Need for relooking into management of eclampsia

ObjectiveTo explore the incidence, types, profiles, gestation, therapies, maternal-fetoneonatal outcomes with special reference to conservative eclampsia management in preterm cases with live baby.MethodsA critical analysis of eclampsia cases over two decades was performed to explore outcomes with different therapies.ResultsOf 64 014 deliveries, 416 cases of eclampsia were managed, giving an incidence of 0.65% of births with decreasing trends (0.79% in Block A and 0.56% in Block E). 132 (31.73%) had lytic cocktail, (58.69% in Block A and 2.66% in Block E), 76 (18.27%) had magnesium sulphate (MgSO4) and pethidine or diazepam (30.43% in Block A and 5.33% in Block E), 208 (50.00%) received MgSO4 and nifedipine (10.86% in Block A and 92.00% in Block E). Mean induction delivery interval with lytic cocktail was 23.2 hours (shortest), and MgSO4 with sedatives, 48 hours, and MgSO4 with nifedipine, 72 hours (longest). In 33 cases, induction could be postponed if babies were live, preterm and mothers' convulsions could be controlled. Lytic cocktail perinatal mortality rate (PMR) was 765.15. PMR of MgSO4 with sedatives was 500. PMR of MgSO4 with nifedipine was 346.ConclusionsThough some babies died in utero, in carefully selected cases with close supervision, pregnancy may be continued with eclampsia to increase fetal maturity without risk to mother, in settings where resources are scarce for very very low birth weight babies. Conservative management improves perinatal outcome but a careful balance of maternal wellbeing is essential.