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

The World Health Organization recommends surveillance, including audits with case reviews of severe maternal morbidities such as eclampsia, to improve obstetric outcomes. We aimed to audit eclampsia and to identify learning opportunities in eclampsia care in Norway.

Our study population included all women discharged with a diagnosis of eclampsia (ICD-10: O15) and with a documented generalized seizure in medical records at two university hospitals in Norway from 2013 to 2022. An eclampsia working group developed a digital eclampsia case report form for gathering clinical information from medical records. Based on a structured summary of information from the digital case report form, the group reviewed the care for women with eclampsia. Each case was discussed and reviewed according to the clinical guidelines by the group. Learning opportunities to improve care were identified and classified according to whether they contributed to the outcome.

Among 93 139 deliveries, 22 women with an initial eclampsia diagnosis were identified (2.4 per 10 000). Subsequent clinical information identified an alternative probable etiology of seizures in five women. None of the 22 women received magnesium sulfate prior to the seizure, and cerebral imaging was performed in 11 of 22 women. In 18 women, learning opportunities were identified, and for eight women, a different management could potentially have prevented eclampsia. The eclampsia working group identified learning opportunities related to underuse of magnesium sulfate prophylaxis when indicated, inadequate management of hypertension both before and after eclamptic seizure, underuse of cerebral imaging as a diagnostic tool, and lack of follow-up consultation with an obstetrician in women diagnosed with eclampsia.

Learning opportunities were found in 18 of 22 women, and improvements in care could potentially have changed the outcome for eight of the women. This audit highlights the importance of differential diagnostic consideration for seizures in pregnant and postpartum women, the use of prophylactic magnesium sulfate when indicated, and the diagnosis and management of hypertension in pregnancy. Eclampsia audits should be incorporated into national routine surveillance and learning systems to improve obstetric care.