Maternal and neonatal outcomes in pregnancies complicated by eclampsia – analysis of cases from 2008–2018

Česká verzia

Authors: Solárová Andrea ¹; Hruban Lukáš ^1,2; Janků- Petr ^{1 3}; Gerychová Romana ^1,2; Jouzová Anna ^1,2; Kraus Andrea ⁴
Authors place of work: Gynekologicko-porodnická klinika LF MU a FN Brno ¹; Lékařská fakulta MU, Brno ²; Ústav zdravotnických věd, LF MU a FN Brno ³; Ústav matematiky a statistiky, Přírodovědecká fakulta MU, Brno ⁴
Published in the journal: Ceska Gynekol 2021; 86(5): 297-303
Category: Original Article
doi: https://doi.org/10.48095/cccg2021297

Summary

Objective: Evaluation of perinatal results in a set of pregnancies complicated by eclampsia. Methods: Analysis of 67,304 births performed at the Department of Gynecology and Obstetrics, Masaryk University, Faculty of Medicine and University Hospital, Brno from 2008–2018. During the given period, eclampsia was diagnosed in 16 mothers (0.2‰). The during the time of eclampsia (week of gestation, prepartum, intrapartum, postpartum) fetal and neonatal status (signs of intrauterine distress, pH of the umbilical artery, Apgar score, intrauterine fetal death, death in the early neonatal period) were evaluated. Symptoms and course of the eclamptic attack, maternal comorbidities, associated obstetric complications (placental abruption, surgical complications, blood loss, hysterectomy) and non-obstetric complications (coagulopathy, renal and hepatic impairment, neurological complications) were monitored. Results: Out of a total of 16 cases of eclampsia, 13 cases (81.3%) were confirmed during pregnancy, one case (6.2%) during childbirth, and two cases (12.5%) within 24 hours after childbirth. The mean gestational week of eclampsia was 33 weeks and 3 days. The typical course of an eclamptic attack characterized by headache and visual disturbances followed by a rapid onset of convulsions was noted in five cases (31%). Fetal hypoxia with a pH of the umbilical artery less than 7.10 occurred in four cases (25%). The dependence of the decrease in pH value on the time interval from the diagnosis of eclampsia to the termination of pregnancy was demonstrated. The pH of the umbilical artery decreased on average by 0.054 every 30 minutes from the onset of the eclamptic attack until the end of pregnancy. There were 3 perinatal deaths in the group (19%). Intrauterine fetal death occurred in one case due to partial abruption of the placenta during an eclamptic attack; two newborns died in the early neonatal period. The cause of death was sepsis in one case and perforation of the intestine in necrotizing enterocolitis in the other. The death of the mother was not recorded in the file. The incidence of preeclampsia in subsequent pregnancies reached 18.8%. Non-obstetric and neurological complications (amaurosis, subarachnoid hemorrhage, amnesia) occurred in the group in three cases (18.8%), and renal failure occurred in two cases (12.5%). Conclusion: The incidence of eclampsia at the Department of Gynecology and Obstetrics, Masaryk University, Faculty of Medicine and University Hospital, Brno reached 0.2‰ and was stable for a long time. Associated serious maternal complications occurred in 37.5% of cases and neonatal complications in 31.3% of cases. Early diagnosis of eclampsia and minimization of the time delay until the end of pregnancy is a prerequisite for reducing the risk of associated complications. An interdisciplinary approach is needed.

Keywords:

perinatal outcomes – Hypoxia – Eclampsia – Convulsions – urgent conditions in obstetrics

Zdroje

1. Cunningham FG, Leveno KJ, Bloom SL et al. Williams obstetrics. 24th ed. New York: McGraw-Hill Education 2014: 728–769.

2. Vlk R. Preeklampsie. Praha: Maxdorf 2015: 233–247.

3. Rodička a novorozenec 2014–2015. 2017 [online]. Dostupné z: https: //www.uzis.cz/sites/default/files/knihovna/rodnov2014_2015.pdf.

4. Abalos E, Cuesta C, Carroli G et al. Pre‐eclampsia, eclampsia and adverse maternal and perinatal outcomes: a secondary analysis of the World Health Organization Multicountry Survey on Maternal and Newborn Health. BJOG 2014; 121 (1): 14–24. doi: 10.1111/1471-0528.12629.

