Maternal and neonatal outcomes in pregnancies complicated by eclampsia – analysis of cases from the years 2008-2018

Abstract

Objective: Evaluation of perinatal results in a set of pregnancies complicated by eclampsia.

Design: Retrospective analysis.

Setting: Department of Gynecology and Obstetrics, Masaryk University, Faculty of Medicine and University Hospital Brno.

Methods: analysis of 67,304 births performed at the Department of Gynecology and Obstetrics, Masaryk University, Faculty of Medicine and University Hospital Brno in the years 2008 - 2018. During the given period, eclampsia was diagnosed in 16 mothers (0.2 ‰). The period time of eclampsia (week of gestation, prepartal, intrapartal, postpartal) fetal and neonatal status (signs of intrauterine distress, pH of the umbilical artery, Apgar score, intrauterine fetal death, death in the early neonatal period) were evaluated. Symptoms and course of the eclamptic attack, maternal comorbidities, associated obstetric complications (placental abruption, surgical complications, blood loss, hysterectomy) and non-obstetric complications (coagulopathy, renal and hepatic impairment, neurological complications) were monitored.

Results: Out of a total of 16 cases of eclampsia, 13 cases (81.3%) were confirmed during pregnancy, one case (6.2%) during childbirth and two cases (12.5%) within 24 hours after childbirth. The mean gestational week of eclampsia was 33 weeks and 3 days. The typical course of an eclamptic attack characterized by headache and visual disturbances followed by a rapid onset of convulsions was noted in five cases (31%). Fetal hypoxia with a pH of the umbilical artery less than 7,10 occurred in four cases (25%). The dependence of the decrease in the pH value on the time interval from the diagnosis of eclampsia to the termination of pregnancy was demonstrated. The pH of the umbilical artery decreased on average by 0,054 every 30 minutes from the onset of the eclamptic attack until the end of pregnancy. Intrauterine fetal death occurred in one case due to partial abruption of the placenta during an eclamptic attack, two newborns died in the early neonatal period (11.8%). In both cases, the cause of death was respiratory distress syndrome and cardiac failure resulting from prematurity. The death of the mother was not recorded in the file. The incidence of preeclampsia in subsequent pregnancies reached 18.8%. The non-obstetric complications, neurological complications (amaurosis, subarachnoid hemorrhage, amnesia) occurred in the group in three cases (18.8%) and renal failure in two cases (12.5%).

Conclusion: The incidence of eclampsia at the Department of Gynecology and Obstetrics, Masaryk University, Faculty of Medicine and University Hospital Brno reached 0.2‰ and is stable for a long time. Associated serious maternal complications occurred in 37.5% of cases and neonatal complications in 31.3% of cases. Early diagnosis of eclampsia and minimization of the time delay until the end of pregnancy is a prerequisite for reducing the risk of associated complications. An interdisciplinary approach is needed.

Keywords: eclampsia, convulsions, urgent conditions in obstetrics, perinatal outcomes, hypoxia