Characteristics and outcomes of patients with eclampsia and severe pre-eclampsia in a rural hospital in Western

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. Background Hypertensive disorders in pregnancy affect 10 % of women and are a main cause of maternal morbidity and mortality worldwide, accounting for more than 50 % of maternal deaths in sub-Saharan Africa [1, 2]. In Tanzania the maternal mortality rate is 454/100.000 of which the proportion caused by hypertensive disorders is unknown [3]. Case * Correspondence: r.mooij1983@gmail.com Ndala Hospital, 15 Ndala, Tabora, Tanzania Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands Full list of author information is available at the end of the article © 2015 Mooij et al. Open Access This article International License (http://creativecommons reproduction in any medium, provided you g the Creative Commons license, and indicate if (http://creativecommons.org/publicdomain/ze fatality rates (CFR) of eclampsia are reported 1–2 % in high income countries (HIC) [4, 5]. In low-income countries (LIC) CFRs vary, but are usually much higher: in two studies from Tanzanian tertiary centres CFRs of 5–8 % were reported [6, 7]. In these studies perinatal mortality was 20–39 % [6, 7]. In the recent decade attention for maternal mortality due to hypertensive disorders has been growing [8–10]. Audit of maternal morbidity and mortality cases due to hypertensive disease in pregnancy has been reported in HIC and LIC [9, 11]. Audit has been introduced at is distributed under the terms of the Creative Commons Attribution 4.0 . org/licenses/by/4.0/), which permits unrestricted use, distribution, and ive appropriate credit to the original author(s) and the source, provide a link to changes were made. The Creative Commons Public Domain Dedication waiver ro/1.0/) applies to the data made available in this article, unless otherwise stated.