An analysis of 127 cases of eclampsia treated by the modified stroganoff method

Abstract From Oct. 15, 1924, to Feb. 15, 1933, a total of 127 cases of typical eclampsia have been observed on the Obstetrical Service of the Johns Hopkins Hospital and routinely treated by the “modified Stroganoff” method. In this series there were fourteen maternal deaths, a mortality of 11.02 per cent. The highest death rate prevailed in the post-partum variety of the disease, and the lowest in the intrapartum. The mortality rates during the Stroganoff regime were lower than at any other period of the thirty-seven years of the clinic's existence, during which time the therapeutic policy has gradually swung from extremely radical to equally conservative methods. Indeed the death rate here given is less than half that obtained under the old radical forms of treatment. Dividing the cases into “mild” and “severe” types according to the classification of Eden, the maternal mortality was 2.86 and 21.05 per cent, respectively. As a result of careful analysis of the above 127 cases of eclampsia, it was found that the following “modified classification” of mildness or severity in our experience gave a more exact criterion as to prognosis than Eden's original one. (1) Temperature of 103° F. or above, (2) pulse rate of 120 or over, (3) blood pressure (systolic) of 180 or over, (4) no or very slight edema, (5) deep and persistent coma, and (6) 20 or more convulsions. If two or more of these criteria occur the case is to be classified as severe. A test of this proposed schedule in 205 consecutive cases of eclampsia resulted in 102 being classified as mild with no deaths and 103 severe with 25 deaths, or 24.27 mortality per cent. Moreover, our findings indicate a very direct correlation between the number of positive criteria of severity and the mortality risk rate. A somewhat higher death rate was noted among the blacks than the whites in the series. Also the young woman below the age of twenty and the primipara seemed to have a more favorable prognosis than the woman in the older stages of her child-bearing career or one who had had previous pregnancies. From the foregoing discussion it seems evident that the modified Stroganoff method offers better results in the treatment of eclampsia than any hitherto tested by us. Indeed one can safely say that in the milder cases the results are quite satisfactory. However, in the severe type of case the mortality under this regime is still extremely high, although more favorable than under any form of treatment previously used. Obviously, as Williams has stated, “the treatment of eclampsia must remain empiric and relatively unsatisfactory until the actual cause of the disease is discovered.” We believe, however, that at the present time the modified Stroganoff treatment offers as good results as any variety in vogue. Quite possibly it is little if any better than certain other essentially conservative procedures that have been suggested, such as that with magnesium sulphate. However, it seems evident that the average patient is much better off the more she is left alone. It is possible, however, that in certain of the more severe cases in which the patients seem to be becoming worse under conservative procedures, and in whom spontaneous delivery will not shortly occur, cesarean section under local or spinal anesthesia might offer more favorable results. If acidosis develops the liberal use of intravenous glucose, with or without insulin, seems definitely beneficial. In our experience, venesection is of no definite value. Finally, it seems important to avoid, so far as is possible, the use of inhalation anesthetics for any type of operative procedure which may become necessary.