TY - JOUR
T1 - Why magnesium sulfate 'coverage' only is not enough to reduce eclampsia
T2 - Lessons learned in a middle-income country
AU - Verschueren, Kim J C
AU - Paidin, Rubinah R
AU - Broekhuis, Annabel
AU - Ramkhelawan, Olivier S S
AU - Kodan, Lachmi R
AU - Kanhai, Humphrey H H
AU - Browne, Joyce L
AU - Bloemenkamp, Kitty W M
AU - Rijken, Marcus J
N1 - Funding Information:
The authors would like to thank the researcher's assistants of each hospital, the hospital registries, the Ministry of Health, and Maternal Mortality Committee Suriname. The individuals the authors would like to thank are the Surinamese doctors Raez Paidin, Raïz Boerleider, Sarah Samijadi, Shailesh Goeptar and Dutch medical students/doctors Nicole Schenkelaars, Rosemarijn Ettema, Stephanie Thierens, Eva van der Linden, Janine Martens and Nienke Krijnen for their contribution of data acquisition during the SurOSS project. We would especially like to thank Nicole de Kort for her valuable contribution to data acquisition and preliminary analysis.
Publisher Copyright:
© 2020 The Author(s)
PY - 2020/10
Y1 - 2020/10
N2 - Objectives: Determine the eclampsia prevalence and factors associated with eclampsia and recurrent seizures in Suriname and evaluate quality-of-care indicator ‘magnesium sulfate (MgSO4) coverage’. Study design: A two-year prospective nationwide cohort study was conducted in Suriname and included women with eclampsia at home or in a healthcare facility. Main outcome measures: We calculated the prevalence by the number of live births obtained from vital registration. Risk factor denominator data concerned hospital births. Descriptive statistics and multivariate regression analysis were performed. Results: Seventy-two women with eclampsia (37/10.000 live births) were identified, including two maternal deaths (case-fatality 2.8%). Nulliparity, African-descent and adolescence were associated with eclampsia. Adolescents with eclampsia had significantly lower BPs (150/100 mmHg) than adult women (168/105 mmHg). The first seizure occurred antepartum in 54% (n = 39/72), intrapartum in 19% (n = 14/72) and postpartum in 26% (n = 19/72). Recurrent seizures were observed in 60% (n = 43/72). MgSO4 was administered to 99% (n = 69/70) of women; however 26% received no loading dosage and, in 22% of cases MgSO4 duration was <24 h, i.e. guideline adherence existed in only 43%. MgSO4 was ceased during CS in all women (n = 40). Stable BP was achieved before CS in 46%. The median seizure-to-delivery interval was 27 h, and ranged from four to 36 h. Conclusion: Solely ‘MgSO4 coverage’ is not a reliable quality-of-care indicator, as it conceals inadequate MgSO4 dosage and timing, discontinuation during CS, stabilization before delivery, and seizure-to-delivery interval. These other quality-of-care indicators need attention from the international community in order to reduce the prevalence of eclampsia.
AB - Objectives: Determine the eclampsia prevalence and factors associated with eclampsia and recurrent seizures in Suriname and evaluate quality-of-care indicator ‘magnesium sulfate (MgSO4) coverage’. Study design: A two-year prospective nationwide cohort study was conducted in Suriname and included women with eclampsia at home or in a healthcare facility. Main outcome measures: We calculated the prevalence by the number of live births obtained from vital registration. Risk factor denominator data concerned hospital births. Descriptive statistics and multivariate regression analysis were performed. Results: Seventy-two women with eclampsia (37/10.000 live births) were identified, including two maternal deaths (case-fatality 2.8%). Nulliparity, African-descent and adolescence were associated with eclampsia. Adolescents with eclampsia had significantly lower BPs (150/100 mmHg) than adult women (168/105 mmHg). The first seizure occurred antepartum in 54% (n = 39/72), intrapartum in 19% (n = 14/72) and postpartum in 26% (n = 19/72). Recurrent seizures were observed in 60% (n = 43/72). MgSO4 was administered to 99% (n = 69/70) of women; however 26% received no loading dosage and, in 22% of cases MgSO4 duration was <24 h, i.e. guideline adherence existed in only 43%. MgSO4 was ceased during CS in all women (n = 40). Stable BP was achieved before CS in 46%. The median seizure-to-delivery interval was 27 h, and ranged from four to 36 h. Conclusion: Solely ‘MgSO4 coverage’ is not a reliable quality-of-care indicator, as it conceals inadequate MgSO4 dosage and timing, discontinuation during CS, stabilization before delivery, and seizure-to-delivery interval. These other quality-of-care indicators need attention from the international community in order to reduce the prevalence of eclampsia.
KW - Eclampsia
KW - Hypertensive disorders of pregnancy
KW - Magnesium sulfate
KW - Middle-income country
KW - Severe maternal morbidity and mortality
UR - http://www.scopus.com/inward/record.url?scp=85091536076&partnerID=8YFLogxK
U2 - 10.1016/j.preghy.2020.09.006
DO - 10.1016/j.preghy.2020.09.006
M3 - Article
C2 - 32979728
SN - 2210-7789
VL - 22
SP - 136
EP - 143
JO - Pregnancy Hypertension
JF - Pregnancy Hypertension
ER -