Significance of pre-hospital care to reduce the morbidity of eclampsia in rural Zambia.

Abstract

Preeclampsia (PE) is the 2nd leading cause of maternal mortality in developing countries. Maternal deaths caused by PE mainly result from eclampsia. The aim of this study was to survey the current status of PE at a local hospital in Zambia and identify preventive measures against eclampsia. The obstetric data of normal pregnant women and patients complicated with gestational hypertension (GH), PE, and eclampsia in 2017 at Zimba Mission Hospital, Zambia were collected from admission and delivery registries and analyzed. The mode of delivery, maternal and perinatal mortality. Among 1704 deliveries, 42 women (2.5%) were complicated with hypertensive disorders of pregnancy (HDP) (GH: 17, PE: 25). There were 2 stillbirths and 1 neonatal death in PE. Magnesium sulfate (MgSO4) was administered to severe PE patients (11 cases) based on the Pritchard regimen for a resource poor setting. No eclampsia happened after starting MgSO4. All eclampsia (8 cases) happened out of hospital at the gestational age of 35-40 weeks. All the eclamptic patients were primigravidae aged 15-23 years old. MgSO4 injection was started on admission. Cesarean section was performed in 7 cases. All the patients of PE including eclampsia were discharged without any sequelae. The Pritchard regimen is considered to be suitable in the setting. However, the morbidity of eclampsia was high out of hospital. We have to educate pregnant women about the risks of PE and encourage the measurement of blood pressure at health facilities.