International Journal of Gynecology and Obstetrics 116 (2012) 232236

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International Journal of Gynecology and Obstetrics

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CLINICAL ARTICLE

Management of eclampsia at Assiut University Hospital, Egypt

Diaa E.M. Abd El Aal , Ahmed Y. Shahin
Department of Obstetrics and Gynecology, Women's Health Center, Assiut University, Assiut, Egypt

a r t i c l e

i n f o

Article history:
Received 1 April 2011
Received in revised form 11 October 2011
Accepted 23 November 2011
Keywords:
Eclampsia
Intensive care unit
Magnesium sulfate
Nifedipine

a b s t r a c t
Objective: To evaluate the protocol used for management of eclampsia at Assiut University Hospital, Assiut,
Egypt. Methods: In a prospective cross-sectional study, data were collected from 1998 women treated for
eclampsia at Assiut University Hospital between January 1990 and January 2010, including 1594 cases of
prepartum eclampsia, 75 of intrapartum eclampsia, 16 of intercurrent eclampsia, and 313 of postpartum
eclampsia. The treatment regimen included use of nifedipine as an antihypertensive, magnesium sulfate as
an anticonvulsant, rapid interruption of pregnancy, and admission to the ICU. Data were evaluated for control
of blood pressure, prevention and control of convulsions, and maternal and perinatal outcomes. Results:
Magnesium sulfate was effective in controlling convulsions in 98.1% of women. Nifedipine initiated a smooth
decline in blood pressure (P > 0.0001). There were 79 maternal deaths (3.95%). Maternal morbidity occurred
in 439 (22%) women. Twenty-seven percent of women delivered vaginally (most of these women were
admitted postpartum). Perinatal mortality occurred in 7.9% of cases. Conclusion: A combination of nifedipine
as an antihypertensive drug, magnesium sulfate as an anticonvulsant, rapid interruption of pregnancy, and
managing the patients in the ICU resulted in a marked improvement in the outcome for both mother and
fetus at Assiut University Hospital.
2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

1. Introduction
In low-resource countries, annually 150 maternal deaths per
100 000 births are related to hypertensive disorders of pregnancy, as
compared with 4 maternal deaths per 100 000 births in high-income
countries [1]. Hypertensive disorders of pregnancy signicantly
increase fetal and neonatal morbidity and mortality [1].
Administration of calcium ion channel blockers such as nifedipine
is an ideal approach to the treatment of patients with hypertensive
disorders of pregnancy. The resulting vasodilator effect of nifedipine
is pronounced in vessels with high vasoconstrictor tone without
diminishing cardiac output. Nifedipine is effective in postpartum control of blood pressure among women with eclampsia [2].
Both the American Congress of Obstetricians and Gynecologists
[3,4] and the Royal College of Obstetricians and Gynecologists [5] recommend the use of magnesium sulfate for treatment of eclampsia,
and good results have been obtained with its use [6]. Management
of affected patients in the intensive care unit (ICU) is strongly recommended by all centers.
The aim of the present study was to evaluate the current protocol
used for management of women with eclampsia in a women's health

Corresponding author at: Department of Obstetrics and Gynecology, Women's

Health Center, Assiut University, Assiut, Egypt. Tel.: + 20 105212137; fax: + 20
2088333327.
E-mail address: abdelaald@yahoo.com (D.E.M. Abd El Aal).

hospital in Egypt in terms of control of blood pressure, prevention

and control of convulsions, and maternal and perinatal outcomes.
2. Materials and methods
In a prospective cross-sectional study conducted at the Women's
Health Hospital, Assiut University, Egypt, data were reviewed from
all women with eclampsia who were admitted to the Department of
Obstetrics and Gynecology between January 1, 1990, and January 1,
2010. The study was approved by the Institutional Review Board
and Ethics Committee.
The study exclusion criteria were all non-eclamptic causes of ts,
including hysterical causes and epilepsy. On admission, each patient
underwent electroencephalography (EEG) after rst-aid measures,
including inserting an intravenous line and clearing the respiratory
airway, were carried out. A careful history of tting was obtained
from the relatives and attendants who usually came in with the patient. Any suspicious EEG changes suggestive of epilepsy were taken
as exclusion criteria.
A complete and thorough medical history, including personal,
menstrual, obstetric, past history of previous convulsions, antipsychotic drugs, and family history of hypertension and convulsions
was taken from the patient, and a clinical and obstetric examination
was conducted. Urine analysis (particularly for proteinuria), complete
blood analysis, and renal and hepatic function tests were carried out.
The previous protocol for management of eclampsia before
1990 comprised the following points. Control of convulsions was

