Perinatal mortality in eclampsia in relation to drug therapy

Area of Science:

• Obstetrics and Gynecology
• Neonatal Medicine
• Pharmacology

Background:

• Eclampsia is a severe complication of pregnancy with significant perinatal risks.
• Understanding the impact of maternal eclampsia on perinatal outcomes is crucial for clinical management.
• Existing treatment protocols for eclampsia require evaluation for their effects on fetal and neonatal survival.

Purpose of the Study:

• To determine the incidence of eclampsia and its associated perinatal mortality.
• To compare the effectiveness of different drug regimens in managing eclamptic pregnancies.
• To identify risk factors contributing to perinatal death in eclamptic neonates.

Main Methods:

• Retrospective analysis of 7500 deliveries, identifying 59 cases of eclampsia.
• Classification of eclamptic mothers into three treatment groups based on drug regimens: diazepam; chlorpromazine (largactil), phenargan, and diazepam; and largactil, pethidine, and phenargan.
• Comparison of perinatal mortality rates and stillbirth occurrences across the treatment groups.

Main Results:

• The perinatal mortality rate for eclamptic babies was 32.7%, substantially higher than the overall rate of 10.5%.
• Mortality rates varied significantly by treatment group: 23.8% (Group I), 18.8% (Group II), and 66.6% (Group III).
• Group III (largactil, pethidine, phenargan) exhibited the highest stillbirth rate (6/8). 100% stillbirth occurred in infants born between 28-32 weeks gestation and weighing less than 1.5 kg.

Conclusions:

• Maternal eclampsia significantly increases perinatal mortality.
• The combination of chlorpromazine (largactil) and pethidine appears to potentiate respiratory depression, leading to higher rates of stillbirth and neonatal death.
• Gestational age (28-32 weeks) and low birth weight (<1.5 kg) are critical factors for stillbirth, irrespective of the drug regimen used.