Abstract
ObjectiveMaternal mortality (MM) is a core indicator of disparities in women’s rights. The study of Near Miss cases is strategic to identifying the breakdowns in obstetrical care. In absolute numbers, both MM and occurrence of eclampsia are rare events. We aim to assess the obstetric care indicators and main predictors for severe maternal outcome from eclampsia (SMO: maternal death plus maternal near miss).MethodsSecondary analysis of a multicenter, cross-sectional study, including 27 centers from all geographic regions of Brazil, from 2009 to 2010. 426 cases of eclampsia were identified and classified according to the outcomes: SMO and non-SMO. We classified facilities as coming from low- and high-income regions and calculated the WHO’s obstetric health indicators. SPSS and Stata softwares were used to calculate the prevalence ratios (PR) and respective 95% confidence interval (CI) to assess maternal characteristics, clinical and obstetrical history, and access to health services as predictors for SMO, subsequently correlating them with the corresponding perinatal outcomes, also applying multiple regression analysis (adjusted for cluster effect).ResultsPrevalence of and mortality indexes for eclampsia in higher and lower income regions were 0.2%/0.8% and 8.1%/22%, respectively. Difficulties in access to health care showed that ICU admission (adjPR 3.61; 95% CI 1.77–7.35) and inadequate monitoring (adjPR 2.31; 95% CI 1.48–3.59) were associated with SMO.ConclusionsMorbidity and mortality associated with eclampsia were high in Brazil, especially in lower income regions. Promoting quality maternal health care and improving the availability of obstetric emergency care are essential actions to relieve the burden of eclampsia.
Highlights
Eclampsia is a rare, potentially life-threatening complication of the hypertensive disorders (HD) of pregnancy, accountable for large numbers in morbidity and deaths among women of reproductive age and their offspring [1,2,3,4]
Difficulties in access to health care showed that intensive care units (ICU) admission and inadequate monitoring were associated with severe maternal outcome from eclampsia (SMO)
Morbidity and mortality associated with eclampsia were high in Brazil, especially in lower income regions
Summary
Potentially life-threatening complication of the hypertensive disorders (HD) of pregnancy, accountable for large numbers in morbidity and deaths among women of reproductive age and their offspring [1,2,3,4]. 94.6% of the data were collected in the USA, highlighting a marked regionalization bias and, the need for more studies, especially in low- and middle-income countries (LMIC) [5,7]. The case fatality rate (number of deaths/number of cases) of eclampsia ranges from 0–1.8% in high-income countries up to 17.7% in India, emphasizing a huge gap in the quality of maternal health care according to social and economic patterns [8]. Over a one-year period, the Swedish Medical Birth Register identified no maternal death due to eclampsia, whilst in India, in the same period, only one hospital reported 11 eclampsia-related deaths [8,9,10]
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