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GPs should have high index of suspicion for eclampsia

Obstetrics and gynaecology

Obstetrics and gynaecology

Eclampsia is maternal convulsion, during or just after pregnancy, occurring in association with two of either hypertension, proteinuria, thrombocytopaenia or liver function disorder. In the 2000-2002 Confidential Enquiry into Maternal and Child Health, it was reported that 6% of pregnancy-related maternal deaths were caused by eclampsia.1

In 1992, eclampsia complicated around 4.9 per 10,000 pregnancies in the UK and had maternal and perinatal mortality rates of 1.8% and 5.4% respectively. Since then, magnesium sulphate has been introduced for the treatment and prevention of eclampsia. Has it made any difference?

Data were collected monthly between February 2005 and February 2006 from all consultant-led maternity units in the UK. The mean monthly reporting rate was 91%.

The data revealed a significant reduction in the incidence of eclampsia. The study identified 214 cases, giving an incidence of 2.7 cases per 10,000 births. In 10% of these cases there was severe maternal morbidity (eg post-partum haemorrhage, renal failure, stroke, pulmonary embolism, disseminated intravascular coagulation), although there were no maternal deaths. The perinatal mortality rate was 5.9%.

Of particular interest to GPs is that 79% of those who developed eclampsia had at least one premonitory symptom or sign in the week before the eclamptic episode. The most common symptoms were headache and visual disturbance. Only 38% of women had established hypertension and proteinuria.

Forty-five per cent of first fits were antepartum, 19% intrapartum and 36% postpartum. Twenty-one per cent of first fits occurred at home.

A total of 199 women were given magnesium sulphate only after the fit. Only 12 women were given it before and after the eclamptic episode. The number of women who were given magnesium sulphate and did not fit was not recorded.

Many GPs feel increasingly deskilled in obstetrics because of the change to midwife-led maternity arrangements. This study reminds us that what is usually a joyous family event can occasionally become frighteningly dangerous.

A high index of suspicion for eclampsia must be maintained when managing pregnant women.

Knight M on behalf of UKOSS. Eclampsia in the United Kingdom 2005. BJOG 2007;114:1072-8

Reviewer

Dr Chris Barclay
GP, Sheffield

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