Eclampsia in the 21st century

Abstract

Definition and IncidenceEclampsia is one of the most serious acute complications of pregnancy, and it carries high morbidity and mortality for both the mother and baby. 1 Eclampsia is defined as the occurrence of 1 or more generalized, tonic-clonic convulsions unrelated to other medical conditions in women with hypertensive disorder of pregnancy. Although 10% of pregnancies are complicated by hypertensive disorders, eclampsia continues to occur in 0.8% of women with hypertensive disorders. 2 During the past 50 years, there has been a reduction in the rate of eclampsia in developed countries with a reported incidence ranging from 1.6 per 10,000 deliveries to 10 per 10,000 deliveries. 3e13 In some low-resource or developing countries, the reported rate of eclampsia ranges from 50 to 151 per 10,000 deliveries (Figure 1). 14e18 Although the rate of eclampsia and the number of maternal deaths from hypertension in pregnancy have fallen steadily over recent years in developing countries, hypertensive disorders still feature among the top 6 causes of maternal mortality in the United States and are responsible for up to 14% of all maternal deaths worldwide. 1,19e21 Our impression is that differences in the incidence and complication rates between developed and developing countries result from gaps in access to care, appropriate and early prenatal care, surveillance and management protocols for timely hospitalization and delivery, antihypertensive therapy for prevention of stroke, pulmonary edema, congestive heart failure and magnesium sulfate prophylaxis during the peripartum period in women with severe preeclampsia. 22,23

Magnesium and Hypertension in Old Age

“…It is noteworthy that the use of intravenous magnesium sulfate in pregnancy-associated hypertension and especially in the prevention and treatment of seizures and PRES in eclampsia is well-established. This is based on evidence of beneficial effects in RCTs like the Magpie trial [ 229 ] and recommended in current guidelines [ 230 , 231 , 232 ], which prospects its validity in the third millennium after practically one hundred years of use. It should be noted that very high doses are used in pre-eclampsia and eclampsia and that the collateral effects are minimal considering that pregnant women are patients in whom particular caution is warranted due to the eventual consequences for both the mother and the newborn.…”

Global health inequality and women – beyond maternal health

“…A global disparity in timely access to regular antenatal care often leads to delayed referral of patients with hypertension or gestational diabetes, converting what could have been ‘routine cases’ to high‐risk pregnancies [7]. Undiagnosed obstetric conditions such as pre‐eclampsia are often exacerbated by poor prenatal care and inability or disinclination to refer to medical care [8].…”

Urinary Angiotensinogen-Melatonin Ratio in Gestational Diabetes and Preeclampsia

“…Management for these conditions has been primarily aimed at symptoms that occur late in the course of the disorder. Women who develop preeclampsia during pregnancy are also at increased risk of eclampsia and cardiovascular events, both in the short and long term ( Fishel Bartal and Sibai, 2020 ). Gestational diabetes prevalence rises with increased pregnancy age, maternal obesity and inactivity ( Farrar, 2016 ).…”