PET Definitions

Severe pre-eclampsia and eclampsia are serious complications of pregnancy, with around 5/1000 maternities in the UK suffering severe pre-eclampsia⁰⁵⁰¹ and 5/10 000 maternities suffering eclampsia.⁹⁴⁰¹ In eclampsia, the case fatality rate has been reported as 1.8% and a further 35% of women experience a major complication.⁹⁴⁰¹ The Confidential Enquiries into Maternal Deaths persistently show substandard care in a significant percentage of the deaths.

Defining pre-eclampsia and eclampsia.

 

Eclampsia is defined as the occurrence of one or more convulsions superimposed on pre-eclampsia.

Pre-eclampsia
is pregnancy-induced hypertension in association with proteinuria (> 0.3 g in 24 hours) ? oedema and virtually any organ system may be affected.

There is consensus that severe hypertension is confirmed with a diastolic blood pressure ≥ 110 mmHg on two occasions or systolic blood pressure ≥ 170 mmHg on two occasions and that, together with significant proteinuria (at least 1 g/litre), this constitutes severe pre-eclampsia. There is less agreement about the degree of moderate hypertension, which together with other symptoms or signs constitutes severe pre-eclampsia. A diastolic blood pressure ≥ 100 mmHg on two occasions and significant proteinuria with at least two signs or symptoms of imminent eclampsia will include many women with severe pre-eclampsia, although it is to be remembered that some women who present with eclampsia have no prodromal signs.⁹⁴⁰¹ An important variant of severe pre-eclampsia is the HELLP syndrome (haemolysis, elevated liver enzymes and low platelet count).

Clinical features of severe pre-eclampsia (in addition to hypertension and proteinuria) are:

severe headache
liver tenderness
visual disturbance
platelet count falling to below 100 x 106/l
epigastric pain and/or vomiting abnormal liver enzymes (ALT or AST rising to above 70 iu/l)
signs of clonus
HELLP syndrome
papilloedema

The Confidential Enquiries reveal that deaths from pre-eclampsia/eclampsia have been reduced from 11.9/million maternities in 1985?1987 to 7.0/million maternities in 2000?2002, when there were 14 deaths. Nine women died from cerebral causes, with substandard care in 50% of cases. The Yorkshire series⁰⁵⁰¹ had no deaths in over 1000 cases of severe pre-eclampsia and eclampsia and supports the view that a standardised care package for pre-eclampsia over delivery, with proven interventions, may reduce the rate of eclampsia.