Severe preeclampsia and eclampsia: adverse obstetric outcomes and prognostic factors

Abstract

Background: Hypertensive disorders of pregnancy are globally a threat to maternal and fetal outcomes. Despite massive efforts worldwide, these disorders continue to be a major adverse influence on the health goals especially in developing countries. The aim of the study was to measure the impact of hypertensive disorders of pregnancy in its most severe form on maternal and fetal outcomes in our region along with the important prognostic factors. The objective of this study was to investigate the maternal and fetal outcome in cases of severe preeclampsia and to evaluate the risk factors and complications associated with adverse outcomes.Methods: Indoor records of pregnant females at more than 20 weeks gestation with preeclampsia with severe features (as defined by the ACOG practice bulletin 222) and eclampsia admitted over a period of one year in a unit of obstetrics at Government Medical College, Amritsar were studied and results were statistically analysed.Results: The incidence of hypertension in pregnancy was 11.85% while that of severe preeclampsia was 6.14%. 57.94% of these women were primigravida’s and 80.16% of the women with severe preeclampsia/eclampsia were in the age group 20-29 years. Severe preeclampsia and eclampsia contributed to 43.75% of maternal deaths (OR 8.8, p value=0.0001) and there was increased incidence of stillbirth (OR 10.03, p value<0.0001) and perinatal mortality (OR 12.97, p value<0.0001). The incidence of preterm birth in cases with severe preeclampsia/eclampsia was 57.14%. Severe anemia as a comorbidity along with respiratory distress and renal impairment were associated with increased probability of maternal death.Conclusions: In addition to ensuring the implementation of routine management principles of, the policy makers should focus on developing critical obstetric care and NICU infrastructure along with dedicated human resources at obstetric centres to manage these high-risk cases. Improvement in the quality of antenatal care can help in diagnosing such patients before the onset of severe features so as to optimize maternal and neonatal outcomes.