Eclampsia in rural Nigeria: The unmitigating catastrophe

Abstract

Introduction:Eclampsia is one of the most dreaded causes of adverse outcomes of pregnancy worldwide. It is one of the greatest causes of maternal and perinatal morbidity and mortality world over. We do not know the prevalence, management outcome, and the devastation caused by this dreaded disease in our center hence the need for this work.Materials and Methods:This is a 7-year retrospective review of all cases of eclampsia managed in Mater Misericordiae Hospital Afikpo, a rural secondary cum referral Catholic Mission Hospital in Afikpo, Ebonyi State in Southeastern Nigeria.Results:The prevalence of eclampsia in our center is 1.12% or one case of eclampsia for every 89 women that delivered in our facility. The majority of the women that had eclampsia in our center 56 (71.8%) were primigravidae. Seventeen women (21.8%) had various antenatal complications with 4 or 23.6% presenting with intrauterine fetal deaths and two (11.8%) each with intrauterine growth restriction, and domestic violence, respectively. Thirty-five or 44.9% of the women were delivered by emergency lower segment cesarean section. Fifteen or 17.9% babies were dead giving a perinatal mortality rate of 174 per 1,000After delivery, and 3 (3.8%) of the women had postpartum hemorrhage. Two women (2.6%) died giving a maternal mortality ratio of 2564 per 100,000 deliveries.Conclusion:Eclampsia is a dreaded obstetric disease with adverse fetal and maternal consequences that are not mitigating, and no effort should be spared in managing it effectively including public enlightenment.

Prevalence of hypertensive disorders of pregnancy and pregnancy outcomes in Sub-Saharan Africa: A systematic review and meta-analysis

“…The characteristics of the cross-sectional, 9 , 35 , 36 , 40 , 42 , 46 – 89 prospective, or retrospective cohort and longitudinal studies 5 , 10 , 37 – 39 , 41 , 90 – 103 ...…”

Pronostic maternel et périnatal de l´éclampsie à l´hôpital de Tombouctou au Mali

“…Deux études réalisées au CHU du Point G à Bamako ont retrouvé que l´éclampsie représentait 6,82 des admissions en période gravido-puerpérale et 22,5% des admissions en service de réanimation [ 3 ]. Dans le reste de l´Afrique, notre incidence à 2,3% était supérieure à celles rapportées à Dakar (8 p 1000) et au Nigeria (1,12%) [ 5 , 6 ]. Elle était cependant moins élevée que les 3,3% rapportés à Ouagadougou [ 7 ].…”

“…Concernant la voie d´accouchement, 77,6% des cas d´éclampsie pendant la grossesse et l´accouchement ont eu une césarienne d´urgence. Ce taux est supérieur à ceux que nous avons retrouvé dans la littérature entre 10 et 50% [ 5 , 6 , 13 ]. Notre taux élevé pourrait s´expliquer par l´état clinique de nos patientes à l´admission avec souvent un état de mal éclamptique dans un contexte de retard à l´admission laissant peu de marge de temps d´intervention.…”

The Use of Magnesium Sulphate in the Management of Severe Preeclampsia and eclampsia in Bayelsa State, Nigeria

“…In resource-poor countries, the incidence of eclampsia varies widely, and findings suggest that the incidence rate varies from between 1 in 100 to 1 in 17009, [14]. In Nigeria, its prevalence ranges between 2% to 16.7% [15][16][17].…”

“…A review of research on pre-eclampsia/eclampsia conducted in Nigeria reflects the gross underuse of MgSO 4 as a life-saving therapeutic drug. This is as a result of ignorance of its use, lack of applicable treatment guidelines, lack of training of health workers on its use, wrong perception that the drug is meant for use only at the highest level of facilities, cost, availability, refusal to change from old practices, little incentives for pharmaceutical companies to commercialize the drug and ready availability of pre-packaged forms of less effective drugs [12,17,[19][20][21]. Tukur and colleagues in 2009 discovered that despite MgSO4 recommendation as the most effective, safe and low-cost drug for treating preeclampsia/ eclampsia, it was still largely unavailable in most developing countries [19].…”