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Hypertensive disorders of pregnancy remain one of the leading direct causes of maternal and perinatal morbidity and mortality in South Africa. A recent cohort study at facility level in South Africa reported a 1% mortality in 1 547 women with preeclampsia, of whom 147 (9.5%) developed eclampsia. Of 1 589 births, there were 332 (21%) perinatal deaths, of which 281 (84.6%) were stillbirths.1 The latest Report on Confidential Enquiries into Maternal Deaths (2014–2016) indicates 661 maternal deaths in patients with hypertensive disorders of pregnancy, with the most primary obstetric complications being eclampsia, severe hypertension, HELLP syndrome (haemolysis, elevated liver enzymes, low platelet count) and liver rupture.2 Eclampsia was the largest sub-category contributing to maternal death. Cerebral complications were the single most common final cause of death in patients with hypertensive disorders (357/661 [54%]).

A retrospective audit of anaesthesia for caesarean section in parturients with eclampsia at a tertiary referral hospital in Cape Town