Characteristics and outcomes of patients with eclampsia and severe pre-eclampsia in a rural hospital in Western Tanzania: a retrospective medical record study.
BACKGROUND
Eclampsia and pre-eclampsia are well-recognized causes of maternal and neonatal mortality in low income countries, but are never studied in a district hospital. In order to get reliable data to facilitate the hospital's obstetric audit a retrospective medical record study was performed in Ndala Hospital, Tanzania.


METHODS
All patients diagnosed with severe pre-eclampsia or eclampsia between July 2011 and December 2012 were included. Medical records were searched immediately following discharge or death. General patient characteristics, medical history, obstetrical history, possible risk factors, information about the current pregnancy, antenatal clinic attendance and prescribed therapy before admission were recorded. Symptoms and complications were noted. Statistical analysis was done with Epi Info®.


RESULTS
Of the 3398 women who gave birth in the hospital 26 cases of severe pre-eclampsia and 55 cases of eclampsia were diagnosed (0.8 and 1.6%). Six women with eclampsia died (case fatality rate 11%). Convulsions in patients with eclampsia were classified as antepartum (44%), intrapartum (42%) and postpartum (15%). Magnesium was given in 100% of patients with eclampsia and was effective in controlling convulsions. Intravenous antihypertensive treatment was only started in 5% of patients. Induction of labour was done in 29 patients (78% of women who were not yet in labour). Delivery was spontaneous in 67%, assisted vaginal (ventouse) in 14% and by Caesarean section in 19% of women. Perinatal deaths occurred in 30% of women with eclampsia and 27% of women with severe pre-eclampsia and were associated with low birth weight and prolonged time between admission and birth.


CONCLUSIONS
2.4% of women were diagnosed with severe pre-eclampsia or eclampsia. The case fatality rate and overall perinatal mortality were comparable to other reports. Better outcomes could be achieved by better treatment of hypertension and starting induction of labour as soon as possible.
Ndala Hospital, 15 Ndala, Tabora, Tanzania. r.mooij1983@gmail.com.|Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands. r.mooij1983@gmail.com.
Rob
R
Mooij
Ndala Hospital, 15 Ndala, Tabora, Tanzania. lugumila@gmail.com.
Joseph
J
Lugumila
College of Health Sciences, University of Dodoma, 395, Dodoma, Tanzania. masuyt@yahoo.co.uk.
Masumbuko Y
MY
Mwashambwa
College of Health Sciences, University of Dodoma, 395, Dodoma, Tanzania. imwampagatwa@yahoo.com.
Ipyana H
IH
Mwampagatwa
Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands. jeroen.vandillen1@radboudumc.nl.
Jeroen
J
van Dillen
Department of Obstetrics and Gynaecology, Leeuwarden Medical Centre, Henri Dunantweg 2, 8934 AD, Leeuwarden, The Netherlands. jelle.stekelenburg@online.nl.
Jelle
J
Stekelenburg
D000293:Adolescent; D000328:Adult; D036861:Delivery, Obstetric / Q000706:statistics & numerical data; D004461:Eclampsia / Q000209:etiology / Q000401:mortality* / Q000628:therapy; D005260:Female; D006780:Hospitals, Rural; D006801:Humans; D007231:Infant, Newborn; D008428:Maternal Mortality; D008499:Medical Records; D054238:Perinatal Mortality; D011225:Pre-Eclampsia / Q000209:etiology* / Q000401:mortality* / Q000628:therapy; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D012307:Risk Factors; D013636:Tanzania / Q000453:epidemiology; D055815:Young Adult