Anesthesiological Management of Eclampsia in Tropical Africa: Experience of the University Hospital Center of Bouake

Introduction: Eclampsia is a common cause of maternal mortality in developing countries. The objective of this study is to evaluate the practice of anesthesia for eclampsia in tropical Africa. Patients and Methods: Retrospective descriptive study on the parturients who benefited from eclampsia anesthesia in the operating theaters of the gynecology and obstetrics department, the University Hospital Center (CHU) of Bouake over a two-year period (January 2015 to December 2016). The parameters studied were: anesthetic risk assessment, anesthetic management, immediate anesthetic and post-anesthetic accidents and incidents. Results: Out of a total of 3831 emergency cesarean sections, 65 were for eclampsia, or 1.69% of obstetrical surgical activity. The mean age of the patients was 20.30 ± 3.34 years (range: 14 years and 39 years). Prenatal consultation was not performed in 70% of cases and 85% of patients were primiparous. Patients classified as ASA IIIU accounted for 75% of the population and in 62% of cases, the Glasgow score was between 9 and 12. Induction was achieved with thiopental in 98% of patients and vecuronium was the only muscle relaxant used. The most common fetal complications were hypotrophy (50%), prematurity (30%) and respiratory distress (40%). Postoperative anesthetic complications were agitation (70%) and wake delay (15%). Maternal mortality was 5% and the neonatal death rate was around 7.69%. The elements of poor maternal prognosis were the ASA IVU class (P = 0.015) and the Aldrete awakening score between 3 and 5 awakening (P = 0.001). Conclusion: Anesthesia for eclampsia at CHU of Bouake is difficult. It needs to be improved thanks to better equipment of the health structures.