Perinatal mortality in eclampsia in relation to drug therapy.

Fifty-nine babies were born to eclamptic mothers among 7500 deliveries giving incidence of occurrence of 0.77 percent. The perinatal mortality in eclamptic babies was 32.7%, whereas the total perinatal mortality rate amongst all the deliveries was 10.5%. The mothers were treated within Group I--diazepam, Group II i chlorpromazine (largactil), phenargan and diazepam and Group III--largactil, phethidine and phenargan. The mortality rate was 23.8%, 18.8% and 66.6% respectively. The highest number of still-born i.e. six out of 8 occurred in Group III. Hundred percent still-born was noted in 28-32 weeks of gestation and birth weight less than 1.5 kg irrespective of drug regimes. Iargactil potentiates the respiratory depressant effect of pethidine and may cause high rate of still-birth and death after birth.

PIP: Between May 1986 and April 1987 in India, 59 infants were born to mothers with eclampsia at the R.G. Kar Medical College and Hospital in Calcutta. The eclampsia rate was 0.77% (59/7500 deliveries). The perinatal mortality rate for eclamptic infants was 32.7%, compared to 10.5% for the total perinatal mortality rate. Pediatricians divided the infants into 3 groups based on the drug used to treat eclampsia: diazepam only (group I); largactil, diazepam, and phenargan (group II); and largactil, pethidine, and phenargan (group III). Group III infants had the greatest mortality rate (66.7%), followed by group I infants (25.8%) and group II infants (18.1%). The still born rate was also highest among group III infants (40.02% vs. 4.76% for group I and 4.52% for group II). Since largactil enhances the respiratory depressant effect of pethidine, it may account for the higher mortality among group III infants. The mode of delivery associated with the highest mortality rate was forceps delivery (35%), largely because forceps were used in very sick mothers and those who were in more intractable convulsion. All infants less than 1.5 kg at 28-32 weeks gestation died. The fact that another study found the mortality rate for this infant group to be 18.28% indicated that the high mortality was due to the effect of the drugs. The mortality rate of the 1.5-2 kg group at 28-32 weeks gestation was 50%. Based on these findings, the pediatric researchers concluded that the combination of pethidine and largactil was responsible for the high mortality rate, especially the still born rate.

Cord blood diazepam: clinical effects in neonates of eclamptic mothers.

Diazepam used in the treatment of eclampsia crosses the placental barrier readily, and may cause various clinical effects in the neonates. Twenty-five (25) live born babies of eclamptic mothers receiving diazepam were studied and cord blood diazepam concentration was estimated. Effect of low dose of diazepam is minimal apart from lowering of rectal temperature and the effects lasted for a period of 12 hours. But high dose (> 30 mg) of diazepam and prolonged duration of diazepam therapy in mothers causes significant depression of the newborn and the effects lasted for a period of 36-48 hours. As the clinical condition of the newborn is not related to the diazepam concentration in cord blood, the cord blood estimation is not helpful in the assessment of clinical effects of the drug in newborn. The tissue storage of the drug in newborn appears to be responsible for the clinical effects.

Incidence of neonatal bacterial infection in cases of prolonged rupture of amniotic membrane.

Thirty cases of premature rupture of amniotic membrane were studied bacteriologically. Twenty cases showed growth of organisms from one or more sites at birth. From 20 control cases no pathogenic organism could be isolated. Out of these 20 cases showing growth of organisms 8 neonates developed clinical infection (deep and superficial) subsequently. The organisms grown from vaginal swab and umbilical swab culture showed maximum correlation to the organism from the infected neonates. Esch coli was found to be most common organism causing infections, next to it was Staph aureus. Growth of anaerobic organisms was found only in cases of prolonged rupture of membrane in mother, but not isolated from infected babies. So bacteriological studies of vaginal, placental, umbilical and nasal swabs and cord blood just after the birth of baby may be of some help in predicting the onset of neonatal infection.