Early diagnosis of “eclampsia”: A challenge in resource limited setting-A case study from primary health centre of Bihar, India

Eclampsia is defined as onset of grand mal seizure activity or unexplained coma during pregnancy or postpartum period usually in a woman previously diagnosed with pre-eclampsia. According to the available evidence, the eclampsia/pre-eclampsia accounts for almost 5% of maternal deaths in India.

Incidence occurred in one of the high delivery load Primary Health Centre (PHC) of Bihar where a mentoring program was being conducted for PHC nurses. A full term pregnancy mother, 4^th gravida arrived at PHC. On examination, mother was identified as having labour pain, vital signs were within normal range & cervical dilation was 6 cm. Mother was shifted to the ward to wait for impending delivery where mother developed tonic-clonic seizures. Seizure treatment was initiated as per GOI guidelines by ANMs under the guidance of mentoring team. Screening test was done from private lab, which confirmed the diagnosis of eclampsia. Mother was transferred in private vehicle to higher centre since ambulance service was not available

In this case mother did not undergo antenatal check up. At the time of admission, blood pressure of the mother was within normal range & associated symptoms were absent still the mother developed eclampsia. Since the resources were not available at PHC for screening of preeclampsia. Hence, difficulty regarding timely case identification and management was faced. It shows the situation of antenatal clinics and 24x7 PHC of Bihar.