Impact of interventions to prevent and manage preeclampsia and eclampsia on stillbirths

Abstract

BackgroundPre-eclampsia and Eclampsia are relatively common complications of pregnancy, leading to considerable maternal and fetal mortality and morbidity. We sought to review the effect of aspirin, calcium supplementation, antihypertensive agents and magnesium sulphate on risk stillbirths.MethodsA systematic literature search was conducted to identify studies evaluating the above interventions. We used a standardized abstraction and grading format and performed meta-analyses where data were available from more than one studies. The estimated effect on stillbirths was determined by applying the standard Child Health Epidemiology Reference Group (CHERG) rules for multiple outcomes. For interventions with insufficient evidence for overall effect, a Delphi process was undertaken to estimate effectiveness.ResultsWe identified 82 relevant studies. For aspirin, maganesium sulphate and use of antihypertensive we found an insignificant decrease in stillbirth and perinatal mortality. For calcium supplementation, there was a borderline significant reduction in stillbirths (RR 0.81, 95 % CI 0.63-1.03). We undertook a Delphi consultation among experts to assess the potential impact of a package of interventions for the management of pre-eclampsia and eclampsia (antihypertensive, magnesium sulphate and C-section if needed). The Delphi process suggested 20% reduction each in both antepartum and intrapartum stillbirths with the use of this package.ConclusionsDespite promising benefits of calcium supplementation and aspirin use cases on maternal morbidity and eclampsia in high risk cases, further work is needed to ascertain their benefits in relation to stillbirths. The Delphi process undertaken for assessing potential impact of a package of interventions indicated that this could be associated with 20% reduction in stillbirths, for input into LiST.

Essential interventions: implementation strategies and proposed packages of care

“…It also had a significant protective effect on maternal mortality and serious morbidity and preterm birth [22-24]. …”

Stillbirths: what difference can we make and at what cost?

“…In a subsequent meta-analysis using CHERG methods, calcium supplementation during pregnancy was associated with an estimated 45% reduction in the risk of gestational hypertension (0·55, 0·36-0·85) and 59% in the risk of pre-eclampsia (0·41, 0·24-0·69). 23,48 Information on stillbirth outcomes was limited, but stillbirth has a known association with hypertensive disease of pregnancy and pre-eclampsia, 49 and therefore calcium supplementation in women with low baseline calcium intake was estimated to reduce the risk of stillbirth by 19%, although the reduction was not signifi cant (table 1). 23 …”

“…The experts suggested a 20% median reduction in each of antepartum stillbirths (IQR 10-30) and intrapartum stillbirths (10-40) from introduction of these interventions. 23 …”

Experiencias y sentimientos vividos durante una gestación de alto riesgo: un estudio documental 2005-2011

“…Los estados hipertensivos de la gestación persisten como la principal causa de muerte materna en los países pobres, siendo responsables de 63.000 muertes anuales y la mortalidad materna por preeclampsia es entre el 0% y 13.2% 16 . La presentación de esta última alteración es entre el 5% y 8% de las gestaciones y puede llevar a resultados perinatales adversos como bajo peso al nacer, prematuridad, muerte fetal y retardo del crecimiento intrauterino 17 . También es causa de secuelas permanentes en la mujer, como alteraciones neurológicas, hepáticas, renales o hematológicas 18 .…”