Eclampsia. I. Observations from 67 recent cases.

Sixty-seven cases of eclampsia were managed from 1977 to 1980, for an incidence of 1 in 310 deliveries. Eighty-four percent of patients were nulliparous and 82% had received some prenatal care. Prior to convulsion, 14 patients (21%) had a diastolic blood pressure below 90 mmHg, 39% had no edema, and 21% had no proteinuria. Thirty-seven patients (55%) had their first convulsion in the hospital. Eight patients had convulsions while receiving magnesium sulfate therapy. Convulsions occurred post partum in 25 patients (37%). In 11 patients the onset of eclampsia occurrred 3 to 11 days after delivery. The total perinatal mortality was 8.6% for all cases of eclampsia. Excluding postpartum cases, perinatal mortality was 13.3%, but was only 5% for those fetuses alive on admission to the perinatal center. Abruptio placentae was present in 9 cases and accounted for 4 of the 6 perinatal deaths. The high incidence of eclampsia at the authors' center has not decreased over the past 20 years, but maternal mortality has been reduced from 2.1 to 0%. It was disturbing to find that management error played some role in the development of eclampsia in 50% of the cases. Significant errors--including ineffective magnesium sulfate therapy, failure to treat adequately prior to transport, and lack of communication with a perinatal center--are discussed.