0020-7292/$ see front matter 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.
doi:10.1016/j.ijgo.2011.10.018

D.E.M. Abd El Aal, A.Y. Shahin / International Journal of Gynecology and Obstetrics 116 (2012) 232236

conducted by an intravenous bolus dose of 1020 mg of valium over a

period of 25 minutes, followed by a continuous intravenous infusion
of 2030 mg of valium in 500 mL of 5% dextrose into a large vein at a
rate not exceeding 2.5 mg/minute until the patient was drowsy (usually a total dose of 1030 mg), and then by continuous intravenous
infusion of valium at a rate of 2.510 mg/hour to maintain drowsiness
for 24 hours after either delivery or the last t. Control of blood pressure was attempted with no preferred anti-hypertensive agent. Interruption of pregnancy was achieved by induction of labor or by
cesarean delivery according to the obstetric indication. Patients
were managed in a semi-dark room with limited facilities because
of the unavailability of ICU at that time.
All studied women were treated by the current protocol as follows.
Control of convulsions was started by a loading dose of magnesium
sulfate (46 g intravenously), given over 10 minutes in 100 mL of 5%
dextrose, followed by 12 g/hour of magnesium sulfate (1 g/hour if
the patient weighed b55 kg; 2 g/hour if the patient weighed
>55 kg), given by continuous intravenous drip. Patient monitoring
included the presence of hypoactive knee jerk: if it became absent,
the intravenous drip was discontinued. The respiratory rate was
observed: rates above 12 cycles/minute ensured the absence of respiratory depression. An indwelling urinary catheter was inserted: the
lowest acceptable urinary output was 25 mL per hour or 600 mL per
24 hours. An intravenous line was established to maintain a continuous route for the administration of drugs and to maintain uid balance. If excess magnesium was suspected, respiration was supported
and the specic antidote (calcium gluconate or calcium chloride)
was administered (10 mL of a 10% solution by intravenous injection
very slowly in not less than 10 minutes). Monitoring of magnesium
sulfate toxicity continued when nifedipine treatment was started.
Control of blood pressure was achieved with antihypertensive
drugs when the diastolic blood pressure was more than 110 mm Hg.
Nifedipine was used primarily, and other drugs (angiotensin-converting enzyme inhibitors or sodium nitroprusside drip) were also administered if nifedipine treatment alone failed. The pregnancy was
terminated immediately after the patient became hemodynamically
stable (i.e. convulsions and blood pressure were under control), either by cesarean or by vaginal delivery if labor was imminent (maximally within 2 hours).
Immediately after delivery, the patient was transferred to ICU and
underwent meticulous observation, including heart rate and blood
pressure monitoring (every 15 min), and temperature and respiratory rate measurement (every 4 hours). Two venous cannulae were
inserted. A urinary catheter was inserted to measure urine volume
in 24 hours, and creatinine clearance and uid balance (intake and
output). Arterial cannulation in a radial artery was performed (Allen
test) to permit peripheral blood gas analysis and to detect collateral
ulnar circulation. Samples were taken for analysis of blood gases (peripheral arterial CO2 [PaCO2] and peripheral arterial O2 [PaO2]), and
liver and kidney function (1 mL of arterial blood in a sterilized heparinized syringe, and 10 mL of venous blood in 2 sterile glass tubes, respectively). A control sample was taken immediately postpartum and
before any treatment was received (except for the loading dose of
magnesium sulfate). The other 3 samples were taken 30 minutes,
24 hours, and 48 hours after delivery. Internal jugular vein cannulation was done for all patients. Fluid intake was balanced according
to central venous pressure (68 cm H2O). Respiration was mechanically assisted if needed.
Data are expressed as number (percentage) or mean SD. Blood
pressure values before and after nifedipine were compared via 2tailed Student t test. A P value of 0.05 was taken as signicant.
3. Results
Data from 1998 women were included in the study: 1594 (79.8%)
women had prepartum eclampsia (took place before true labor

