Characteristics of symptoms of imminent eclampsia: A case referent study from a tertiary hospital in Tanzania

Background: Maternal mortality in developing countries is unacceptably high with eclampsia being consistently among the top causes. As yet, primary prevention of this complication is not possible since causes of pre-eclampsia are largely unknown and biochemical, hematological and radiological markers have proved unsuitable for routine prediction of eclamptic fits. Although headache, visual disturbance, abdominal pain, nausea, and vomiting are routinely elicited when managing pre-eclampsia and have been reported to predict eclamptic fits, the literature attempting to characterize them is scanty. We sought to establish characteristics of the prodromal symptoms of eclampsia and compare them with similar symptoms as experienced by normotensive pregnant women at Muhimbili National Hospital (MNH) in Tanzania. Methods: This study was conducted at MNH in 2010 by enrolling 123 eclamptic and 123 normotensive women. Women in the two groups were interviewed about their experiences and characteristics of headache, visual disturbances, abdominal pain, nausea and vomiting using a semi structured questionnaire. The severity, nature and other characteristics of the symptoms were assessed using standard scale/methods and data compared among the two groups. Results: Prodromal symptoms of eclampsia were present in 90% of eclamptic women. Headache was more frequent among eclamptic women (88%) than the normotensive (43%), p < 0.001). The symptom was also more perceived as severe among eclamptic (46.3%) than the normotensive (5.7%), p < 0.001. The most frequent location for headache was frontal in 65.7% of eclamptic women compared to frontal (41.5%) or generalized (39.6%) for the normotensive. Likewise, visual problems were significantly more frequent among eclamptic women (39%) compared to the normotensive (3%), p < 0.001. Upper abdominal pain was significantly more reported by eclamptic (36%) than normotensive women (0.9%), p = 0.001. The general occurrence of abdominal pain, nausea and vomiting was not significantly different in the two groups. The time lag from development of a symptom to eclamptic fit was up to seven days for most symptoms except visual disturbances of which 98% developed fits within 12 hours. Conclusion: Whereas the prodromal symptoms of eclampsia and similar symptoms in normotensive women were common, the characteristics of headache and visual disturbance differ significantly in the two groups. The knowledge of these differences could be utilized to improve the quality of management of pre-eclamptic women in order to prevent eclampsia.