[Eclampsia in Landspítali, Iceland - A clinical, statistical analysis during the period 1982-2022]

Eclampsia is a serious complication of pregnancy and childbirth. Preeclampsia is considered to be its precursor and antenatal monitoring is of crucial importance. The study aimed to investigate the incidence of eclampsia at Landspítali, timing of seizures, signs of preeclampsia, subsequent diagnosis of neurological diseases and sequelae, and maternal mortality rate.

The cohort consisted of women diagnosed with eclampsia at Landspítali between 1982 and 2022. Data was collected from forty medical records, excluding seven misdiagnosed cases. Statistical significance was calculated with Fisher's exact test and a multinomial exact test.

During the study period, the incidence of eclampsia remained consistent at ~1:3610 births, i.e. 33 cases out of 119.125 births. The eclampsia occurred as follows: 52% antepartum, 27% intrapartum, and 21% postpartum. Twenty-four women were diagnosed with preeclampsia before the eclampsia occurred. Nine women had no signs of preeclampsia, and this subgroup was proportionally larger (though non-significant p=0.44) in the latter part of the study period. Five women were subsequently diagnosed with neurological disease or symptoms. All women for whom information was available (32 out of 33), were alive 42 days after the eclampsia.

The incidence of eclampsia was low and remained consistent during the study period and the mortality rate approximates zero. Nothing indicates that the incidence will decrease unless we learn more about predictive factors. Few women were subsequently diagnosed with neurological disease or experienced neurological symptoms, but there appears to be a significant lack of good work practices for searching and follow-up of such symptoms and other consequences of eclampsia.