233

pains), 75 (3.8%) had intrapartum eclampsia (eclamptic ts after the

onset of true labor pains), 16 (0.8%) had intercurrent eclampsia
(eclamptic ts had no relation to labor pains), and 313 (15.7%) had
postpartum eclampsia (ts after delivery).
There were no signicant differences in age or parity among the
groups of patients with different types of eclampsia, but pregnancy
duration (weeks) was signicantly longer among women with postpartum eclampsia (Table 1). A recurrence of convulsions while receiving magnesium sulfate treatment occurred in only 39 (1.95%) of
women. The highest rate of recurrence was 35.9% (14 cases) in the
postpartum group as compared with 61.5% (24 cases) in the prepartum group, 2.7% (1 case) in the intrapartum group, and 0% (no
cases) in the intercurrent group.
A sublingual dose of 1020 mg of nifedipine initiated a smooth
and predictable decline in blood pressure (systolic and diastolic)
within 5 minutes, and produced a peak effect between 30 and 60 minutes. After nifedipine administration, blood pressure decreased to
approximately 16% of the pretreatment values. Good blood pressure
control was achieved in 93.5% of the patients. In all groups, there
was a signicant reduction in systolic and diastolic blood pressure
after nifedipine administration (P b 0.0001) (Table 2).
The dose needed to control blood pressure varied among the different groups of patients, with marked individual variations in response to treatment. There was no correlation between the
nifedipine dose required per day and either the pre- or posttreatment blood pressure.
There were 79 maternal deaths, representing a case fatality rate of
3.95%. The highest rate occurred in the postpartum group (25 cases)
(Table 3). With regard to maternal morbidity, 439 (22%) women
had severe morbidity. The postpartum group had the highest rate of
morbidity (31.3%), whereas the intercurrent group had the lowest
rate (12.5%).
The most common morbidities were a marked deterioration in
kidney function without reaching acute renal failure (78 women), a
marked deterioration in liver function (49 women), a signicant deterioration in arterial blood gases and acidbase parameters (87
women), postpartum hemorrhage (44 women), thrombocytopenia
(38 women), recurrence of ts while receiving treatment (25
women), coagulation disorders (29 women), HELLP (hemolytic anemia, elevated liver enzymes, low platelet count) syndrome (20
women), acute renal failure that required dialysis (15 women), and
visual disturbances (8 women, 2 of whom had temporary loss of vision) (Table 3). Women with intrapartum eclampsia had the highest
increase in serum bilirubin, liver enzymes (Table 4), and blood urea;
those in the prepartum group had the highest increase in serum creatinine; and those in the postpartum group had the highest increase
in uric acid. The intrapartum group showed the highest reduction in
creatinine clearance (Table 5).
Arterial blood gases and acidbase balance were affected in all 4
patient groups. Thus, statistical analysis was done for all patients
with eclampsia. pH showed a signicant increase after 24 and
Table 1
Clinical characteristics of women with different types of eclampsia.
Item

Prepartum Intrapartum Intercurrent Postpartum

eclampsia
eclampsia
eclampsia eclampsia
(n = 313)
(n = 16)
(n = 1594) (n = 75)

Age, y
Mean SD
25.1 6.4
Range
1645
Parity
Mean SD
1.7 2.3
Range
09
Duration of pregnancy, wk
Mean SD
37.1 2.8
Range
3640
a

Signicant at P b 0.05.

25.5 6.8
1845

23.5 6.0
1835

25.0 6.3
1745

2.0 2.5
08

1.0 2.2
06

1.6 2.3
09

37.8 2.6
3540

36.6 3.4
3539

39 2.2
3641

234

D.E.M. Abd El Aal, A.Y. Shahin / International Journal of Gynecology and Obstetrics 116 (2012) 232236

Table 2
Changes in blood pressure after use of nifedipine among the different groups of
patients.
Group

Systolic blood pressure,

mm Hg

Prepartum eclampsia
(n = 1594)
Intrapartum eclampsia
(n = 75)
Intercurrent eclampsia
(n = 16)
Postpartum eclampsia
(n = 313)
a

Diastolic blood pressure,

mm Hg

Before

After

163.2 22.2

140.2 14.2

113.8 14.9

Before

After
96 9.8

168.5 20.2

139.1 12.3

114.2 13.7

95.2 9.5

157.2 20.4

142.7 11.9

117.3 10.1

95 4.7

165.1 21.4

140.5 15.9

113.1 14.2

96.5 9.8

Signicant at P b 0.0001.

