Dilantin as anticonvulsant in eclampsia

Sixty-six cases of eclampsia amongst 9178 deliveries were managed from July, 1997 to December, 1998 in the department of obstetrics and gynaecology at UCMS & GTB Hospital, Delhi. The aim was to evaluate the changing trends in patients of eclampsia and to assess the efficacy of dilantin in its treatment. The incidence recorded was 1 in 139 deliveries (0.7%). Majority (90.91%) were unsupervised in antenatal period and 68.18% were primigravidae. Eclampsia developed at < 28 weeks of pregnancy in 3.03% of patients. All the patients had hypertension and proteinuria at the time of admission and 51.52% showed hypertensive changes on fundus examination. While single anticonvulsant therapy in the form of dilantin was used to manage 57.57% of patients, 13.64% required intubation and positive pressure ventilation. Fit recurrence on treatment was noticed in 40.91% of patients. Lower segment caesarean section was conducted in 18.18% of patients. Three maternal deaths (4.56%) attributed to ventricular tachycardia, aspiration and intracerebral haemorrhage were recorded. Morbidity was frequent in the form of status eclampticus (n = 5), postpartum psychosis (n = 5), retinal detachment (n = 1), coagulation abnormality (n = 11). The perinatal mortality rate was 30.43%. The study concludes that eclampsia is still rampant in India and despite better medical facilities, maternal and perinatal mortality remains high. The efficacy of dilantin as anti-eclamptic needs to be reviewed.