Risk factors in relation to eclampsia in Nepal

Optimizing treatment for the prevention of pre-eclampsia/eclampsia in Nepal: is calcium supplementation during pregnancy cost-effective?

Background

In Nepal, pre-eclampsia/eclampsia (PE/E) causes an estimated 21% of maternal deaths annually and contributes to adverse neonatal birth outcomes. Calcium supplementation has been shown to reduce the risk of PE/E for pregnant women and preterm birth. This study presents findings from a cost-effectiveness analysis of a pilot project, which provided calcium supplementation through the public sector to pregnant women during antenatal care for PE/E prevention as compared to existing PE/E management in Nepal.

Methods

Economic costs were assessed from program and societal perspectives for the May 2012 to August 2013 analytic time horizon, drawing from implementing partner financial records and the literature. Effects were calculated as disability-adjusted life years (DALYs) averted for mothers and newborns. A decision tree was used to model the cost-effectiveness of three strategies delivered through the public sector: (i) calcium supplementation in addition to the existing standard of care (MgSO₄); (ii) standard of care, and (iii) no treatment. Uncertainty was assessed using one-way and probabilistic sensitivity analyses in TreeAge Pro.

Results

The costs to start-up calcium introduction in addition to MgSO₄ were $44,804, while the costs to support ongoing program implementation were $72,852. Collectively, these values correspond to a program cost per person per year of $0.44. The calcium program corresponded to a societal cost per DALY averted of $25.33 ($25.22–29.50) when compared against MgSO₄ treatment. Primary cost drivers included rate for facility delivery, costs associated with hospitalization, and the probability of developing PE/E. The addition of calcium to the standard of care corresponds to slight increases in effect and cost, and has a 84% probability of cost-effectiveness above a WTP threshold of $40 USD when compared to the standard of care alone.

Conclusions

Calcium supplementation for pregnant mothers for prevention of PE/E provided with MgSO₄ for treatment holds promise for the cost-effective reduction of maternal and neonatal morbidity and mortality associated with PE/E. The findings of this study compare favorably with other low-cost, high priority interventions recommended for South Asia. Additional research is recommended to improve the rigor of evidence available on the treatment strategies and health outcomes.

Maternal and perinatal outcomes of eclampsia with and without HELLP syndrome in a teaching hospital in western Turkey

In this study, we compared the perinatal and maternal outcomes of women with eclampsia with and without HELLP syndrome. A total of 219 pregnancies complicated by eclampsia with and without HELLP syndrome managed between January 2002 and December 2011, were reviewed. The incidence of eclampsia was 1.7/1,000 deliveries. Among 219 patients with eclampsia, 141 (64.4%) did not develop HELLP syndrome and 78 (35.6%) did develop HELLP syndrome. Maternal age and the rates of nulliparity were similar in both groups. Interval time from eclamptic seizure to delivery was significantly longer in the without-HELLP syndrome group (0.92 ± 0.29 weeks vs 0.16 ± 0.12 weeks, p = 0.028). Furthermore, overall perinatal mortality (particularly after gestational week 32) was significantly higher in the with-HELLP syndrome group (20.5% vs 9.9%, p = 0.029). In conclusion, patients with HELLP syndrome had significantly higher perinatal mortality than those with eclampsia without HELLP syndrome and no regular prenatal care.

Apport de l'imagerie neurologique chez les éclamptiques encore symptomatiques après 24 heures : étude descriptive à propos de 19 cas

OBJECTIVE

To describe the neuroimaging findings in eclamptic patients still symptomatic after 24 hours.

PATIENTS AND METHODS

All parturients consecutively admitted over a 12-month period for eclampsia and presenting with neurological disorders (coma, focal neurological abnormalities, and eye sight disturbance) underwent cerebral CT-scan and/or MRI.

RESULTS

Nineteen women were studied, and all had abnormal neuroradiological findings. The CT-scan was normal in three cases. Cerebral oedema was the predominant lesion (14 cases). It was localized in the parietal or occipital area (12 cases), paraventricular area (1 case), or was diffuse (1 case). Diffusion weighted MRI was performed in four cases and showed cytotoxic cerebral oedema in one case. There were three cases of cerebral venous thrombosis and two cases of intracerebral haemorrhage.

CONCLUSION

Various neuroradiological lesions can be observed in eclamptic patients. A localized cerebral oedema is the most frequent. Diffusion weighted MRI should be systematically done when neurological disorders persist.