No fewer than 61.1 per cent (33) of maternal eclamptic deaths (54 cases) between 1953 and 1960 were found to be avoidable when the results from the University of Natal's Obstetric Unit at King Edward VIII Hospital were analyzed. This stimulated a change in our routine treatment of eclampsia from a policy which relied on conservatism and sedation to one with a high Caesarean section rate and emergency restoration of normotension.The reduction of the maternal and perinatal mortality rate which ensued in a large series of eclamptics is reported here. TREATMENTBecause maternal mortality increases with the frequency of eclamptic fits, anti-convulsant treatment commenced in the admission suite. As we believe that eclamptic convulsions are due to cerebral anoxia from intracranial vascular spasm, haemorrhage, hypertensive encephalopathy and cerebral oedema (Eastman, 1956;Lewis, 1964), the objectives of our treatment were to relieve cerebro-vascular spasm; to increase cerebral blood-flow ; and to decrease cerebral oedema. Cerebral irritability was further reduced by sedation.Thus 12 -5 mg. Nepresol (a hydrallazine-like hypotensive with spasmolytic activity) and 50 mg. of pethidine were given intravenously followed by an intramuscular injection of 50 mg. pethidine. The patients were closely supervised and if the blood pressure remained elevated (after 10 minutes) or fits recurred a further intravenous injection of Nepresol and pethidine was given. On some occasions it was necessary to supplement this rCgime with an intramuscular injection of 10 ml. of 50 per cent magnesium sulphate. Since Nepresol frequently produced profound tachycardia, Puroverine (protoveratrine A and B) 0 . 2 mg. (intravenously) was substituted if the pulse rate exceeded 120 beats per minute.The rare normotensive (blood pressure 130/90 mm. Hg or less) patient with eclampsia usually responded to pethidine and magnesium sulphate alone, and it was rarely necessary to use paraldehyde to achieve adequate sedation.The patient was transferred to the general labour ward (theatre) when the fits were controlled and the fall in blood pressure stabilized. The patients were treated in the labour theatre because it was here that they had the most continuous nursing and medical attention. Indeed, the policy of treating eclamptics in the dark all too often extends beyond literal into figurative realms ! Management of the PregnancyThe safest and quickest method of terminating pregnancy offers the patient the best hope of cure. The mode of delivery depended on whether the patient was in established labour, and if so, whether there was an early prospect of delivery. If the convulsions could not be controlled rapidly or the patient was not in labour, a Caesarean section was performed unless the cervix was favourable and a swift delivery was anticipated following artificial rupture of the membranes and an oxytocin infusion. The obstetrical manage-1019
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