Article Text

Download PDFPDF
Audit of management of eclampsia and severe pre-eclampsia against RCOG standards
  1. J Reiley,
  2. H Moss,
  3. J Gibson
  1. Greater Glasgow and Clyde NHS Trust Area Perinatal Effectiveness Committee, Glasgow, UK


Introduction Confidential enquiries into maternal deaths show substandard care in a significant percentage of the deaths from eclampsia.1 The RCOG Green Top Guideline No 10(A) (2006)2 makes recommendations to standardise the approach of the management of severe pre-eclampsia/eclampsia to improve outcomes.

Aim To evaluate the management of women presenting with severe pre-eclampsia and eclampsia to any of our 4 regional maternity units against the RCOG guideline.2

Method A 1 year retrospective audit.

Results 78/80 identified cases were available for analysis. Two pregnancies resulted in stillbirth. The mean gestation at delivery was 35+0 (range 26+2 to 40+3).

Diagnosis The average number of blood pressure readings was 3 per patient, all had appropriate blood tests performed, quantification of proteinuria was made primarily by dipstick testing.

Therapy Labetalol was used in 65 cases (88%) including 5/8 asthmatics. 39 (55%) with severe pre-eclampsia and all with eclampsia received magnesium sulphate. The majority received a 4 g loading and 1 g/h maintenance dose. There were no recurrent seizures. Fluid restriction was evident antenatally/intrapartum in 55% and postpartum in 67%. Consultant obstetricians reviewed 75 patients within 24 h of diagnosis. Senior anaesthetic input was significantly less (50%).

Fetal assessment/preparation All (viable) had CTGs performed. All deliveries more than 48 h after diagnosis had ultrasound assessment of the fetus performed. 23 women delivered a live birth before 34 weeks gestation, all received steroids.

Conclusions Management of a well known complication still requires improvements. A region wide guideline has been devised to direct therapy, improved fluid balance and facilitate comprehensive multidisciplinary care.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.