MATERNAL AND FETAL OUTCOMES IN ANTEPARTUM ECLAMPSIA: A PROSPECTIVE OBSERVATIONAL STUDY

Abstract

Background: Antepartum eclampsia is a severe obstetric emergency associated with substantial maternal and perinatal morbidity and mortality. Despite advances in antenatal surveillance, anticonvulsant therapy, blood pressure control, critical care, and neonatal support, eclampsia continues to pose a major challenge, particularly among women presenting late to tertiary care facilities. The severity of maternal disease, recurrent seizures, prematurity, placental abruption, and delayed referral may adversely influence both maternal and fetal outcomes. The present study evaluated the clinical profile, management, maternal complications, fetal and neonatal outcomes, and factors associated with adverse outcomes among women with antepartum eclampsia. The aim is to investigate maternal and fetal outcomes among women with antepartum eclampsia presenting to a tertiary care hospital and to identify clinical and obstetric factors associated with adverse maternal and perinatal outcomes. Materials and Methods: This prospective observational, institution-based study was conducted in the Department of Obstetrics and Gynaecology, North Bengal Medical College & Hospital, West Bengal, over two years from April 2024 to March 2026. A total of 125 pregnant women diagnosed with antepartum eclampsia were consecutively enrolled. Eligible participants were pregnant women with antepartum eclampsia who provided written informed consent. Women with postpartum eclampsia, chronic medical conditions unrelated to hypertensive disorders of pregnancy, or inability/unwillingness to provide consent were excluded. Data were collected through structured interviews, clinical examination, and review of medical records. Maternal demographic characteristics, gestational age, seizure profile, blood pressure, laboratory parameters, proteinuria, treatment, mode and timing of delivery, maternal complications, and neonatal outcomes were recorded. Categorical variables were expressed as frequencies and percentages, and associations were assessed using the chi-square test. A p-value <0.05 was considered statistically significant. The primary maternal outcome was maternal death and the primary fetal outcome was stillbirth. Results: Antepartum eclampsia was observed predominantly among young women, primigravidas, rural residents, and those who were unbooked or referred. The mean maternal age was 24.1 ± 4.3 years, and 69.6% of women were primigravidas. Most women presented before term, with a mean gestational age at onset of 32.9 ± 3.6 weeks. Multiple seizures occurred in 53.6% of women, while 84.8% underwent caesarean delivery. Maternal complications included thrombocytopenia, renal dysfunction, cardiopulmonary complications, and obstetric complications, with maternal mortality of 5.6%. Preterm delivery occurred in 83.2% of pregnancies, low birth weight in 78.4% of live births, and perinatal mortality was 19.2%. Abruptio placentae, maternal renal impairment, delivery before 34 weeks, and Glasgow Coma Scale score <13 at admission were significantly associated with increased odds of perinatal mortality. Conclusion: Antepartum eclampsia was associated with substantial maternal and perinatal morbidity and mortality despite prompt tertiary-care management. The study population was predominantly young, rural, primigravid, and unbooked, with a high frequency of preterm presentation and recurrent seizures. Maternal mortality was 5.6% and perinatal mortality was 19.2%. Unbooked status, delayed referral, recurrent seizures, severe hypertension, and early-onset disease were significantly associated with adverse maternal outcomes, whereas placental abruption, maternal renal impairment, delivery before 34 weeks, and neurological compromise were significant predictors of perinatal mortality