48 hours (P b 0.01 and P b 0.001). PaCO2 (mm Hg) decreased markedly

after 30 minutes and reached its lowest level after 48 hours (P b 0.05,
P b 0.01). PaO2 (mm Hg) was reduced markedly after 30 minutes
(P b 0.05) and continued to decrease signicantly (P b 0.05). Base excess increased after 30 minutes (not signicant), but had decreased
signicantly after 48 hours (P b 0.05). Bicarbonate concentration
showed a signicant increase after 30 minutes (P b 0.05). Oxygen saturation remained nearly the same (Table 6).
There was a high incidence of cesarean delivery (73%) among the
patient cohort: the incidence was highest in the prepartum group
(89.6%), and lowest in the postpartum group (2.9%) (Table 7). The incidence of perinatal mortality was 7.9%: the incidence was highest in
the intrapartum group (12.1%) and lowest in the intercurrent group
(7.4%). The overall incidence of low Apgar score at 1 minute (needing resuscitation) was 48.2%: the incidence was highest among
women with prepartum eclampsia (50.2%) and lowest among
women with intercurrent eclampsia (26.6%). At 5 minutes, the incidence of low Apgar score had dropped markedly to 7.4%. Most of
the neonates with low Apgar score at 5 minutes had intracranial
hemorrhage and marked respiratory distress syndrome owing to
prematurity (Table 8).
4. Discussion
The present study showed that magnesium sulfate controlled convulsions in 98.1% of women and prevented recurrence in almost the
same percentage. It has been reported that eclamptic convulsions
rarely, if ever, develop after the administration of standard regimens
of magnesium sulfate [6]. By contrast, Pritchard [3] and Sibai et al.
[4] reported that 10 of 83 women (12%), in whom eclampsia was
treated before delivery, experienced convulsions shortly after injection of the loading dose; however, most women remained free of seizures after an additional 2 g of intravenous magnesium sulfate.
Similar results were obtained by Smith and McEwan [7], and Rozenberg [8]. Magnesium sulfate, rather than phenytoin, reduces the risk
ratio of seizure recurrence and maternal death, and improves fetal
outcomes among eclamptic women [9]. Abd El Aal et al. [10] reported
that magnesium sulfate was effective in controlling convulsions in
98% of women, and that only 2% of women showed recurrence. Oladokun et al. [11] reported repeated convulsion in 15% of patients
Table 3
Maternal outcome among the different groups of patients.a
Maternal outcome

Survived
Died
Morbidity
a

Prepartum
eclampsia
(n = 1594)

Intrapartum
eclampsia
(n = 75)

Intercurrent
eclampsia
(n = 16)

Postpartum
eclampsia
(n = 313)

1543 (96.9)
51 (3.1)
324 (20.3)

71 (94.7)
4 (5.3)
15 (20.0)

16 (100.0)
0 (0.0)
2 (12.5)

289 (92.3)
24 (7.7)
98 (31.3)

Values are given as number (percentage).

Table 4
Liver function tests among the different groups of patients.a

Bilirubin, mg/mL
b1
12
>2
SGOT, U/mL
20
>20
SGPT, U/mL
16
>16

Prepartum
eclampsia
(n = 1594)

Intrapartum
eclampsia
(n = 75)

Intercurrent
eclampsia
(n = 16)

Postpartum
eclampsia
(n = 313)

513 (32.2)
972 (61.0)
109 (6.8)

46 (61.3)
20 (26.7)
9 (12.0)

9 (56.3)
6 (37.5)
1 (6.2)

229 (73.2)
68 (21.7)
16 (5.1)

821 (51.5)
773 (48.5)

34 (45.3)
41 (54.7)

9 (56.3)
7 (43.7)

162 (51.8)
151 (48.2)

834(52.3)
760 (47.7)

29 (38.7)
46 (61.3)

9 (56.3)
7 (43.7)

176 (56.2)
137 (43.8)

Abbreviations: SGOT, serum glutamic oxaloacetic transaminase; SGPT: serum glutamic

pyruvic transaminase.
a
Values are given as number (percentage).

