Maternal Mortality From Preeclampsia/Eclampsia
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.
References (33)
- et al.
Lessons for low-income regions following the reduction in hypertension-related maternal mortality in high-income countries
Int J Gynecol Obstet
(2011) - et al.
Challenges associated with hypertensive disease during pregnancy in low-income countries
Int J Gynecol Obstet
(2010) Pre-eclampsia
Lancet
(2000)- et al.
WHO analysis of causes of maternal death: A systematic review
Lancet
(2006) - et al.
Pregnancy-related mortality from preeclampsia and eclampsia
Obstet Gynecol
(2001) - et al.
Maternal mortality due to hypertensive disorders of pregnancy in a tertiary care center in Southern India
Int J Gynaecol Obstet
(2010) - et al.
Acute renal failure in pregnancies complicated by hemolysis, elevated liver enzymes, and low platelets
Am J Obstet Gynecol
(1993) - et al.
A 20-year (1989-2008) audit of maternal mortality in Damascus, Syria
Int J Gynaecol Obstet
(2011) - et al.
Lost opportunities for effective management of obstetric conditions to reduce maternal mortality and severe maternal morbidity in Argentina and Uruguay
Int J Gynecol Obstet
(2010) - et al.
Maternal death in the 21st century: Causes, prevention, and relationship to cesarean delivery
Am J Obstet Gynecol
(2008)