Clinical morbidities, trends, and demographics of eclampsia: a population-based study

Abstract

OBJECTIVE We sought to identify trends, demographics, and pre-pregnancy and peripartum morbidities of eclampsia in California. STUDY DESIGN We identified cases of eclampsia by International Classification of Diseases, Ninth Revision code using California health discharge data from 2001 through 2007. Cases with missing race/ethnicity as well as age <15 years or >55 years were excluded. Among the remaining cases, patients with eclampsia (n = 1888) were compared against those without (n = 2,768,983). Adjustments were performed for potential confounding variables using logistic regression. Significance was set at P < .05. RESULTS The incidence of eclampsia decreased over time, from 8.0 cases per 10,000 deliveries in 2001, to 5.6 cases per 10,000 deliveries in 2007 (P < .001). There was a bimodal distribution in age-related risk, with the highest risks at the extremes of age. Non-Hispanic blacks were associated with the highest risk of eclampsia while Asians had the lowest risk. Several antepartum morbidities had increased associations with eclampsia, including preexisting cardiac disease (adjusted odds ratio [OR], 6.84; 95% confidence interval [CI], 5.40–8.66), lupus erythematosus (adjusted OR, 3.68; 95% CI, 1.53–8.86), and twin gestations (adjusted OR, 3.28; 95% CI, 2.70–3.99). Peripartum complications increased in eclampsia included cerebrovascular hemorrhage/disorders (adjusted OR, 112.15; 95% CI, 77.47–162.35), peripartum cardiomyopathy (adjusted OR, 12.88; 95% CI, 6.08–27.25), amniotic fluid embolism (adjusted OR, 11.94; 95% CI, 3.63–39.21), and venous thromboembolism (adjusted OR, 10.71; 95% CI, 5.14–22.32). CONCLUSION This large population database confirms that there is a decline in eclampsia over time. However, there are extremely morbid complications associated with eclampsia, emphasizing the need for its close monitoring and prevention.

A correlation of lactate dehydrogenase enzyme levels in pregnancy induced hypertensive disorders with severity of disease, maternal and perinatal outcome

“…13 Our study also proved that eclampsia was more common at an early age which is also proved by Fong et al, which states that eclampsia has a bimodal distribution which peaks in youngest and oldest age group. 14 Jaiswar et al, observed the mean LDH level in control was 278.33±119.25 IU/L, in mild preeclampsia was 400.45±145.21 IU/L, severe preeclampsia was 646.95±401.64…”

Peripartum Cardiomyopathy

“…32 The prevalence of preeclampsia in many of these studies may be underestimated because preeclampsia is often underreported and misclassified and because the presence of preeclampsia is often used as an exclusion criterion from the diagnosis of PPCM. PPCM is also frequently found in association with eclampsia, with an odds ratio of 12.9 in a California population study of 1888 patients with eclampsia 33 and 27.9 in the multistate hospital discharge study of PPCM cases noted above. 18 It is important to realize that preeclampsia or pregnancyinduced hypertension can also trigger pulmonary edema in the absence of PPCM.…”

Eclampsia: maternal and perinatal outcome among tribal population of Bastar, Chhattisgarh, India in a tertiary care centre

“…[12][13][14][15] The incidence of eclampsia in developed countries is estimated to about 5-7/10,000 deliveries whereas in developing countries varies widely 1 case/100 to 1 case/1700 pregnancies. 5,16,17 Majority of the patients are of primigravida (78.8%) in their early reproductive age <25 years (60.4%) with unsupervised pregnancy ( in their antenatal period and referred cases (76.8%). These data's are comparable to other studies.…”

“…PPH (8.4%), APH (6.8%), ARF (13.2%), Hypertensive retinal changes (5.6%), pulmonary oedema (4.4%), HELLP syndrome (4.4%), DIC (2.0%), Septicaemia (2.8%), prolonged unconsciousness (1.2%) and death (11.2%) similar to study of Pradeep MR et al, Sunita TH et al and the study conducted in Nigeria but case fatality rate (11.2%) is very high in comparison to other Indian studies as well as from developed countries because of being a tribal area there are limited health resources and there is delay in reaching the tertiary care centre as most of the cases (52/84) developing complications having large interval (>12 hrs) from onset of convulsion to delivery which is a significant factor determining the maternal as well as perinatal outcome. 5,[8][9][10]12,18,19,[23][24][25] Most common cause of maternal death in our study is pulmonary oedema (21.4%) because of limited facility of intensive care unit, ventilator as well as large drainage area of poor tribal population. Other deaths are due to HELLP syndrome, ARF, Septicaemia, Cerebral haemorrhage and multiorgan failure.…”

“…The incidence is much higher in India and other developing countries ranges from 1 in 100 to 1 in 1700 pregnancies, where as in developed countries it is 1 in 2000 to 1 in 3448 pregnancies. [2][3][4][5] Perinatal mortality is reported to be 5%-11% in developed countries where as it is as high as 40 % in developing countries. 6,7 According to recent studies due to ignorance regarding antenatal check-up, lack of transport and lack of early communication with tertiary hospital, play an important role in perinatal morbidity and mortality of eclampsia cases.…”