The Global Impact of Pre-eclampsia and Eclampsia
Section snippets
Maternal Health is a Human Right
More than 30 years ago, the high maternal mortality in low- and middle-income countries was highlighted as a “neglected tragedy.”3 Although the risk of maternal death has reduced in some of these countries over the intervening years, little has improved for many with the highest mortality. Nevertheless, most maternal deaths are potentially avoidable. Most could be prevented by access to appropriate maternity services and to emergency obstetric care, and many of the root causes are related to
Pre-eclampsia and Eclampsia
Hypertension is common during pregnancy. Approximately 10% of women will have their blood pressure recorded as above normal at some point before delivery. Pre-eclampsia, defined as hypertension accompanied by proteinuria,9 usually occurs during the second half of pregnancy and complicates 2%-8% of pregnancies.10 For women who have mild to moderate hypertension alone, pregnancy outcome is similar to that for women with normal blood pressure. Once proteinuria develops, or blood pressure becomes
Mortality and Morbidity for Women
Eclampsia is rare in Europe, with 2 to 3 cases reported per 10,000 births.11, 12 In developing countries, eclampsia is more common, with the incidence estimated as 16-69 cases per 10,000 births.13 Although rare, eclampsia accounts for more than 50,000 maternal deaths each year.14 Overall, 10%-15% of direct maternal deaths are associated with pre-eclampsia and eclampsia in low- and middle-income countries.14, 15 Ninety-nine percent of maternal deaths occur in low- and middle-income countries.1
Mortality and Morbidity for Infants
Pre-eclampsia can affect blood supply to the placenta, leading to poor intrauterine growth, and can precipitate preterm birth. Therefore, risks for the infant are also increased. Pre-eclampsia is an antecedent for up to 12% of infants born small for gestational age35 and one-fifth of those born preterm.36 Perinatal mortality is high after pre-eclampsia,18, 37 and even higher after eclampsia.13, 27, 38 One-quarter of stillbirths and neonatal deaths in developing countries are associated with
Long-term Sequelae for Women and Children
Whether pre-eclampsia and eclampsia have long-term implications for the health and well-being of the women remains uncertain. Nevertheless, there is growing evidence that women who have had gestational hypertension or pre-eclampsia are at increased risk later in life for hypertension, stroke, and ischemic heart disease.46, 47, 48 What is less clear is whether this reflects a common pathway, or whether having pre-eclampsia increases this risk.49
There are also long-term consequences for the
References (71)
- et al.
Maternal mortality—a neglected tragedyWhere is the M in MCH?
Lancet
(1985) - et al.
WHO analysis of causes of maternal death: a systematic review
Lancet
(2006) - et al.
Pregnancy-related mortality from preeclampsia and eclampsia
Obstet Gynecol
(2001) - et al.
Screening and surveillance of pregnancy hypertension—an economic approach to the use of daycare
Baillieres Clin Obstet Gynaecol
(1990) - et al.
Obstetric patients treated in intensive care units and maternal mortalityRegional teams for the survey
Eur J Obstet Gynecol Reprod Biol
(1996) - et al.
Caesarean delivery rates and pregnancy outcomes: the 2005 WHO global survey on maternal and perinatal health in Latin America
Lancet
(2006) - et al.
EclampsiaVIII. Risk factors for maternal morbidity
Am J Obstet Gynecol
(2000) - et al.
Case-control study of risk factors for complicated eclampsia
Obstet Gynecol
(1997) - et al.
Post-traumatic stress disorder after pre-eclampsia: an exploratory study
Gen Hosp Psychiatry
(2002) - et al.
Adverse perinatal outcomes are significantly higher in severe gestational hypertension than in mild preeclampsia
Am J Obstet Gynecol
(2002)
Epidemiology and causes of preterm birth
Lancet
Primary, secondary, and tertiary interventions to reduce the morbidity and mortality of preterm birth
Lancet
An overview of mortality and sequelae of preterm birth from infancy to adulthood
Lancet
Case-control study of antenatal and intrapartum risk factors for cerebral palsy in very preterm singleton babies
Lancet
Antenatal risk factors for cerebral palsy
Best Pract Res Clin Obstet Gynaecol
Intrauterine exposure to preeclampsia and adolescent blood pressure, body size, and age at menarche in female offspring
Obstet Gynecol
Blood-pressure measurement and classification in pregnancy
Lancet
Antiplatelet agents for prevention of pre-eclampsia: a meta-analysis of individual patient data
Lancet
Magnesium for preventing and treating eclampsia: time for international action
Lancet
Reducing eclampsia-related deaths—a call to action
Lancet
The World Health Report 2005: Make every mother and child count
The Millennium Development Goals: Report 2008
Death in childbirth: an international study of maternal care and maternal mortality, 1800-1950
General practitioners and obstetrics: a brief history
J R Soc Med
Maternal health and human rights
Lancet
(Foreward) A Cochrane pocketbookPregnancy and childbirth
Report of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy
Am J Obstet Gynecol
World Health Organization international collaborative study of hypertensive disorders of pregnancyGeographic variation in the incidence of hypertension in pregnancy
Am J Obstet Gynecol
Eclampsia in the United Kingdom 2005
BJOG
Eclampsia in Sweden
Hypertens Pregnancy
Post Magpie: how should we be managing severe preeclampsia?
Curr Opin Obstet Gynecol
Maternal mortality associated with hypertensive disorders of pregnancy in Africa, Asia, Latin America and the Caribbean
Br J Obstet Gynaecol
Cited by (1969)
Physiologic blood pressure patterns in pregnancies with mild chronic hypertension
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