ROL Eclampsia

REVIEW OF LITERATURE
HISTORICAL ASPECTS4
The disease “eclampsia” is known since the birth of modern medicine
and even before that. The syndrome of pre-eclamptic toxemia is known for the
last 200 years. Still, the disease continues to haunt the obstetrician with
considerable severity.
Oldest source for eclampsia literature starts from 22,00 BC, when Kahun
Papyrus mentioned - the use of a wooden stick to prevent the mother from
biting her tongue on the day of delivery.
Indian Atharvaveda and Sushrutha Samhita of old but unknown dates
mention eclampsia. Atharvaveda described an amulet, to be worn by the
mother at her 8th month of pregnancy for warding off convulsions during child
birth.
In Sushrutha Samhita, it has been mentioned that, `the child moving in
the womb of a dead mother, who had just expired from convulsions, should be
delivered by cutting open the abdomen’.
Hippocrates, in his aphorisms section VI, No.39, wrote convulsion take
place either from repletion or depletion. He noted that headaches, convulsions
and drowsiness represented omnious signs in postpartum period.
Rossilin (1513) listed unconsciousness with convulsions is the omnious
sign of eclampsia.
Gaebel Khouren (1596) stated that pregnant uterus causes convulsions
particularly if it contains a malformed fetus.

According to Dentar and co-workers, the word `eclampsia’ first
appeared in the treatise on gynaecology by varandeous in 1619.
Pan (1664) mentioned generalised clonic spasms in pregnancy.
Mauriceau (1668) stated that the danger to the mother and fetus is more,
if the mother doesnot recover consciousness between convulsions. He
recognised that primigravidas are more at risk of convulsion than multigravidas
and the disease can be treated by prompt delivery.
In 1722, Deltamohe recognised that early delivery in these patients
facilitated their recovery.
In 1768, Denman said that disease seldom or never occured in towns
where people lived luxuriously. He described medical management versus
termination of pregnancy.
In 1778, Levergel suggested early induction of labor and even caesarean
section at one time as immediate means for the patient recovery. The prime
object of a phlebotomy was to reduce cerebral congestion, which was thought
as a cause of convulsion.
Demanet (1797) was the first to relate convulsions with oedema. Rayer
(1840) found protein in the urine of these pregnant oedematous patients.
Brights description of acute nephritis in 1827 made kidney disease
fashionable. Since oedema and albuminuria were characteristic features of both
eclampsia and nephritis, eclampsia was thought to be renal disorder and
convulsions were attributed to ureamia. When this was disproved, new theories
proliferated. Some authors hypothesised that eclampsia was due to compression of ureters, others to a
summation of external irritants and a few
returned to the idea that it was simply epilepsy.
Credited with the discovery of proteinuria in eclampsia, Lever (1843)
observed that proteinuria disappeared following delivery and therefore
eclampsia is not due to nephritis. Lever also observed that eclampsia was more
common in first pregnancies than subsequent ones.

In 1884, Delore was certain that the cause was a specific bacterium
which he named bacillus eclampsiae, until to his dismay, it was identified as a
common organism Proteus vulgaris. Then the idea took hold that the disorder
was due to the existence of specific toxins of pregnancy which were produced
in the placenta ( Ahlfeld, 1894) and thus it came to be called toxemia.
In 1905, J.B. Delee of Chicago read every thing on toxaemia he could
lay his hands on, and concluded with a touch of exasperation “you all know the
trite expression of zwiefel, that eclampsia is a disease of theories, that I have
had more and more proved to me as I waded through the oceans of literature..
As a matter of fact we know practically nothing of the causation of eclampsia.
A theory has only to be set up by one investigator to be knocked down by
another.... only one point seems to be generally considered, that eclampsia is
due to the action of a toxin in blood upon the nerve centres”.
When cause of a disease is obscure, rational treatment is difficult and
there is often a multiplicity of remedies. So, was it with toxaemia.
Stronganoff and Tweedy believed in sedation to control the convulsions
and in complete non-interference with pregnancy. Tweedy advocated in
addition, elimination of toxin by stomach wash, purge and bowel wash. In
1919 Tweedy reported maternal mortality of 8.1%.
Titus and Givens (1992), are credited with introduction of I.V. glucose
solutions.
MgSO4 was used as purgative both orally or rectally since 1700. In
1906, Horn first reported parentral use of MgSO4 which was given
intrathecally.
In 1954, Taylor, Tillman and Blanchard compared the rates of still birth
week by week, with the rates of neonatal death to be expected if the infants had
been delivered in each given week. Taylor concluded that the degree of
proteinuria is more critical than the level of blood pressure in determining the
fetal death.
In 1968 Lean, Ratnam and Sivasamban reported perinatal mortality of
11% with immediate caesarean section and prompt induction of labor. The
primary reliance was on quick delivery.
By late 1920’s the Slogan in the treatment of eclampsia became, `treat
the eclampsia medically and ignore the pregnancy’ since then almost every
drug having a sedative, anti- hypertensive or a diuretic effect has been
introduced in the management of eclampsia.

