Why magnesium sulfate ‘coverage’ only is not enough to reduce eclampsia: Lessons learned in a middle-income country
Pregnancy Hypertension, vol. 22, pp. 136–143
Abstract
OBJECTIVES: Determine the eclampsia prevalence and factors associated with eclampsia and recurrent seizures in Suriname and evaluate quality-of-care indicator 'magnesium sulfate (MgSO4) coverage'. STUDY DESIGN: A two-year prospective nationwide cohort study was conducted in Suriname and included women with eclampsia at home or in a healthcare facility. MAIN OUTCOME MEASURES: We calculated the prevalence by the number of live births obtained from vital registration. Risk factor denominator data concerned hospital births. Descriptive statistics and multivariate regression analysis were performed. RESULTS: Seventy-two women with eclampsia (37/10.000 live births) were identified, including two maternal deaths (case-fatality 2.8%). Nulliparity, African-descent and adolescence were associated with eclampsia. Adolescents with eclampsia had significantly lower BPs (150/100 mmHg) than adult women (168/105 mmHg). The first seizure occurred antepartum in 54% (n = 39/72), intrapartum in 19% (n = 14/72) and postpartum in 26% (n = 19/72). Recurrent seizures were observed in 60% (n = 43/72). MgSO4 was administered to 99% (n = 69/70) of women; however 26% received no loading dosage and, in 22% of cases MgSO4 duration was <24 h, i.e. guideline adherence existed in only 43%. MgSO4 was ceased during CS in all women (n = 40). Stable BP was achieved before CS in 46%. The median seizure-to-delivery interval was 27 h, and ranged from four to 36 h. CONCLUSION: Solely 'MgSO4 coverage' is not a reliable quality-of-care indicator, as it conceals inadequate MgSO4 dosage and timing, discontinuation during CS, stabilization before delivery, and seizure-to-delivery interval. These other quality-of-care indicators need attention from the international community in order to reduce the prevalence of eclampsia.
Authors 9
-
Kim J. C. Verschueren corresponding
Utrecht University · University Medical Center Utrecht · Wilhelmina Children's Hospital
Affiliation as printed
Department of Obstetrics, Birth Centre Wilhelmina's Children Hospital, Division Woman and Baby, University Medical Center Utrecht, the Netherlands. Electronic address: kim.sxm@gmail.com
Department of Obstetrics, Birth Centre Wilhelmina's Children Hospital, Division Woman and Baby, University Medical Center Utrecht, the Netherlands
-
Affiliation as printed
Department of Obstetrics, Academic Hospital Paramaribo, Paramaribo, Suriname
-
Affiliation as printed
Department of Obstetrics, Academic Hospital Paramaribo, Paramaribo, Suriname
-
Affiliation as printed
Department of Obstetrics, 's Lands Hospitaal, Paramaribo, Suriname
-
Utrecht University · Academic Hospital Paramaribo · University Medical Center Utrecht · Wilhelmina Children's Hospital
Affiliation as printed
Department of Obstetrics, Birth Centre Wilhelmina's Children Hospital, Division Woman and Baby, University Medical Center Utrecht, the Netherlands; Department of Obstetrics, Academic Hospital Paramaribo, Paramaribo, Suriname; Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
Department of Obstetrics, Academic Hospital Paramaribo, Paramaribo, Suriname
Department of Obstetrics, Birth Centre Wilhelmina's Children Hospital, Division Woman and Baby, University Medical Center Utrecht, the Netherlands
Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
-
Leiden University Medical Center
Affiliation as printed
Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands. Electronic address: h.h.h.kanhai@lumc.nl
Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
-
Utrecht University · University Medical Center Utrecht
Affiliation as printed
Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands. Electronic address: J.L.Browne@umcutrecht.nl
Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
-
Utrecht University · University Medical Center Utrecht · Wilhelmina Children's Hospital
Affiliation as printed
Department of Obstetrics, Birth Centre Wilhelmina's Children Hospital, Division Woman and Baby, University Medical Center Utrecht, the Netherlands. Electronic address: K.W.M.Bloemenkamp@umcutrecht.nl
Department of Obstetrics, Birth Centre Wilhelmina's Children Hospital, Division Woman and Baby, University Medical Center Utrecht, the Netherlands
-
Utrecht University · University Medical Center Utrecht · Wilhelmina Children's Hospital
Affiliation as printed
Department of Obstetrics, Birth Centre Wilhelmina's Children Hospital, Division Woman and Baby, University Medical Center Utrecht, the Netherlands; Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands. Electronic address: mrijken2@umcutrecht.nl
Department of Obstetrics, Birth Centre Wilhelmina's Children Hospital, Division Woman and Baby, University Medical Center Utrecht, the Netherlands
Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands
Cited by 8 stored of 8
8 results
No patents citing this paper on Lens.org (checked 2026-10-11).