Eclampsia in Italy: A prospective population-based study (2017-2020)

Abstract

Objective: To estimate the incidence, and to investigate risk factors, management, and perinatal outcomes of eclampsia in Italy.

Study design: This is a prospective population-based cohort study enrolling all women admitted for eclampsia between November 2017 and March 2020. Incident cases were reported using electronic and anonymous data collection forms.

Main outcome measures: Incidence, risk factors, maternal and perinatal morbidity, and mortality.

Results: 109 cases were included for an estimated incidence rate of 1.5 (95 % CI 1.2-1.8) per 10.000 births. Risk of developing eclampsia was associated with multiple pregnancies (RR = 4.51; p < 0.001) and with pregnancies achieved with assisted reproductive technologies (RR = 3.03; p < 0.001). Magnesium sulfate was used as prophylaxis in almost 30 % of women with preeclampsia, and to treat an eclamptic fit in 89 % of women. The time interval between the first fit and delivery was 62 min for antepartum and 10 min for intrapartum cases. Around one third of women developed at least one other major complication and one mother died. Severe morbidity affected 13.3 % of the newborns. Two fetal and one neonatal death were reported.

Conclusions: Our data revealed low incidence of eclampsia in Italy and prompt administration of antihypertensive drugs and magnesium sulfate to prevent eclampsia and to treat the recurrence of seizures. However, the rate of severe maternal complications is still high: increasing the time interval between fit and delivery seems to be crucial to achieve an effective stabilization of maternal conditions and reduce maternal major complications.

Keywords: Eclampsia; Hypertensive disorders of pregnancy; Maternal mortality; Medical disorders in pregnancy; Preeclampsia.