Evolution of Magnesium Sulphate for Eclampsia

Eclampsia is said to occur when a woman with preeclampsia experiences generalised tonic-clonic seizures during pregnancy or shortly after delivery [1]. Eclampsia complicates between 1 to 2% of all cases of severe preeclampsia [2]. Preeclampsia is a multi-systemic disorder, characterised by hypertension and proteinuria occurring after the 20th week of pregnancy in a woman who has been previously normotensive and non-proteinuric. It is classified as one of the hypertensive disorders of pregnancy [1,2]. Eclampsia was first associated with albuminuria in 1839, before hypertension in 1897 [3]. These discoveries, coupled with the introduction of antenatal care in the first decade of the 20th century, led to better understanding and earlier diagnosis of the precursor condition known as preeclampsia. In spite of this, mortality from eclampsia still remained high in the 20th century, necessitating active search for treatment [3]. The low and middle income countries suffer a disproportionately higher morbidity and mortality from preeclampsia and eclampsia. The incidence of eclamptic convulsions reported in developed countries is 1/2000 while in developing countries; the incidence varies from 1/500 to 1/50 deliveries [4]. Most (99%) of the 63,000 women worldwide that die every year from preeclampsia and eclampsia are in low-income countries [5]. The reported case fatality rates from eclampsia range from 1.8% in some centres in high-income countries, to as high as 15% in Nigeria and Bangladesh [6,7]. This condition accounts for 25% of maternal deaths in Latin America and 10% of maternal deaths in Africa and Asia [8].