Pre-eclampsia complicates 5–8% of pregnancies and significantly contributes to maternal mortality in the United States (Berg et al., 2003; Chang et al., 2003), the United Kingdom (de Swiet, 2000; Scott and Owen, 1996), Europe (Hogberg et al., 1994; Schuitemaker et al., 1998) and, most notably, in developing nations (Bouvier-Colle et al., 2001). Pre-eclampsia is a disease unique to human pregnancy, with pathophysiologic effects which may compromise cardiovascular, renal, hematologic, neurologic, hepatic, and other organ systems. Early-onset pre-eclampsia is associated with greater morbidity (Murphy and Stirrat, 2000). The classification of hypertensive diseases and the pathophysiology of pre-eclampsia are comprehensively addressed in other sections of this book. The purpose of this chapter is to provide a practical guide to clinicians caring for patients with complications of pre-eclampsia.
The incidence of eclampsia in the United Kingdom and the United States is approximately 5 per 10,000 births (Atrash et al., 1990; Douglas and Redman, 1994). However, at teaching hospitals in Africa, the eclampsia rate is reported around 50 per 10,000 deliveries (Adze et al., 2001; Majoko and Mujaji, 2001), likely an effect of home births and late medical care. Contemporary maternal mortality rates of eclampsia are under 2% in developed countries but are significantly higher in developing nations (Table 27.8). In the Dallas series of 245 eclamptics, one maternal death occurred, which was attributed to magnesium overdose (Cunningham et al., 1984).