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Outcomes of severe pre‐eclampsia/eclampsia in Yorkshire 1999/2003
Author(s) -
Tuffnell D.J.,
Jankowicz D.,
Lindow S.W.,
Lyons G.,
Mason G.C.,
Russell I.F.,
Walker J.J.
Publication year - 2005
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/j.1471-0528.2005.00565.x
Subject(s) - eclampsia , medicine , caesarean section , obstetrics , guideline , incidence (geometry) , prospective cohort study , pregnancy , maternal death , pediatrics , surgery , population , genetics , physics , environmental health , pathology , optics , biology
Objective To establish the risk of serious complications from severe pre‐eclampsia and eclampsia in a region using a common guideline for the management of these conditions. Design A five‐year prospective study. Setting Sixteen maternity units in Yorkshire. Population All women managed with severe pre‐eclampsia and eclampsia. Methods A common guideline was developed for the management of women with these conditions. A network of midwives prospectively collected outcome data. Main outcome measure Incidence of the conditions and serious complication rates. Results A total of 210,631 women delivered in the 16 units between 1 January 1999 and 31 December 2003. One thousand eighty‐seven women were diagnosed with severe pre‐eclampsia or eclampsia (5.2/1000). One hundred and fifty‐one women had serious complications including 82 women (39/10,000) having eclamptic seizures and 49 women (23/10,000) requiring ICU admission. There were no maternal deaths but 54 out of 1145 babies died before discharge, giving a mortality rate of 47.2/1000. Of the 82 cases of eclampsia, 45 occurred antenatally (55%), 18 before admission to the maternity unit. Eleven cases occurred in labour (13%), including 1 during a caesarean section, and 26 cases occurred following delivery (32%). Twenty‐five women developed pulmonary oedema (2.3% of cases) and six women required renal dialysis (0.55% of cases). One hundred and sixty‐five (15%) required no antihypertensive therapy and 489 (53%) of the remainder required only oral therapy. Two hundred and one (18.5%) required more than one drug. Conclusion A regional guideline for severe pre‐eclampsia and eclampsia can be developed and implemented. Its use may contribute to a low rate of serious complications.