Population-based study of eclampsia: Lessons learnt to improve maternity care

• Published in: PloS one Vol. 19; no. 5; p. e0301976
• Main Authors: Korb, Diane, Azria, Elie, Sauvegrain, Priscille, Carbillon, Lionel, Langer, Bruno, Seco, Aurélien, Chiesa-Dubruille, Coralie, Bouvier-Colle, Marie Hélène, Deneux-Tharaux, Catherine
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 02.05.2024; Public Library of Science (PLoS)
• Subjects: Adult; Analysis; Care and treatment; Data collection; Disorders; Eclampsia; Eclampsia - epidemiology; Eclampsia - therapy; Evaluation; Evidence-based medicine; Female; France - epidemiology; Humans; Hypertension; Incidence; Intensive care; Laboratories; Magnesium; Magnesium sulfate; Maternal health services; Maternal Health Services - standards; Maternal mortality; Medical care; Medicine and Health Sciences; Methods; Midwifery; Morbidity; Mothers; Neonates; Obstetrics; Patient outcomes; Physical Sciences; Population studies; Population-based studies; Pre-eclampsia; Pre-Eclampsia - epidemiology; Pre-Eclampsia - therapy; Preeclampsia; Pregnancy; Pregnancy complications; Prenatal care; Prenatal Care - standards; Prevention; Quality management; Statistics; Sulfates; Womens health; Young Adult; France
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0301976

Among hypertensive disorders of pregnancy (HDP), eclampsia is a rare but serious event, often considered avoidable. Detailed assessment of the adequacy of care for the women who have eclampsia can help identify opportunities for improvement and for prevention of the associated adverse maternal and neonatal outcomes. 1/ To estimate the incidence and describe the characteristics of women with eclampsia and to compare them with those of women with non-eclamptic hypertensive disorders of pregnancy (HDP)-related severe maternal morbidity (SMM) and of control women without SMM 2/ To analyse the quality of management in women who had eclampsia, at various stages of their care pathway. It was a planned ancillary analysis of the EPIMOMS population-based study, conducted in six French regions in 2012-2013. Among the 182,309 maternities of the source population, all women with eclampsia (n = 51), with non-eclamptic HDP-related SMM (n = 351) and a 2% representative sample of women without SMM (n = 3,651) were included. Main outcome was the quality of care for eclampsia assessed by an independent expert panel at three different stages of management: antenatal care, care for pre-eclampsia and care for eclampsia. The eclampsia incidence was 2.8 per 10,000 (95%CI 2.0-4.0). Antenatal care was considered completely inadequate or substandard in 39% of women, as was pre-eclampsia care in 76%. Care for eclampsia was judged completely inadequate or substandard in 50% (21/42), mainly due to inadequate use of magnesium sulphate. The high proportion of inadequate quality of care underlines the need for an evidence-based standardisation of care for HDP.