patients and it belonged to the Phenytoin group.Conclusion: As proved in many other studies this study also showed that MagnesiumSulphate was superior to Phenytoin in terms of recurrence of fits, maternal and neonataloutcome. In our country where many deaths still occur due to Eclampsia the valuablerole of magnesium Sulphate should not be ignored and health personnels should betrained for its frequently than it is practiced to-day.Key Words: Eclampsia, Preeclampsia, Magnesium Sulphate, Phenytion.
Highlights
Eclampsia is defined as the development of convulsions and or coma unrelated to other cerebral conditions during pregnancy or in the postpartum period in patients with signs and symptoms of preeclampsia
Magnesium Sulphate is established as the drug of choice in pregnancy with severe hypertention and eclampsia, few health care personnel's are still reluctant to start the therapy .Other alternatives being phenytoin, diazepam and lytic cocktail
The highest rate of maternal mortality was found in the early eclampsia cases 22.2% and lowest in the intercurrent eclampsia subtypes (0%)
Summary
Eclampsia is defined as the development of convulsions and or coma unrelated to other cerebral conditions during pregnancy or in the postpartum period in patients with signs and symptoms of preeclampsia. The most commonly used regime is the Magnesium Sulphate either the standard intramuscular regime of Pritchard[4] or the IV regime of Zuspan or Sibai[5] Phenytoin which is a well recognized anticonvulsant is frequently used in Eclampsia It stabilizes the neuronal membranes and therapeutic levels after IV load can be achieved rapidly. It can decrease the blood pressure and increase the cerebral blood flow, with little effect on the respiratory drive, gastric emptying and level of consciousness. Inspite of alt these advantage studies have shown it to be less effective than Magnesium Sulphate
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