Pregnancy-related mortality from preeclampsia and eclampsia

Objective: To examine the role of preeclampsia and eclampsia in pregnancy-r elated mortality. Methods: We used data from the Centers for Disease Control and Prevention's Pregnancy Mortality Surveillance System to examine pregnancy-related death s from preeclampsia and eclampsia from 1979 to 1992. The pregnancy-related mortality ratio for preeclampsia-eclampsia was defined as the number of dea ths from preeclampsia and eclampsia per 100,000 live births. Case-fatality rates for 1988-1992 were calculated for preeclampsia and eclampsia deaths p er 10,000 cases during the delivery hospitalization, using the National Hos pital Discharge Survey. Results: Of 4024 pregnancy-related deaths at 20 weeks' or more gestation in 1979-1992, 790 were due to preeclampsia or eclampsia (1.5 deaths/100,000 l ive births). Mortality from preeclampsia and eclampsia increased with incre asing maternal age. The highest risk of death was at gestational age 20-28 weeks and after the first live birth. Black women were 3.1 times more likel y to die from preeclampsia or eclampsia as white women. Women who had recei ved no prenatal care had a higher risk of death from preeclampsia or eclamp sia than women who had received any level of prenatal care. The overall pre eclampsia-eclampsia case-fatality rate was 6.4 per 10,000 cases at delivery , and was twice as high for black women as for white women. Conclusion: The continuing racial disparity in mortality from preeclampsia and eclampsia emphasizes the need to identify those differences that contri bute to excess mortality among black women, and to develop specific interve ntions to reduce mortality from preeclampsia and eclampsia among all women. (C) 2001 by The American College of Obstetricians and Gynecologists.