Maternal outcome in eclampsia at Harare Maternity Hospital

OBJECTIVES: To study the presentation, management and determinants of maternal outcome in eclampsia at Harare Maternity Hospital (HMH) in order to design interventions for reduction of maternal mortality. DESIGN: Cross sectional descriptive study. SETTING: Harare Maternity Hospital, Harare, Zimbabwe. SUBJECTS: All women with diagnosis of eclampsia treated at HMH during an 18 month period. MAIN OUTCOME MEASURES: The study variables included age, parity, booking status, gestational age, location at time of first seizure, number of fits, seizure to delivery interval, maternal complications and the clinical management. RESULTS: There were 151 women with eclampsia from 25,425 deliveries in HMH (5.9 per 1,000 deliveries). The case fatality was 26.5%. The majority of fits (67.5%) occurred antepartum. The mothers who died were significantly older than the survivors, mean age 25.8 versus 22.3 (p = 0.007), and had a higher proportion of multiple seizures, 0.67 versus 0.39 (p = 0.009). In 38% of cases the first seizure occurred at home. The proportion of complications was higher among those who died. Deficiencies in clinical management were more common in the women who died, 39.5% versus 20.9% for survivors (OR 2.55; 95% CI 1.09 to 5.99) and they included delays in achieving delivery, inadequate clinical assessment and poor monitoring. CONCLUSION: Eclampsia remains a significant cause of maternal mortality in HMH with a high case fatality rate. Advanced maternal age, antepartum onset of convulsions and multiple fits were associated with increased risk of maternal death. There were deficiencies in the clinical management of a high proportion of cases.