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NeilsonConclusionThe number of deaths from pre-eclampsia/eclampsia has notfallen. The most pressing need, as before, is to treat hypertension(and especially systolic hypertension) quickly and effectivelyto prevent haemorrhagic stroke. Iatrogenichypertension should be avoided by abandoning the use ofergometrine in routine third-stage management. The incidenceof eclampsia has halved in the UK, presumably as aresult of the widespread use of magnesium sulphate, followingpublication of the Magpie trial. 7 The UKOSS study hasshown that the overall case fatality rate associated witheclampsia is low in the UK, but serious morbidity can occur. 2However, this Enquiry, albeit over a different time-scale, hasidentified an unprecedented number of deaths associatedwith eclamptic seizures. This is a reminder that eclampsia is aserious complication that, where possible, should be avoided.Disclosure of interestsNone.FundingThis work was undertaken by the Centre for Maternal andChild Enquiries (CMACE) as part of the CEMACH programme.The work was funded by the National PatientSafety Agency; the Department of Health, Social Servicesand Public Safety of Northern Ireland; NHS QualityImprovement Scotland (NHS QIS); and the ChannelIslands and Isle of Man.AcknowledgementsThis chapter has been seen and discussed with Mr StevenWalkinshaw, Consultant Obstetrician of LiverpoolWomen’s Hospital. The Pathology overview was written byDr H Millward-Sadler, Consultant Histopathologist ofSouthampton University Hospitals NHS Trust. jReferences1 Knight M, Nelson-Piercy C, Kurinczuk JJ, Spark P, Brocklehurst P. Aprospective national study of acute fatty liver of pregnancy in the UK.Gut 2008;57:951–6.2 Knight M. Eclampsia in the United Kingdom 2005. BJOG2007;114:1072–8.3 Douglas KA, Redman CW. Eclampsia in the United Kingdom. BMJ1994;309:1395–400.4 National Collaborating Centre for Women’s and Children’s Health.Hypertension in Pregnancy: The Management of Hypertensive DisordersDuring Pregnancy. National Institute for Health and Clinical ExcellenceGuideline 107. London: RCOG. August 2010. [www.guidance.nice.org.uk/CG107/]. Accessed 5 October 2010.5 McDonald SJ, Abbott JN, Higgins SP. Prophylactic ergometrine-oxytocinversus oxytocin for the third stage of labour. Cochrane DatabaseSyst Rev 2004;Issue 1:CD000201.6 National Collaborating Centre for Women’s and Children’s Health. IntrapartumCare. Care of Healthy Women and their Babies DuringChildbirth. London: RCOG. Revised Report 2008. [http://www.ncc-wch.org.uk/guidelines/guidelilnes-programme/guidelines-programmepublished/intrapartum-care/]Accessed 5 October 2010.7 Altman D, Carroli G, Duley L, Farrell B, Moodley J, Neilson J, et al. Dowomen with pre-eclampsia, and their babies, benefit from magnesiumsulphate? The Magpie Trial: a randomised placebo-controlledtrial Lancet 2002;359:1877–90.70 ª 2011 Centre for Maternal and Child Enquiries (CMACE), BJOG 118 (Suppl. 1), 1–203