Maternal outcome in eclampsia at Harare Maternity Hospital.
OBJECTIVE
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.


METHODS
Cross sectional descriptive study.


METHODS
Harare Maternity Hospital, Harare, Zimbabwe.


METHODS
All women with diagnosis of eclampsia treated at HMH during an 18 month period.


METHODS
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.


CONCLUSIONS
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.
Majoko
F
F
Department of Obstetrics and Gynaecology, University of Zimbabwe Medical School, P O Box A178, Avondale, Harare, Zimbabwe. fmajoko@healthnet.zw
Mujaji
C
C
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000927:Anticonvulsants / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D004461:Eclampsia / Q000188:drug therapy / Q000401:mortality*; D005260:Female; D006801:Humans; D008428:Maternal Mortality; D011247:Pregnancy; D012306:Risk; D016896:Treatment Outcome; D015030:Zimbabwe / Q000453:epidemiology
D000927:Anticonvulsants