Saving Mothers' Lives: - Public Health Agency for Northern Ireland

Table 3.2
Numbers of deaths from pre-eclampsia or eclampsia; United Kingdom 2003-05.
Triennium Cerebral Pulmonary Hepatic Total
Intracranial
haemorrhage
Subarachnoid Infarct Oedema All ARDS Oedema Other All Rupture Failure/
necrosis
Other All
1985-87 11 0 0 0 11 9 1 2 12 0 1 3 4 27
1988-90 10 2 2 0 14 9 1 0 10 0 1 2 3 27
1991-93 5 0 0 0 5 8 3 0 11 0 0 4 4 20
1994-96 3 1 0 3 7 6 2 0 8 2 1 2 5 20
1997-99 7 0 0 0 7 2 0 0 2 2 0 5 7 16
2000-02 9 0 0 0 9 1 0 0 1 0 0 4 4 14
2003-05 10 0 2 0 12 0 0 0 0 0 2 4 6 18
Incidence of eclampsia in the United Kingdom
Cases of severe maternal morbidity and mortality from eclampsia were surveyed through the UKOSS
system from February 2005 to February 2006 1 . Over the thirteen months of the study, 209 confi rmed cases
of eclampsia, including deaths, were reported. This represented an estimated incidence of 26.8 cases per
100,000 maternities with a 95% confi dence interval from 23.3 to 30.7. This represents a signifi cant decrease
since an earlier national surveillance study, which found an incidence of 49 per 100,000 maternities, with
a confi dence interval from 45 to 54 per 100,000 maternities in 1992 2 . Ninety-nine per cent of women in the
UKOSS study were treated with magnesium sulphate in accordance with national guidelines.
The women who died
The ages of the women ranged between 23 and 40 years, with a median age of 33 years. The gestational
ages at delivery ranged from 21 to 42 weeks, with a median of 37 weeks. Nine women were at, or after,
term (37 weeks of gestation or more) at the time of delivery and only two were less than 28 weeks’
pregnant. Fulminating disease occurred throughout the gestational range. Their parity ranged between 0
and 5 previous pregnancies, with a median of one. Seven women were primigravid. All the pregnancies
were singleton.
Twelve women were White, two each were Black Caribbean or Black African and the other two women
had recently arrived from other parts of the world. Only one did not speak English. Two booked late for
antenatal care despite problems in previous pregnancies and one woman appeared to be a health tourist
arriving in the UK near term.
Six women had eclamptic fi ts, fi ve in the antenatal period. HELLP syndrome was diagnosed in eight women.
Thirteen cases showed features of remediable factors, and in eight of these there was major sub-standard care.
As in the last Report, intracranial haemorrhage was the single most common cause of death, and failure
of effective anti-hypertensive therapy the most common source of sub-standard care. Although most substandard
care was seen in the hospital sector, there were examples in primary care of midwives failing to
test urine for proteinuria in women who subsequently developed severe pre-eclampsia.
All of the women who died were in hospital. In one case, the fi rst indication of clinical concern was the
observation of fetal growth restriction, pre-dating signs of pre-eclampsia.
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