Eclampsia: Trends in Incidence and Outcomes over 30 Years

O’Connor, Heather; Hehir, Mark P.; Kent, Etaoin; Foley, Michael; Fitzpatrick, Chris; Geary, Michael; Malone, Fergal D.

doi:10.1055/s-0032-1331026

Cited by 17 publications

(16 citation statements)

References 24 publications

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“…With preeclampsia complicating 2-8% of pregnancies and eclampsia occurring in 4-6 per 10,000 live births, 1 these hypertensive disorders of pregnancy remain among the principal causes of maternal and perinatal morbidity and mortality. In an attempt to provide a clear approach to the diagnosis, evaluation, and management of the different hypertensive disorders of pregnancy, the Society of Obstetricians and Gynaecologists of Canada (SOGC) endorsed a series of clinical practice guidelines (hereafter ''the guidelines'') based on the best available scientific evidence.…”

Section: Introductionmentioning

confidence: 99%

Magnesium sulfate for eclampsia prevention: Quality of care evaluation in a tertiary centre in Québec, Canada

et al. 2014

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Background: The current Canadian guidelines endorse the use of MgSO 4 for treatment of eclampsia and for prophylaxis in severe preeclampsia.Our study aimed to audit our institution's compliance regarding these guidelines. Methods:We conducted a retrospective study to evaluate MgSO 4 use in: all our cases of eclampsia since 2002, 50 cases of severe preeclampsia, and 50 cases of non-severe preeclampsia.Results: Sixty-five cases of preeclampsia were analyzed after initial chart review. A high rate of preeclampsia severity misdiagnosis was observed (35%, 23/65). Only 69% (25/36) of the patients correctly diagnosed with severe preeclampsia received MgSO 4 ; after diagnosis correction, 42% (25/59) of the patients with severe preeclampsia received the medication. Of our eight cases of eclampsia, none of the patients received MgSO 4 before the seizure (although three had clear indications). Conclusion:Given the importance of prophylactic MgSO 4 use in preventing eclampsia, we have implemented informative measures aimed at rapidly achieving complete compliance with the national guidelines.

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Section: Introductionmentioning

confidence: 99%

Magnesium sulfate for eclampsia prevention: Quality of care evaluation in a tertiary centre in Québec, Canada

et al. 2014

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“…6,10 Several recent studies from Canada and Ireland have demonstrated a decline in eclampsia incidence over time. Liu et al 6 found a decline from 12.4 per 10,000 to 5.9 from 2003 through 2009 in Canada, while O'Connor et al 4 found a decline from 5.4 per 10,000 to 3.5 over a span of 30 years in Ireland. It is believed that the use of magnesium sulfate prophylactically has been associated with a decrease in incidence of eclampsia.…”

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confidence: 97%

“…1 The spectrum of hypertensive disease in pregnancy, which includes preeclampsia-eclampsia, is one of the leading causes of maternal morbidity and mortality both in the United States and worldwide, resulting in 10–15% of maternal deaths. 2–4 Eclampsia is further associated with increased morbidity due to risks of hypoxic-ischemic brain damage and intracranial hemorrhage from seizure activity. 5 Of eclampsia cases, 2–20% are complicated by perinatal loss, while 1–20% are complicated by maternal fatality, with the highest rates of morbidity and mortality in developing countries.…”

mentioning

confidence: 99%

“…5 Of eclampsia cases, 2–20% are complicated by perinatal loss, while 1–20% are complicated by maternal fatality, with the highest rates of morbidity and mortality in developing countries. 4,6–8 The risk of eclamptic seizures is approximately 2% in patients with untreated severe preeclampsia, while it is roughly 0.5% in patients with mild preeclampsia. 9 Eclampsia may occur antenatally, intrapartum, or postnatally.…”

mentioning

confidence: 99%

“…It is believed that the use of magnesium sulfate prophylactically has been associated with a decrease in incidence of eclampsia. 4,11 …”

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confidence: 99%

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

Fong

Chau

Pan

et al. 2013

American Journal of Obstetrics and Gynecology

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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.

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Complications of Preeclampsia

Tolcher

Mendez‐Figueroa²,

Aagaard

2018

Critical Care Obstetrics

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Eclampsia: Trends in Incidence and Outcomes over 30 Years

Abstract: Over the study period, MgSO4 has become the leading antiseizure medication used, and this has led to a significant decrease in rates of eclampsia.

Cited by 17 publications

References 24 publications

Magnesium sulfate for eclampsia prevention: Quality of care evaluation in a tertiary centre in Québec, Canada

Magnesium sulfate for eclampsia prevention: Quality of care evaluation in a tertiary centre in Québec, Canada

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

Complications of Preeclampsia

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