Eclampsia in Southern Alberta: is there a role for seizure prophylaxis in all women with gestational hypertension?

Clinical and Biomarkers Difference in Prepartum and Postpartum Eclampsia

Background

There is a large body of literature which assessed the incidence and risk factors of eclampsia, but little was done in assessing the association of clinical features and biological markers with prepartum and postpartum eclampsia.

Methods

A total of 361 eclamptic women admitted to three teaching hospitals between 2008 and 2013 were included in this analysis. A comparative analysis was done for several clinical and biological variables to assess their association with prepartum and postpartum eclampsia.

Results

The overall incidence of eclampsia was 1.2% (prepartum 71% and postpartum 29%). The majority of women with prepartum eclampsia were young, primigravida, more hypertensive, symptomatic and proteinuric. Conversely, the majoritys of the women with post-partum eclampsia were adult, multiparous, carrying pregnancy to term, anemic, thrombocytopenic, and with hepatic dysfunction. The commonest severity symptom (headache) was less common in postpartum eclamptic women.

Conclusion

The incidence of eclampsia was among the highest in the world. And, the analysis has shown that the clinical and biochemical spectrum of prepartum and postpartum eclampsia were apparently different. The majority of the women who developed postpartum eclampsia were multiparous and adult. Derangement of biomarkers was also more common in women with postpartum eclampsia.

Maternal and Perinatal Outcomes of Eclampsia: Nova Scotia, 1981-2000

OBJECTIVE

To determine the prevalence of eclampsia and the associated maternal and perinatal outcomes in the province of Nova Scotia.

METHODS

From the Nova Scotia Atlee Perinatal Database, the population-based rates of preeclampsia, eclampsia, and HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome for the period 1988 to 2000 were determined. A retrospective case review was then performed of all women with eclampsia at the tertiary maternity hospital in Halifax, Nova Scotia, Women's Hospital, IWK Health Centre, for the years 1981 to 2000.

RESULTS

In the province of Nova Scotia from 1988 to 2000, there were 142,362 births. Thirty-nine women developed eclampsia (0.27/1000). Over this time interval, the prevalence of severe preeclampsia fell from 2.08% to 1.63%, and the diagnosis of HELLP syndrome increased from 0.03% to 0.31%. At the Women's Hospital, IWK Health Centre, between 1981 and 2000, there were 31 cases of eclampsia in 105,651 deliveries (0.29/1000). Sixty-one percent of first convulsions occurred antepartum, 13% occurred intrapartum, and 26% occurred postpartum. Eighty-one percent of women reported prodromal symptoms. Sixty-one percent of the women received anti-hypertensive therapies, 48% received antiepileptic therapies, and 97% received magnesium sulfate. Ten percent of the women had convulsions while on magnesium sulfate therapy. Antepartum eclampsia was associated with increased rates of general anaesthesia (26%) and Caesarean section (79%). There were no maternal deaths, but the rate of major maternal complications was 32%. The perinatal mortality rate was 64 in 1000 deliveries, and the rate of severe perinatal complications was 56%.

CONCLUSION

The incidence of eclampsia in Nova Scotia is 0.27 per 1000 deliveries. Although rare, this condition is associated with significant maternal and perinatal morbidity.