Blood pressure assessment and first-line pharmacological agents in women with eclampsia

• In a retrospective single-centre review eclampsia occurred in one in 1780 births.
• Blood pressure was only measured in 47% of patients in the four hours before fitting.
• 78% of the patients who had blood pressure measured before the fit were hypertensive.
• Magnesium sulphate was not given to eclamptic patients during ambulance transfer to hospital.
• 25% of caesarean sections were performed under neuraxial anaesthesia.

BackgroundEclampsia is a life-threatening complication of pregnancy. Timely blood pressure assessment and administration of magnesium sulphate are essential management. In this retrospective single-centre study we examined the timing and magnitude of maternal blood pressure before eclampsia, and whether magnesium sulphate was administered as the first agent for treatment.MethodsWe conducted a five-year review of eclampsia in a tertiary referral obstetric hospital. Using data from electronic birthing records and hospital coding (ICD-10AM) we identified patients with the diagnostic criteria for eclampsia and assessed patient characteristics, blood pressure and pharmacological treatment.ResultsThere were 33 812 births from July 2008 to June 2013 with 19 cases of eclampsia (1:1780). Patients were 32 ± 5.9 years of age, 36 ± 3.9 weeks of gestation, 63% were nulliparous and all had a singleton pregnancy. Antepartum eclampsia occurred in 74%. In the four hours before a fit, 47% of patients had blood pressure recorded, of whom 78% were hypertensive. Magnesium sulphate was administered as first therapy in 47% of patients but it was not given to any patient transferred to hospital by ambulance. Of the patients who fitted antenatally, 86% underwent caesarean section, of whom 25% received neuraxial anaesthesia.ConclusionsOur study highlights the need for vigilance when managing pregnant women with hypertension, especially in the third trimester as eclampsia is most likely preceded by raised blood pressure. It also highlights the need for timely commencement of magnesium sulphate in the community and during transfer to hospital for the treatment of eclampsia, and for prevention of eclampsia in hospital when thresholds for severe preeclampsia are met.