PRE-ECLAMPSIA
AND ECLAMPSIA
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How
should the woman with severe pre-eclampsia or eclampsia be
managed following delivery?
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BMJ. 1994 Nov
26;309(6966):1395-400.
Eclampsia in the United Kingdom.
Douglas KA ,
Redman CW .
Nuffield Department of Obstetrics and Gynaecology,
John Radcliffe Hospital, Oxford University.
OBJECTIVES--To measure the incidence of eclampsia, establish how often it is
preceded by signs of pre-eclampsia, document the morbidity associated with
eclampsia, and determine the maternal case fatality rates.
DESIGN--A prospective, descriptive study of every case of eclampsia in the
United Kingdom in 1992. Information was collected from reviews of hospital
case notes and questionnaires to general practitioners.
SETTING--All 279 hospitals in the United Kingdom with a consultant obstetric
unit.
RESULTS--Obstetricians and midwives notified 582 possible cases, and 383
were confirmed as eclampsia. The national incidence of eclampsia was
4.9/10,000 maternities (95% confidence interval 4.5 to 5.4). Most
convulsions occurred despite antenatal care (70%) and within one week of the
woman's last visit to a doctor or midwife (85%). Three quarters of first
seizures occurred in hospital, of which 38% developed before both
proteinuria and hypertension had been documented. Forty four per cent of
cases occurred postpartum, more than a third (38%) antepartum, and the
remainder (18%) intrapartum. Nearly one in 50 women (1.8%) died, and 35% of
all women had at least one major complication. The rate of stillbirths and
neonatal deaths was 22.2/1000 and 34.1/1000, respectively. Preterm eclampsia
occurred more commonly antepartum and was associated with more maternal
complications and fetuses that were small for gestational age, as well as
with higher rates of stillbirth and neonatal mortality. Antepartum eclampsia,
which was more likely to occur preterm, was associated with a higher rate of
maternal complications and a higher neonatal mortality. Both factors
(gestational prematurity and antepartum occurrence) contributed
independently to the severity of the outcome.
CONCLUSION--Eclampsia occurs in nearly one in 2000 maternities in the United
Kingdom and is associated with high maternal morbidity and fatality in
cases. It may present unheralded by warning signs. Preterm and antenatal
eclampsia seem to be particularly severe.
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