Symptoms of imminent eclampsia among women attending care at Muhimbili National Hospital: a case refferent study

Abstract

ABSTRACT Background Preeclampsia affects about 5 to 10% of all pregnancies and eclamptic seizure is one of its serious complications. In many developing countries including Tanzania, maternal and perinatal mortality due to eclampsia are high. As yet, primary prevention of eclampsia is not possible since the causes are largely unknown. Headache, visual disturbance, abdominal pain, nausea, and vomiting have been reported by various studies to precede most eclamptic seizures; thus could be used to predict and therefore prevent some cases given the availability of magnesium sulphate. These symptoms however are also common in normal pregnancy and post delivery mothers due to physiological changes of pregnancy and common disease conditions that usually affect pregnant women in our settings. The present study evaluated the characteristics of symptoms that are consistent with imminence of eclampsia Methodology This was a case referent study in which 123 eclamptic and 123 non eclamptic mothers that best matched in terms of age, parity, gestation age and delivery were enrolled, making a total of 246 women. The presence and characteristics of headache, visual disturbance, abdominal pain, nausea, and vomiting were enquired. A 4 grade scale was used to grade the severity of headache. In the rest of symptoms, common presenting features were utilized. vii Results Headache was common in both groups but was more frequent in eclamptic than in referent group of women (88% vs. 43%, p <0.001). In eclamptic mothers headache was mainly severe, frontal and most of the seizures happened within one week of the onset of headache, as compared to referent women where headache was mostly mild and either frontal or generalized. Visual problems were significantly frequent in eclamptics than in referent women, (39% vs. 3% p<0.001). Of the eclamptic mothers who presented with visual problems, 45(94%) had blurring of vision, 32(67%) had blind spots, 10(21%) had photophobia and only 7(15%) had total blindness. A total of 47(98%) of eclamptic mothers developed seizures within 12hours of the onset of visual problems. The frequency of abdominal pain was not significantly different between eclamptic and referent mothers (47% vs.38% p=0.156), however upper quadrant abdominal pain was significantly reported in eclamptic than in referent group of women (36% vs.9%, p=0.001). There was no significant difference on the type of abdominal pain presented by both groups. Nausea was common in both eclamptics and referent group of women (60% vs. 54%, p=0.303). There was no difference on presentation with vomiting among eclamptic and referent women (62% vs. 68% p=0.516) and in both groups the type of vomiting was commonly non projectile. Conclusion This study has revealed that headache, abdominal pain, nausea and vomiting are common to pregnancy whether or not complicated by preeclampsia/eclampsia. The characteristics of headache, visual disturbances and abdominal pain differ between eclamptics and viii women without preeclampsia/eclampsia. In a pre eclamptic woman, an onset of a severe frontal headache or upper quadrant abdominal pain would suggest an occurrence of seizures within one week. Visual disturbance is the most ominous sign as seizures ensue within 12 hours of its onset. Nausea and vomiting cannot be reliably used to predict eclampsia.