receiving anticonvulsants. The reason behind this wide variation in

results is unclear; it might be attributed to differences in ethnicity,
and to better outcomes due to ICU management in the present study.
In Australia, Lee et al. [12] reported that no single antihypertensive drug was superior to other agents, and that nifedipine and labetalol had equal efcacy. In the present study, although good blood
pressure control was achieved in 93.5% of patients by the use of nifedipine alone, variable doses of nifedipine were needed to control
blood pressure, starting with a 1020 mg single oral dose and a
total dose ranging from 40 to 60 mg/day. There was wide variability
and marked individual variations in nifedipine dose according to the
response to treatment. In addition, there was no correlation between
the dose of nifedipine required per day and the pre- or posttreatment blood pressure. The present ndings are consistent with
those of Barton et al. [2], who suggested a total dose of 60 mg/day
in divided doses (10 mg/4 hours). Similarly, Fenakel et al. [13] suggested an initial dose of 1030 mg of nifedipine sublingually, and
achieved good blood pressure control in 95.8% of patients by oral administration of 80120 mg/day nifedipine. Other studies also indicate that oral nifedipine signicantly reduces both systolic and
diastolic blood pressure [10,14,15].
Luan [16] reported that early termination of pregnancy leads to
good outcome. No deaths occurred among 106 cases of eclampsia
after early termination of pregnancy by either vaginal or cesarean delivery. In the present study the maternal mortality rate was 4.1%,
which is nearly 50% lower than previous results at our institute [10].
Other studies have reported mortality rates ranging from as low as
2.9% [17], 3.3% (a population of eclamptic patients who were moribund at admission) [18], 9.5% [19], and 13% [3] to as high as 23.3%.
Onuh and Aisien [20] reported a case fatality rate of 10.7% (11

Table 5
Kidney function tests among the different groups of patients.a
Prepartum
eclampsia
(n = 1594)
Blood urea, mg/dL
b25
972
>25
622
Serum creatinine, mg/dL
1.4
954
>1.4
640
Serum uric acid, mg/dL
6
1083
>6
511
Creatinine clearance, mL/min
100
1076
>100
518
a

Intrapartum
eclampsia
(n = 75)

Intercurrent
eclampsia
(n = 16)

Postpartum
eclampsia
(n = 313)

(61.0)
(39.0)

19 (25.4)
56 (74.6)

7 (43.8)
9 (56.2)

176 (56.2)
137 (43.8)

(59.8)
(41.2)

24 (32.0)
51 (68.0)

7 (43.8)
9 (56.2)

170 (54.3)
139 (45.7)

(67.9)
(32.1)

30 (40.0)
45 (60.0)

6 (37.5)
10 (62.5)

187 (59.7)
126 (40.3)

(67.5)
(32.5)

35 (46.7)
40 (53.3)

7 (43.8)
9 (56.2)

193 (60.7)
120 (39.3)

Values are given as number (percentage).

D.E.M. Abd El Aal, A.Y. Shahin / International Journal of Gynecology and Obstetrics 116 (2012) 232236
Table 6
Changes in arterial blood gases and acidbase status among all patients.a
Time at sample taking

pH
PaCO2, mm Hg
PaO2, mm Hg
Base E
Bicarbonate
O2 saturation

Table 8
Fetal outcome among the different groups of patients.a

T + 30 min

7.34 0.01
33.70 0.61
116.20 6.30
1.81 2.04
18.90 0.34
97.47 0.33

7.37 0.30
31.60 0.56
106.90 4.70
1.85 1.32
20.30 1.40
97.54 0.25

T + 24 h
c
e

7.41 0.01
31.10 0.46
98.10 3.50
0.56 1.50
21.20 1.16
97.58 0.27

d
c

7.41 0.01
30.30 0.49
96.30 2.10
1.75 1.44
17.80 0.28
97.65 0.35

d
c
e

Values are given as mean SD.

T indicates immediately postpartum and before any treatment (except loading
dose of magnesium sulfate).
c
Signicant at P b 0.01.
d
Signicant at P b 0.001.
e
Signicant at P b 0.05.
b