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REVIEW OF LITERATURE

The disease “eclampsia” is known since the birth of modern medicine

biting her tongue on the day of delivery.

Indian Atharvaveda and Sushrutha Samhita of old but unknown dates

mention eclampsia. Atharvaveda described an amulet, to be worn by the

In Sushrutha Samhita, it has been mentioned that, `the child moving in

delivered by cutting open the abdomen’.

Hippocrates, in his aphorisms section VI, No.39, wrote convulsion take

place either from repletion or depletion. He noted that headaches, convulsions

and drowsiness represented omnious signs in postpartum period.

Rossilin (1513) listed unconsciousness with convulsions is the omnious

Gaebel Khouren (1596) stated that pregnant uterus causes convulsions

particularly if it contains a malformed fetus.

appeared in the treatise on gynaecology by varandeous in 1619.

Pan (1664) mentioned generalised clonic spasms in pregnancy.

if the mother doesnot recover consciousness between convulsions. He

recognised that primigravidas are more at risk of convulsion than multigravidas

and the disease can be treated by prompt delivery.

In 1722, Deltamohe recognised that early delivery in these patients

facilitated their recovery.

In 1768, Denman said that disease seldom or never occured in towns

where people lived luxuriously. He described medical management versus

In 1778, Levergel suggested early induction of labor and even caesarean

object of a phlebotomy was to reduce cerebral congestion, which was thought

(1840) found protein in the urine of these pregnant oedematous patients.

Brights description of acute nephritis in 1827 made kidney disease

fashionable. Since oedema and albuminuria were characteristic features of both

eclampsia and nephritis, eclampsia was thought to be renal disorder and

returned to the idea that it was simply epilepsy.

Credited with the discovery of proteinuria in eclampsia, Lever (1843)

observed that proteinuria disappeared following delivery and therefore

common in first pregnancies than subsequent ones.

which he named bacillus eclampsiae, until to his dismay, it was identified as a

in the placenta ( Ahlfeld, 1894) and thus it came to be called toxemia.

In 1905, J.B. Delee of Chicago read every thing on toxaemia he could

trite expression of zwiefel, that eclampsia is a disease of theories, that I have

As a matter of fact we know practically nothing of the causation of eclampsia.

A theory has only to be set up by one investigator to be knocked down by

another.... only one point seems to be generally considered, that eclampsia is

due to the action of a toxin in blood upon the nerve centres”.

When cause of a disease is obscure, rational treatment is difficult and

there is often a multiplicity of remedies. So, was it with toxaemia.

Stronganoff and Tweedy believed in sedation to control the convulsions

and in complete non-interference with pregnancy. Tweedy advocated in

addition, elimination of toxin by stomach wash, purge and bowel wash. In

1919 Tweedy reported maternal mortality of 8.1%.

MgSO4 was used as purgative both orally or rectally since 1700. In

primary reliance was on quick delivery.

By late 1920’s the Slogan in the treatment of eclampsia became, `treat

drug having a sedative, anti- hypertensive or a diuretic effect has been

introduced in the management of eclampsia.

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