Elsevier

Seminars in Perinatology

Volume 36, Issue 1, February 2012, Pages 56-59
Seminars in Perinatology

Maternal Mortality From Preeclampsia/Eclampsia

https://doi.org/10.1053/j.semperi.2011.09.011Get rights and content

Preeclampsia/eclampsia is one of the 3 leading causes of maternal morbidity and mortality worldwide. During the past 50 years, there has been a significant reduction in the rates of eclampsia, maternal mortality, and maternal morbidity in the developed countries. In contrast, the rates of eclampsia, maternal complications, and maternal mortality remain high in the developing countries. These differences are mainly due to universal access to prenatal care, access to timely care, and proper management of patients with preeclampsia–eclampsia in the developed countries. In contrast, most of maternal deaths and complications are due to lack of prenatal care, lack of access to hospital care, lack of resources, and inappropriate diagnosis and management of patients with preeclampsia–eclampsia in the developing countries. Preeclampsia/eclampsia is associated with substantial maternal complications, both acute and long-term. Clear protocols for early detection and management of hypertension in pregnancy at all levels of health care are required for better maternal as well as perinatal outcome. This is especially important in the developing countries.

Section snippets

Acute and Long-term Maternal Complications of Preeclampsia

Preeclampsia is associated with substantial maternal complications, both acute and long-term (Table 1).11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21 The deaths that occur secondary to preeclampsia mainly result from eclampsia, uncontrolled hypertension, or systemic inflammation. Most of these maternal deaths are caused by intracerebral hemorrhage.13, 16 Approximately 20% of women with preeclampsia develop hypertension or microalbuminuria within 7 years of a preeclamptic pregnancy, as compared with

Maternal Mortality and Morbidities

Although the maternal mortality rate in the United States is approximately 7.5 per 100,000, most studies suggest that the actual number of maternal deaths is larger because of the continuing problem of underreporting.12 Maternal mortality has decreased over the past half of the 20th century, but preventable cases continue to occur. The majority of the approximately 600,000 annual maternal deaths take place in developing countries, whereas Western Europe and the United States probably have

Maternal Complications in Severe Preeclampsia and Hemolysis, Elevated Liver Enzymes, Low Platelets Syndrome

Severe preeclampsia is associated with increased risk of maternal mortality (0.2%) and increased rates of maternal morbidities (5%), such as convulsions, pulmonary edema, acute renal or liver failure, liver hemorrhage, disseminated intravascular coagulopathy, and stroke. These complications are usually seen in women who develop preeclampsia before 32 weeks' gestation and in those with preexisting medical conditions (Table 2).26, 27, 28

Hemolysis, elevated liver enzymes, and low platelets (HELLP)

Eclampsia

Although eclampsia is associated with an increased risk of maternal death in developed countries (0%-1.8%),2, 5, 30, 31, 32, 33 the mortality rate is as high as 15% in developing countries (Table 3).2, 14, 15, 16 The high maternal mortality reported from the developing countries was noted primarily among patients who had multiple seizures outside the hospital and those without prenatal care.5, 6, 13, 14 In addition, this high mortality rate could be attributed to the lack of resources and

Disparity in the Rate of Eclampsia and Maternal Complications From Preeclampsia–Eclampsia Between the Developing and Developed Countries

As previously discussed, there are substantial differences in the rates of eclampsia, maternal death, and maternal complications from hypertensive disorders of pregnancy among various countries.2, 6, 9 Despite the availability of magnesium sulfate for the prophylaxis and treatment of eclamptic seizures, the rates of eclampsia and maternal complications remain very high. This is because magnesium sulfate will only prevent eclamptic seizures in women who are hospitalized with severe preeclampsia

Conclusions

Hypertensive disease in pregnancy complicated by preeclampsia/eclampsia requires proper antenatal care, early recognition and referral, adequate treatment, and timely delivery. The lack of protocols for disease management or failure to follow clinical protocols of care contributes toward avoidable medical factors. Clear protocols for management of hypertension in pregnancy at all levels of health care are required for better maternal as well as perinatal outcome.

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