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Eclampsia: a multinational population-based study

Introduction

Eclampsia is one of the most serious acute complications of pregnancy, associated with high maternal and perinatal morbidity and mortality. It is defined as a maternal near-miss event by the World Health Organization. Although prevalence has declined in high-income countries over the past two decades (0.18–0.62 per 1,000 deliveries), hypertensive disorders remain among the leading causes of direct maternal death. The introduction of magnesium sulfate as the drug of choice for prevention and treatment of seizures has significantly improved outcomes, yet variations in incidence, management, and prognosis persist across countries.

Aim

The study is aiming to:

  • Update data on the incidence of eclampsia in participating countries
  • Identify maternal characteristics and antenatal risk factors
  • Investigate clinical management and treatment strategies
  • Assess maternal and perinatal outcomes

Study design

The study is being conducted as a multinational, population-based cohort involving 8 INOSS countries:

  • Belgium
  • France
  • Italy
  • Namibia
  • The Netherlands
  • Norway
  • Romania
  • Slovakia

A total of 615 cases are being collected for analysis.

Case definition

Eclampsia is defined as the occurrence of convulsions during pregnancy or postpartum not attributable to other causes, and generally associated with features of preeclampsia (hypertension, proteinuria, or laboratory abnormalities).

Data collection

The study is collecting data prospectively using standardized forms, including:

  • Diagnostic criteria (hypertension, proteinuria, thrombocytopenia, liver function abnormalities)
  • Risk factors (age, parity, citizenship, assisted reproductive technologies, multiple pregnancy, comorbidities, hypertensive disorders)
  • Premonitory signs and symptoms
  • Maternal treatment (magnesium sulfate, antihypertensives, anticonvulsants)
  • Number and timing of seizures
  • Mode and timing of delivery
  • Maternal investigations (MRI, CT)
  • Maternal and perinatal outcomes (ICU/NICU admission, morbidity, mortality)

Data protection

Aggregate data are being transmitted to the Istituto Superiore di Sanità (Italy) for analysis. Each participating country retains ownership of its data. Data protection and confidentiality procedures comply with national and European regulations.

Expected impact

By combining high-quality, standardized data from multiple countries, the study is expected to:

  • Provide updated estimates of eclampsia incidence
  • Improve understanding of maternal risk factors and clinical presentation
  • Promote evidence-based best practices for prevention and management
  • Contribute to reducing maternal and perinatal morbidity and mortality associated with hypertensive disorders of pregnancy

Updated: Thursday, 16 October 2025 15:41 (v1)