Eclampsia at a tertiary hospital 1973-99.

Background: To investigate changes in incidence, patient characteristics, comorbidity and in the care provided in cases of eclampsia at a tertiary hospital during the period 1973-99.

Methods: Thirty-nine cases were identified through the Swedish National Birth Registry. Incidences and rates regarding patient characteristics and outcomes (duration of intensive care unit surveillance, assisted ventilation, multiple seizures, predefined major complications, perinatal mortality, small for gestational age, and neonatal intensive care surveillance) were compared between the time periods 1973-79, 1980-89 and 1990-99 with trend analysis.

Results: The incidences in the three time periods were 3.0/10,000 births [95% confidence interval (CI) 0.1-5.9], 6.2/10,000 births (95% CI 2.7-9.7) and 10.9/10,000 births (95% CI 6.4-15.4), respectively, which constitutes a significant difference according to trend analysis (p = 0.006). There were no differences in patient characteristics or comorbidity. Onset occurred in hospital in 85% of the cases.

Conclusions: The increase in the incidence of eclampsia reported here is contrary to international trends up until the early 1990s. The incidence in 1990-99 is also higher than the reported national incidence in Sweden 1976-80, which was 2.9/10,000 births. Despite successful identification of women at risk for eclampsia and hospital surveillance, several cases were not prevented. Better prognostic tests that identify impending eclampsia are needed to bring the incidence down further.