The burden of eclampsia: results from a multicenter study on surveillance of severe maternal morbidity in Brazil.
OBJECTIVE
Maternal mortality (MM) is a core indicator of disparities in women's rights. The study of Near Miss cases is strategic to identifying the breakdowns in obstetrical care. In absolute numbers, both MM and occurrence of eclampsia are rare events. We aim to assess the obstetric care indicators and main predictors for severe maternal outcome from eclampsia (SMO: maternal death plus maternal near miss).


METHODS
Secondary analysis of a multicenter, cross-sectional study, including 27 centers from all geographic regions of Brazil, from 2009 to 2010. 426 cases of eclampsia were identified and classified according to the outcomes: SMO and non-SMO. We classified facilities as coming from low- and high-income regions and calculated the WHO's obstetric health indicators. SPSS and Stata softwares were used to calculate the prevalence ratios (PR) and respective 95% confidence interval (CI) to assess maternal characteristics, clinical and obstetrical history, and access to health services as predictors for SMO, subsequently correlating them with the corresponding perinatal outcomes, also applying multiple regression analysis (adjusted for cluster effect).


RESULTS
Prevalence of and mortality indexes for eclampsia in higher and lower income regions were 0.2%/0.8% and 8.1%/22%, respectively. Difficulties in access to health care showed that ICU admission (adjPR 3.61; 95% CI 1.77-7.35) and inadequate monitoring (adjPR 2.31; 95% CI 1.48-3.59) were associated with SMO.


CONCLUSIONS
Morbidity and mortality associated with eclampsia were high in Brazil, especially in lower income regions. Promoting quality maternal health care and improving the availability of obstetric emergency care are essential actions to relieve the burden of eclampsia.
Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas - UNICAMP, Campinas, São Paulo, Brazil.
Juliana C
JC
Giordano
Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas - UNICAMP, Campinas, São Paulo, Brazil.
Mary A
MA
Parpinelli
Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas - UNICAMP, Campinas, São Paulo, Brazil; Center for Studies on Reproductive Health of Campinas (CEMICAMP), Campinas, São Paulo, Brazil.
Jose G
JG
Cecatti
Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas - UNICAMP, Campinas, São Paulo, Brazil.
Samira M
SM
Haddad
Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas - UNICAMP, Campinas, São Paulo, Brazil.
Maria L
ML
Costa
Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas - UNICAMP, Campinas, São Paulo, Brazil.
Fernanda G
FG
Surita
Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas - UNICAMP, Campinas, São Paulo, Brazil.
Joao L
JL
Pinto E Silva
Center for Studies on Reproductive Health of Campinas (CEMICAMP), Campinas, São Paulo, Brazil.
Maria H
MH
Sousa
D001938:Brazil / Q000453:epidemiology; D003430:Cross-Sectional Studies; D004461:Eclampsia / Q000401:mortality*; D062665:Epidemiological Monitoring; D005260:Female; D006801:Humans; D015994:Incidence; D009035:Mothers / Q000706:statistics & numerical data*; D009774:Obstetrics / Q000592:standards* / Q000706:statistics & numerical data; D011247:Pregnancy; D015995:Prevalence; D012044:Regression Analysis; D012959:Socioeconomic Factors