title: Maternal and obstetric factors associated with delayed postpartum eclampsia: a national study population.
abstract: OBJECTIVE
  To estimate the incidence of delayed postpartum eclampsia and to investigate whether maternal characteristics and outcomes were different between women with delayed or early postpartum eclampsia.
  
  
  METHODS
  Prospective population-based study.
  
  
  METHODS
  All 229 UK hospitals with consultant-led maternity units in the UK.
  
  
  METHODS
  All women delivering between February 2005 and February 2006.
  
  
  METHODS
  Maternal characteristics and outcomes were compared between women with delayed (≥ 12 hours between delivery and eclampsia) and early postpartum eclampsia.
  
  
  METHODS
  Rates with 95% confidence intervals (CIs). Adjusted odds ratio estimates.
  
  
  RESULTS
  Seventy-six women had postpartum eclampsia, representing an incidence of 1.0/10 000 (95% CI 0.7-1.2/10 000) maternities. Among the women having postpartum eclampsia, 53 (70%; 95% CI 59-79) occurred in the first 12 hours following delivery, eight (11%; 95% CI 3-20) during hours 12-24, four (5%; 95% CI 2-13) during the 24-48 hours after delivery and 11 (14%; 95% CI 7-24) more than 48 hours after delivery. Maternal characteristics, biological and clinical symptoms in the week preceding eclampsia and neonatal outcomes were not significantly different in the delayed eclampsia group in comparison with the early postpartum eclampsia group. However, the cesarean delivery rate was higher in women with delayed eclampsia in comparison with earlier postpartum eclampsia [13 (57%) vs. 6 (11%); odds ratio 10.1, 95% CI 3.12-33.3].
  
  
  CONCLUSIONS
  Close follow-up should be performed in the 12 hours following delivery in women with hypertensive disorders of pregnancy. Beyond this, the risk of eclampsia is very low, and eclampsia occurs mainly among women who have had a cesarean delivery.
authors.affiliation: National Perinatal Epidemiology Unit, University of Oxford, Old Road Campus, Oxford, UK. gkayem@gmail.com
authors.forename: Gilles
authors.initials: G
authors.lastname: Kayem
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Kurinczuk
authors.forename: Patsy
authors.initials: P
authors.lastname: Spark
authors.forename: Peter
authors.initials: P
authors.lastname: Brocklehurst
authors.forename: Marian
authors.initials: M
authors.lastname: Knight
mesh_terms: D000328:Adult; D036861:Delivery, Obstetric; D004461:Eclampsia / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D015994:Incidence; D010298:Parity; D049590:Postpartum Period; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D013997:Time Factors