Learning opportunities in eclampsia care: A ten-year audit from Norway, 2013-2022

Area of Science:

• Obstetrics and Gynecology
• Maternal Health
• Neurology

Background:

• The World Health Organization advocates for surveillance of severe maternal morbidities like eclampsia.
• Audits with case reviews are crucial for improving obstetric outcomes.
• This study focused on auditing eclampsia care in Norway to identify learning opportunities.

Purpose of the Study:

• To conduct an audit of eclampsia cases in Norway.
• To identify specific learning opportunities in eclampsia care.
• To assess potential improvements in obstetric outcomes through case review.

Main Methods:

• Retrospective review of women diagnosed with eclampsia (ICD-10: O15) and generalized seizures from 2013-2022 at two Norwegian university hospitals.
• Development of a digital eclampsia case report form for data collection.
• Review of each case by an eclampsia working group according to clinical guidelines to identify learning opportunities.

Main Results:

• 22 women were diagnosed with eclampsia (2.4 per 10,000 deliveries).
• None received magnesium sulfate prior to seizure; cerebral imaging was used in 11 cases.
• Learning opportunities were identified in 18 cases, with potential outcome improvement in eight, highlighting issues in magnesium sulfate prophylaxis, hypertension management, diagnostic imaging, and follow-up care.

Conclusions:

• 18 of 22 eclampsia cases presented learning opportunities, with potential for improved outcomes in eight.
• Highlights the need for differential diagnosis of seizures, appropriate use of magnesium sulfate, and effective hypertension management in pregnancy.
• Recommends integrating eclampsia audits into national surveillance systems for continuous quality improvement in obstetric care.