24 - Severe pre-eclampsia and eclampsia

Summary

Hypertensive disease in pregnancy is a prominent cause of maternal and perinatal mortality and morbidity in both developed and developing countries. In regions with well-organised health services, the incidence of eclampsia is about 1/2000 maternities, with 1/200 women developing severe pre-eclampsia. Although maternal death is rare in these countries, there is significant maternal and perinatal morbidity. In developing countries, the incidence and mortality rates of eclampsia are about 20-fold higher, with maternal mortality rates of 15–20% and perinatal loss rates of about 20–40%.

The definition of severe pre-eclampsia varies but is usually taken to be sustained hypertension greater than 160/100 mmHg associated with proteinuria over 1g/litre. The addition of one or more convulsions defines eclampsia.

Conservative management of carefully selected cases of severe preeclampsia between 25 and 32 weeks of gestation may be considered to gain more time for fetal maturity. This chapter covers management during labour or when the decision has been taken to terminate the pregnancy by induction of labour or caesarean section.

Clinical and pathological features

There are certain women who are at increased risk of developing preeclampsia.