Leitch C R, Cameron A D, Walker J J
Glasgow Royal Maternity Hospital, UK.
Br J Obstet Gynaecol. 1997 Aug;104(8):917-22. doi: 10.1111/j.1471-0528.1997.tb14351.x.
To determine changes in the incidence and pattern of eclampsia within the same geographical area over a 60-year period.
A retrospective, descriptive study of 1259 consecutive women classified, at the time, as having had an eclamptic convulsion between the years 1931 and 1990.
A large city centre teaching hospital and the surrounding catchment area.
The changes in the incidence and timing of the convulsion and the outcomes for the mother and baby.
Over the study period, the incidence of eclampsia fell by more than 90%, from 74.1/10,000 in the 1930s to 7.2/10,000 in the 1980s. Most of the reduction occurred over the first four decades, with little change in the last 20 years. Overall, 44% of the cases of eclampsia occurred in the antenatal period, 33% intrapartum and 23% postpartum. Since the biggest decreases were seen in the incidence of antenatal and particularly intrapartum eclampsia, there has been a relative increase in the proportion of eclampsia occurring postpartum. Maternal death from eclampsia occurred in 15.1% of cases between 1931 and 1940, 13.4% between 1941 and 1950, but fell dramatically to < or = 3.9% after 1950. There has been no maternal death since 1964. Apart from the first decade, postpartum eclampsia was associated with significantly less risk of death to the mother throughout the study period. Perinatal death rate has fallen steadily from 432.6/1000 cases of eclampsia between 1931 and 1940 over the first three decades, to 168.7/1000 between 1961 and 1970. There has been little change since, although a lower proportion of neonatal deaths occurred as stillbirths.
We found a significant reduction in both the incidence of eclampsia and associated morbidity in this population over the last 60 years. This has occurred in association with the introduction of the National Health Service, widespread antenatal care for all and a general improvement in health and welfare. Any further reduction in the incidence in the UK may be difficult to achieve. Since the incidence of eclampsia is now low, efforts should perhaps be directed at minimising the morbidity associated with severe pre-eclampsia rather than prevention of convulsions.
确定在同一地理区域内，子痫的发病率和模式在60年期间的变化情况。
一项回顾性描述性研究，对1931年至1990年间连续收治的1259例当时被归类为发生子痫抽搐的女性进行研究。
一个大城市中心的教学医院及其周边集水区。
抽搐的发病率和发生时间的变化，以及母婴结局。
在研究期间，子痫的发病率下降了90%以上，从20世纪30年代的74.1/10000降至80年代的7.2/10000。大部分下降发生在前四十年，后二十年变化不大。总体而言，44%的子痫病例发生在产前，33%在产时，23%在产后。由于产前子痫尤其是产时子痫的发病率下降幅度最大，产后子痫所占比例相对增加。1931年至1940年间，15.1%的子痫病例发生孕产妇死亡，1941年至1950年间为13.4%，但1950年后急剧降至≤3.9%。自1964年以来未发生孕产妇死亡。除了第一个十年外，在整个研究期间，产后子痫导致母亲死亡的风险显著较低。围产儿死亡率在前三十年中从1931年至1940年间每1000例子痫病例中的432.6稳步下降至1961年至1970年间的168.7。此后变化不大，尽管新生儿死亡中死产的比例有所降低。
我们发现，在过去60年中，该人群中的子痫发病率和相关发病率均显著降低。这与国家医疗服务体系的引入、普及全民产前保健以及健康和福利的总体改善有关。在英国，子痫发病率可能难以进一步降低。由于子痫发病率现在较低，或许应致力于将与重度子痫前期相关的发病率降至最低，而非预防抽搐。
