Eclampsia: an enigma

Chitra Joshi, Deepa Hatwal, Zehra Mohsin


Background: Eclampsia is the commonest cause of convulsions in pregnancy next being epilepsy. Incidence varies from 1 in 100 to 1 in 2000 pregnancies. Eclampsia accounts for 24% of all maternal deaths in India. Eclampsia is a significant cause of perinatal mortality and morbidity in non-industrialised countries (up to 40% perinatal deaths).

Methods: We are reporting a retrospective study on the patients of eclampsia attending a tertiary care hospital. The study included 3907 deliveries conducted in VCSG Govt. Medical Science & Research Institute, Srinagar, Pauri Garhwal, Uttarakhand from April 2012 to Sep. 2014.

Results: The total number of eclampsia cases was 98. The antepartum eclampsia cases were 87 and the postpartum eclampsia cases were 11.The incidence of antepartum eclampsia was 2.22% (87/3907) at our center. The total number of maternal deaths due to eclampsia was 6. The total Case Fatality Rate was 11.11% (6/57). There were 6 early neonatal deaths most commonly due to prematurity. There were 20 (22.99%) intrauterine deaths.

Conclusions: Early prediction and diagnosis requires high index of suspicion and comprehensive training of health professionals at all levels of health care. The answer to poor management of eclampsia lies in better education and training of all obstetricians, anesthetists, midwives, and general practitioners in the diagnosis and treatment of severe pre-eclampsia and eclampsia.


Pre- Eclampsia, Eclampsia, Epilepsy, Maternal mortality rate

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Working Group Report on High Blood Pressure in Pregnancy. National Institute of Health, National Heart Lung and Blood Institute, National High blood pressure education program, NIH publication. 2000;00-3029.

Douglas KA, Redman CWG. Eclampsia in the United Kingdom. BMJ. 1994;309:1395-400.

Sheth L. Chalmers. Magnesium for preventing and treating eclampsia: time for international action. The Lancet. 1995;359:9321;1872 -3S.

WHO. International Collaborative Study of hypertensive disorders of pregnancy. Geographic variation in the incidence of hypertension in pregnancy. Am J Obstet Gynecol. 1998;158:80-3.

Bedi N, Kamboj I, Dhillon BS, Saxena BN. Maternal deaths in India- Preventable tragedies (An ICMR task force study). J Obstet Gynecol Ind. 2001;51:86-92.

Nanda S, Sharma JB et al. Perinatal mortality in eclampsia. J Obstet Gynecol Ind. 1989;39:792-5.

Swain S, Ojha KN, Prakash A, Bhatia BD. Maternal and perinatal mortality due to eclampsia. Indian Pediatr 1993;30(6):771-3.

Sultana R, Bashir R. Presentation and management outcome of Eclampsia. J Ayub Med Coll Abbottabad 2005;17(2): 59-62.

Hussain F, Johanson RB, Jones P. One year survey of maternal mortality associated with eclampsia in Dhaka Medical College Hospital. Journal of Obstetrics & Gynaecology. 2000;20(3):239-41.

Moodley J, Daya P. Eclampsia a continuing problem in the developing world. Int J Gynecol Obstet. 1993;44:9-14.

Chelsey LC. A short history of eclampsia. Obstet Gynecol. 1974;43:599-602.

Salha O, Walker JJ. Modern management of eclampsia. Postgrad Journal. 1999;75(880):78-82.

Noris M, Perico N, Remuzzi G. Mechanisms of disease: Pre-eclampsia. Nat Clin Pract Nephrol. 2005;1(2):98-114.

Sibai B, Dekker G, Kupferminc M. Pre-eclampsia. Lancet. 2005;365:785-99.

Sibai BM. Evaluation and management of severe preeclampsia before 34 weeks' gestation. Am J Obs Gyn. 2011;205(3):191-8.

Hernández-Díaz S, Toh S, Cnattingius S. Risk of preeclampsia in first and subsequent pregnancies: prospective cohort study. BMJ. 2009;338:b2255.