Pregnancy outcome in eclamptics at the University of Abuja Teaching Hospital, Gwagwalada, Abuja: a 3 year review.

BACKGROUND Eclampsia remains one of the major causes of maternal morbidity and mortality especially in the developing countries. In Nigeria, it is the 3 rd commonest cause of maternal mortality. The high maternal morbidity and mortality due to eclampsia in the developing countries has been ascribed to late referral, delay in hospitalization, lack of transport, unbooked status of patients and multiple seizures prior to admission. OBJECTIVE To review the presentation and management of eclampsia at the University of Teaching Hospital (UATH), the factors associated with it, the maternal and perinatal outcome and make recommendations on how to reduce maternal and perinatal morbidity and mortality from eclampsia. METHODOLOGY The case notes of all the patients that had eclampsia between 1 st May 2005 and 30 th April 2008 were retrieved and analyzed. The informations sought for include age of the patients, parity, booking status, type of eclampsia and blood pressure at presentation. Other informations include level of proteinuria, anticonvulsants used, mode of delivery, maternal complications and perinatal outcome. RESULTS There were 4471 total deliveries within the period, out of which 59 had eclampsia, giving an incidence of 13 per 1000 deliveries. There were 5 maternal deaths, giving a case fatality rate of 8.5%. Eclampsia was commonest amongst the age group of 20-24 years (34.8%). Primigravidae constituted 60.9% of the cases. Majority of the patients (89.1 %) were unbooked. Antepartum eclampsia (73.9%) was more than intra-partum (19.6%) and postpartum (2.2%) combined. Thirty two patients had severe hypertension on admission (diastolic BP= 110 mmHg) while 11 (23.9%) had mild hypertension (diastolic BP 90- < 110mmHg). Twenty patients (47.8%) were managed with diazepam alone while 19 patients (41.3%) were managed with magnesium sulphate alone. Five patients were managed with both. Thirty nine (84.8%) were delivered through caesarean section while 5 (10.8%) were delivered vaginally. Maternal complications include 6 cases of acute renal failure and one case of visual impairment. Thirty seven babies were delivered live while 8 stillbirths were recorded. Six babies (13.0%) had very low birth weight, 14 (30.4%) had low birth weight and 16 (34.8%) had normal birth weight. CONCLUSION Eclampsia still remains a major cause of maternal morbidity and mortality in Nigeria. More awareness and enabling factors should be created for more women to access antenatal facilities. Information about danger signs of pre-eclampsia/eclampsia should be made available to antenatal clients. Government should be committed to providing emergency obstetric case facilities in our hospitals for effective management of eclampsia.