5. Roberts JM, August PA, Bakris G et al. Hypertension in Pregnancy. 2021 [online]. Available from: https: //ilpqc.org/wp-content/docs/htn/ACOGExecSummary/HypertensioninPregnan-cy.pdf.

6. Alves E, Azevedo A, Rodrigues T et al. Impact of risk factors on hypertensive disorders in pregnancy, in primiparae and multiparae. Ann Hum Biol 2013; 40 (5): 377–384. doi: 10.3109/03014460.2013.793390.

7. Jaatinen N, Ekholm E. Eclampsia in Finland; 2006 to 2010. Acta Obstet Gynecol Scand 2016; 95 (7): 787–792. doi: 10.1111/aogs.12882.

8. Imarengiaye CO, Isesele TO. Intensive care management and outcome of women with hypertensive diseases of pregnancy. Niger Med J 2015; 56 (5): 333–337. doi: 10.4103/0300-1652.170389.

9. Sigismondi C, Valsecchi L, Gerevini S et al. Management of seizure on Postpartum Day 8: a case report of late postpartum eclampsia. Taiwan J Obstet Gynecol 2016; 55 (3): 444–445. doi: 10.1016/j.tjog.2016.04.025.

10. Verma AK, Garg RK, Pradeep Y et al. Posterior encephalopathy syndrome in women with eclampsia: predictors and outcome. Pregnancy Hypertens 2017; 10: 74–82. doi: 10.1016/j.preghy.2017.06.004.

11. ÚZIS ČR. Rodička a novorozenec 2008. 2009 [online]. Dostupné z: https: //www.uzis.cz/sites/default/files/knihovna/rodnov2009.pdf.

12. ÚZIS ČR. Rodička a novorozenec 2009. 2009 [online]. Dostupné z: https: //www.uzis.cz/sites/default/files/knihovna/rodnov2009.pdf.

13. ÚZIS ČR. Rodička a novorozenec 2010. 2010 [online]. Dostupné z: https: //old.uzis.cz/sites/default/files/knihovna/rodnov2010.pdf.

14. ÚZIS ČR. Rodička a novorozenec 2011. 2011 [online]. Dostupné z: https: //uzis.cz/sites/default/files/knihovna/rodnov2011.pdf.

15. ÚZIS ČR. Rodička a novorozenec 2012. 2012 [online]. Dostupné z: https: //www.uzis.cz/sites/default/files/knihovna/rodnov2012.pdf.

16. ÚZIS ČR. Rodička a novorozenec 2013. 2013 [online]. Dostupné z: https: //www.uzis.cz/sites/default/files/knihovna/rodnov2013.pdf.

17. Ananth CV, Keyes KM, Wapner R. Pre-eclampsia rates in the United States, 1980–2010: age-period-cohort analysis. BMJ 2013; 347: f656415. doi: 10.1136/bmj.f6564.

18. Gruslin A, Lemyre B. Pre-eclampsia: fetal assessment and neonatal outcomes. Best Pract Res Clin Obstet Gynaecol 2011; 25 (4): 491–507. doi: 10.1016/j.bpobgyn.2011.02.004.

19. NICE guideline. Hypertension in pregnancy: diagnosis and management. 2019 [online]. Available from: https: //www.nice.org.uk/guidance/NG133.

20. Revize doporučeného postupu ČGPS ČLS JEP z roku 2009, Hypertenze v graviditě. Management hypertenzních onemocnění v těhotenství. Ceska Gynekol 2013; 78 (Suppl): 45–47. 2019 [online]. Dostupné z: https: //www.gynultrazvuk.cz/uploads/recommendedaction/25/doc/p-2019-06-management-hypertenznich-onemocneni-v-tehotenstvi.pdf.

21. Nerenberg KA, Park AL, Vigod SN et al. Long-term risk of a seizure disorder after eclampsia. Obstet Gynecol 2017; 130 (6): 1327–1333. doi: 10.1097/aog.0000000000002364.

22. Knight M. Eclampsia in the United Kingdom 2005. BJOG 2007; 114 (9): 1072–1078. doi: 10.1111/j.1471-0528.2007.01423.x.

23. Munro PT. Management of eclampsia in the accident and emergency department. J Accid Emerg Med 2000; 17 (1): 7–11. doi: 10.1136/emj.17.1.7.

24. RCOG. Guideline No. 10 (A). The management of severe pre-eclampsia/eclampsia. 2010 [online]. Available from: http: //79.170.40.175/isshp.com/wp-content/uploads/2014/05/rcog.pdf.