Incidence of eclampsia and related complications across 10 low- and middle-resource geographical regions: Secondary analysis of a cluster randomised controlled trial

Abstract

Background In 2015, approximately 42,000 women died as a result of hypertensive disorders of pregnancy worldwide; over 99% of these deaths occurred in low- and middle-income countries. The aim of this paper is to describe the incidence and characteristics of eclampsia and related complications from hypertensive disorders of pregnancy across 10 low- and middle-income geographical regions in 8 countries, in relation to magnesium sulfate availability. Methods and findings This is a secondary analysis of a stepped-wedge cluster randomised controlled trial undertaken in sub-Saharan Africa, India, and Haiti. This trial implemented a novel vital sign device and training package in routine maternity care with the aim of reducing a composite outcome of maternal mortality and morbidity. Institutional-level consent was obtained, and all women presenting for maternity care were eligible for inclusion. Data on eclampsia, stroke, admission to intensive care with a hypertensive disorder of pregnancy, and maternal death from a hypertensive disorder of pregnancy were prospectively collected from routine data sources and active case finding, together with data on perinatal outcomes in women with these outcomes. In 536,233 deliveries between 1 April 2016 and 30 November 2017, there were 2,692 women with eclampsia (0.5%). In total 6.9% ( n = 186; 3.47/10,000 deliveries) of women with eclampsia died, and a further 51 died from other complications of hypertensive disorders of pregnancy (0.95/10,000). After planned adjustments, the implementation of the CRADLE intervention was not associated with any significant change in the rates of eclampsia, stroke, or maternal death or intensive care admission with a hypertensive disorder of pregnancy. Nearly 1 in 5 (17.9%) women with eclampsia, stroke, or a hypertensive disorder of pregnancy causing intensive care admission or maternal death experienced a stillbirth or neonatal death. A third of eclampsia cases (33.2%; n = 894) occurred in women under 20 years of age, 60.0% in women aged 20–34 years ( n = 1,616), and 6.8% ( n = 182) in women aged 35 years or over. Rates of eclampsia varied approximately 7-fold between sites (range 19.6/10,000 in Zambia Centre 1 to 142.0/10,000 in Sierra Leone). Over half (55.1%) of first eclamptic fits occurred in a health-care facility, with the remainder in the community. Place of first fit varied substantially between sites (from 5.9% in the central referral facility in Sierra Leone to 85% in Uganda Centre 2). On average, magnesium sulfate was available in 74.7% of facilities (range 25% in Haiti to 100% in Sierra Leone and Zimbabwe). There was no detectable association between magnesium sulfate availability and the rate of eclampsia across sites ( p = 0.12). This analysis may have been influenced by the selection of predominantly urban and peri-urban settings, and by collection o...

Incidence and determinant of eclampsia and its associated complication in tertiary care hospital of Gujarat

“…10 One multicentric communitybased study at south east region show the lower (0.5%) incidence rate compare to this study. 11 It is hospital-based study it caters high percentage of referred cases giving higher incidence of eclampsia. Incidence of eclampsia was more common in unbooked cases in this study.…”

<p>Perception of Midwives Towards Magnesium Sulfate Use at Chatinkha Maternity Wing in Blantyre, Malawi: A Qualitative Study</p>

“…7 On the other hand maternal deaths due to eclampsia ranged from 1.1% in Zambia to 15.5% in Sierra Leone, with 3.2% in Malawi. 7 Additionally, pre-eclampsia and eclampsia is the third leading cause of maternal deaths in Malawi. 8,10 Currently the maternal mortality ratio (MMR) is at 439 per 100,000 live births according to 2015 data reported in a Malawi Demographic Health Survey of 2017 while, according to UNICEF and the WHO, the 2015 MMR is 634 per 100,000 live births.…”

“…Preeclampsia and eclampsia contribute to 14% of maternal deaths worldwide, and the majority of these deaths occur in Low and Medium Income Countries (LMICs), Malawi inclusive, with some variations among countries. 1,7 For instance, between 2016 and 2017, out of 10,000 deliveries, rates of eclampsia ranged from 19.6/10,000 in Zambia to 142.0/10,000 in Sierra Leone and 107.1/10,000 in Malawi. 7 On the other hand maternal deaths due to eclampsia ranged from 1.1% in Zambia to 15.5% in Sierra Leone, with 3.2% in Malawi.…”

“…1,7 For instance, between 2016 and 2017, out of 10,000 deliveries, rates of eclampsia ranged from 19.6/10,000 in Zambia to 142.0/10,000 in Sierra Leone and 107.1/10,000 in Malawi. 7 On the other hand maternal deaths due to eclampsia ranged from 1.1% in Zambia to 15.5% in Sierra Leone, with 3.2% in Malawi. 7 Additionally, pre-eclampsia and eclampsia is the third leading cause of maternal deaths in Malawi.…”

Perceptions on preeclampsia and eclampsia among older women in rural southwestern Uganda

“…[20] In sub-Saharan Africa, about one third of the mothers with eclampsia will experience a still birth and eclampsia is responsible for almost 20% of maternal mortality and disability. [21] Maternal mortality may be higher in rural areas due to di culty in access to services as shown in a recent study in south western Uganda where most of the maternal deaths were related to late referrals. [15] Rural women often experience delays to make a decision to seek care, delay to reach place of care and delay in receiving appropriate and adequate care.…”