Eclampsia Incidence, Management and Outcomes Across Multi-Country Surveillance Cohorts: Individual Participant Data Meta-Analysis.

Abstract

To estimate the incidence of eclampsia, characterise maternal and perinatal profiles, and document outcomes across seven countries within the International Obstetric Survey System and identify inter-country differences that may improve maternal and perinatal care. Multi-country analysis of population-based cohort data. Six high-income countries (Belgium, France, Italy, the Netherlands, Norway, Slovakia) and one upper-middle-income country (Suriname). All women admitted with eclampsia in participating countries between 2012 and 2019. Individual participant data meta-analysis. Incidence of eclampsia, maternal demographics, pregnancy characteristics, clinical management, mode of delivery and maternal and perinatal outcomes. 615 cases of eclampsia were notified resulting in a pooled incidence of eclampsia of 2.2 per 10,000 deliveries in high-income countries and 36.6 per 10,000 deliveries in Suriname. About 42% of women were diagnosed with preeclampsia before seizure onset and one-third experienced their first seizure postpartum. Hypertension was the most reported clinical sign (91.1%). Most women were treated with magnesium sulphate (91.1%) and antihypertensive medications (89.8%). Caesarean section was performed in 72.7% of cases. About 53% of births was preterm with most of them linked to antepartum cases. Maternal and neonatal deaths were rare but more frequent in Suriname. The declining incidence of eclampsia in Europe may be attributed to enhanced management, supported by ongoing audits and confidential enquiries; however, potential ascertainment bias limits causal interpretation. Global efforts remain crucial to promote awareness, timely prevention and implement standardised management guidelines for eclampsia across all settings.