Eclampsia in Australia and New Zealand: A prospective population-based study

Wendy Pollock; Michael J Peek; Alex Wang; Zhuoyang Li; David Ellwood; Caroline S E Homer; Lisa Jackson Pulver; Claire McLintock; Geraldine Vaughan; Marian Knight; Elizabeth A Sullivan

doi:10.1111/ajo.13100

Eclampsia in Australia and New Zealand: A prospective population-based study

Aust N Z J Obstet Gynaecol. 2020 Aug;60(4):533-540. doi: 10.1111/ajo.13100. Epub 2019 Dec 16.

Authors

Wendy Pollock^{1

2

3}, Michael J Peek⁴, Alex Wang⁵, Zhuoyang Li⁵, David Ellwood⁶, Caroline S E Homer⁷, Lisa Jackson Pulver⁸, Claire McLintock⁹, Geraldine Vaughan⁵, Marian Knight¹⁰, Elizabeth A Sullivan^{5

11}

Affiliations

¹ Maternal Critical Care, Melbourne, Victoria, Australia.
² Department of Nursing, The University of Melbourne, Melbourne, Victoria, Australia.
³ School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia.
⁴ Obstetrics and Gynaecology, ANU Medical School, College of Health and Medicine, The Australian National University, Canberra, Australian Capital Territory, Australia.
⁵ The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia.
⁶ Department of Obstetrics and Gynaecology, Griffiths University, Southport, Queensland, Australia.
⁷ Maternal and Child Health, Burnet Institute, Melbourne, Victoria, Australia.
⁸ Indigenous Strategy and Services, The University of Sydney, Sydney, New South Wales, Australia.
⁹ National Women's Health, Auckland City Hospital, University of Auckland, Auckland, New Zealand.
¹⁰ Maternal and Child Population Health, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
¹¹ Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia.

PMID: 31840809
DOI: 10.1111/ajo.13100

Abstract

Background: Eclampsia is a serious consequence of pre-eclampsia. There are limited data from Australia and New Zealand (ANZ) on eclampsia.

Aim: To determine the incidence, management and perinatal outcomes of women with eclampsia in ANZ.

Materials and methods: A two-year population-based descriptive study, using the Australasian Maternity Outcomes Surveillance System (AMOSS), carried out in 263 sites in Australia, and all 24 New Zealand maternity units, during a staggered implementation over 2010-2011. Eclampsia was defined as one or more seizures during pregnancy or postpartum (up to 14 days) in any woman with clinical evidence of pre-eclampsia.

Results: Of 136 women with eclampsia, 111 (83%) were in Australia and 25 (17%) in New Zealand. The estimated incidence of eclampsia was 2.2 (95% confidence interval (CI) 1.9-2.7) per 10 000 women giving birth. Aboriginal and Torres Strait Islander women were over-represented in Australia (n = 9; 8.1%). Women with antepartum eclampsia (n = 58, 42.6%) were more likely to have a preterm birth (P = 0.04). Sixty-three (47.4%) women had pre-eclampsia diagnosed prior to their first eclamptic seizure of whom 19 (30.2%) received magnesium sulphate prior to the first seizure. Nearly all women (n = 128; 95.5%) received magnesium sulphate post-seizure. No woman received prophylactic aspirin during pregnancy. Five women had a cerebrovascular haemorrhage, and there were five known perinatal deaths.

Conclusions: Eclampsia is an uncommon consequence of pre-eclampsia in ANZ. There is scope to reduce the incidence of this condition, associated with often catastrophic morbidity, through the use of low-dose aspirin and magnesium sulphate in women at higher risk.

Keywords: eclampsia; maternal morbidity; pre-eclampsia; pregnancy; seizure.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Australia / epidemiology
Eclampsia* / drug therapy
Eclampsia* / epidemiology
Female
Humans
Infant, Newborn
Magnesium Sulfate
New Zealand / epidemiology
Pregnancy
Premature Birth*
Prospective Studies

Substances

Magnesium Sulfate