Analysis of the causes of maternal death in eclampsia

Objective: To analyze the causes of maternal death in eclamptic mothers. Materials and method: The study was conducted over a period of one year 1.1.201231.12.2012 in all eclamptic mothers. Pregnancy was terminated in all antenatal eclampsia irrespective of gestational age. All of them were treated with Pritchard regimen of Magnesium Sulphate (MgSO4). Preeclampsia profile and special investigations were done. Sublingual/ intranasal/oral nifedipine and oral labetalol were used as antihypertensive. Results: Incidence of eclampsia was 3.57%, case fatality rate was 3.57% and maternal mortality ratio was 4.32/1000 live births. 29.76% maternal death was due to eclampsia. All 25 dead mothers were hypertensive during admission. Among them 64% (16) mothers had severe hypertension. 44% mothers had repeated convulsion. In majority (60%) MgSO4 regimen could be started after 12 hrs convulsion. 33.33% of dead mothers delivered within 12 hr of admission. 9 (42.85%) mothers died before delivery. 3 mothers came after outside delivery. 36% mothers died within 12hrs. 48% mothers died in the next 12 hrs and 16% (4) mothers died 48hrs after admission. 52.38% mothers had vaginal delivery. Only 4.7% had caesarean delivery. 40% mothers died of cerebral hemorrhage. 28% mothers died of pulmonary edema, 12% due to postpartum hemorrhage and 2 mothers due to hepatic coma. One mother died of aspiration, one mother due to septicemia. One died due to acute renal failure. Conclusion: we have a long way to go to achieve the goal to reduce the maternal mortalily due to preventable causes. We have to improve our existing health care delivery system, referral system and infrastructure before achieving the target.