What is the leading direct cause of maternal death in women who die from eclampsia?

• A Pulmonary oedema and aspiration pneumonitis
• B HELLP syndrome with spontaneous hepatic rupture
• C Acute tubular necrosis causing renal failure
• D Intracranial haemorrhage ✓

Explanation

Intracranial haemorrhage, resulting from the combination of extreme hypertension, loss of cerebral autoregulation, and fibrinoid necrosis of cerebral vessels, is the most common cause of death in eclampsia. This underpins aggressive control of severe systolic hypertension, since lowering systolic pressure below 160 mmHg reduces haemorrhage risk. Pulmonary oedema, renal failure, hepatic rupture, and aspiration are recognised contributors but individually account for fewer deaths than cerebral haemorrhage in classic series of eclamptic mortality.

Reference: Williams Obstetrics, 26th ed.

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