maternal deaths among 103 women with eclampsia), and a maternal

mortality ratio of 22.97%. Munro [21] reported that 23% of study patients required ventilation, and 35% had at least 1 major complication.
The latest Saving Mothers Report (20052007) indicates that 55.3% of
maternal deaths caused by hypertensive disorders of pregnancy were
due to eclampsia. This compares to a value of 17.8% in the present
study: the postpartum group had the highest ratio (26.4%), and the
prepartum group had the lowest ratio (16.1%).
In the present study, there was marked signicant decrease in
PaO2 after 30 minutes. The main cause of a decrease in peripheral arterial oxygen tension may be an increase in oxygen consumption and
utilization by tissues over time to overcome the period of tissue hypoxia that follows low cardiac output. Young and Weinstein [22]
recorded shallow slow breathing in 79% of patients with eclampsia
who received 2 g of magnesium sulfate by rapid intravenous infusion,
which may explain the high PaCO2 noted in their study. In the present
study, magnesium sulfate was given by infusion, which may explain
the absence of similar respiratory effects in the patients.
Templeton and Kelman [23] found that, although patients with
eclampsia had a slightly lower mean PO2 value as compared with
normal pregnant women, the differences were insignicant and
most patients with eclampsia had a PaO2 value within the normal
range. They also found a signicant increase in the (Aa) PO2 difference, and an increase in physiological shunt, which indicates the
presence of a degree of pulmonary ventilation/perfusion imbalance.
Belfort and Kirshon [24] found a decrease in arterial O2 and CO2 tension in women with severe hypertensive disorders of pregnancy.
Their results are compatible with the results of the present study,
which found a decrease in O2 and CO2 tension. Belfort and Kirshon
[24] suggested that critical tissue hypoxia among patients with
eclampsia may explain the association of multiorgan dysfunction
with severe end-stage disease. In the present study, the pH increased
signicantly, possibly due to respiratory alkalosis. Belfort and Kirshon [24] also reported the same changes in PaCO2, pH, and arterial
blood base balance.
Kelton et al. [25] reported profound and progressive thrombocytopenia, which was particularly associated with compromised liver and
renal function. Although these serious changes may occur occasionally with minimal hypertension, thrombocytopenia was not correlated
with severity of hypertension in the present study.

Table 7
Mode of delivery among the different groups of patients.a
Mode of delivery

Prepartum
eclampsia
(n = 1594)

Intrapartum
eclampsia
(n = 75)

Intercurrent
eclampsia
(n = 16)

Postpartum
eclampsia
(n = 313)

Vaginal delivery
Cesarean delivery

109 (6.8)
1485 (93.2)

35 (46.7)
40 (53.3)

6 (37.5)
10 (62.5)

295 (94.2)
18 (5.8)

Values are given as number (percentage).

Prepartum
eclampsia
(n = 1594)

Intrapartum
eclampsia
(n = 75)

Intercurrent
eclampsia
(n = 16)

Postpartum
eclampsia
(n = 313)

Survived
Died
Apgar score at 1 minute
03
37
710
Apgar score at 5 minutes
03
37
71

1496 (93.5)
98 (6.5)

66 (88)
9 (12)

15 (93.8)
1 (6.2)

289 (92.3)
24 (7.7)

4 (6.1)
11 (16.7)
51 (77.2)

1 (6.6)
3 (20)
11 (73.4)

NA
NA
NA

0 (0)
2 (3)
64 (97)

0 (0)
0 (0)
15 (100)

NA
NA
NA

Fetal outcome
T + 48 h
c

235

184 (12.4)
492 (32.8)
820 (54.8)
3 (0.2)
106 (7.1)
1359 (90.8)

Abbreviation: NA, not applicable.

a
Values are given as number (percentage).

The incidence of cesarean delivery was 76.7% among all groups in

the present study as compared with values of 50.12% to 60% in previous reports [16,19]. At Assiut University Hospital, cesarean delivery is
preferred for eclamptic patients. It is preferred for patients who are
sure of their dates, and those whose cervix is not dilated enough to
deliver within 4 hours to avoid maternal deterioration. It is also preferred for those who, owing to a lack of health education, are usually
admitted with no previous prenatal care and with unsure dates in
order to protect a potentially preterm birth or a fetus with intrauterine growth restriction from going through vaginal delivery.
The perinatal mortality was 7.5% in the present study; only 1 neonatal death was reported during treatment for eclampsia, which represents an improvement of 5% over previous results obtained at our
institution before implementing the current protocol [10]. These ndings are low in comparison to other studies: with the exception of
Taner et al. [19], who recorded a high perinatal mortality of 59.1%,
reported values vary from 1 among 14 cases [21], to 6.4% [12] or
193 per 1000 [17]. Mortality was mostly related to either abruptio
placentae or extreme prematurity [3]. All of these results are comparable to the present ndings. The higher rates of cesarean delivery in
the present study might be justied by saving many preterm infants
from the sequelae of vaginal delivery. Also, most of the women presented with no labor pain and had ts before attending.
In conclusion, the combination of nifedipine as an antihypertensive drug, magnesium sulfate as an anticonvulsant, rapid termination
of pregnancy, and ICU management resulted in a marked improvement in maternal and fetal outcomes of eclampsia. Future studies
similar to the Lampet trial, which is still in the recruitment phase,
and comparisons of labetalol and magnesium sulfate for seizure prevention in eclampsia are needed.
Conict of interest
The authors have no conicts of interest.
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