Eclampsia is a grave obstetric emergency, particularly prevalent in low- and middle-income countries where access to quality antenatal care is often limited.1 Derived from the Greek term meaning “a flash of lightning,” eclampsia refers to the sudden onset of seizures in women with preeclampsia—a hypertensive disorder characterized by elevated blood pressure and proteinuria during pregnancy.2,3 It represents the most severe manifestation in the continuum of hypertensive disorders during gestation, which begins with gestational hypertension, progresses to preeclampsia, and culminates in eclampsia.4

Globally, hypertensive disorders complicate approximately 5–10% of pregnancies and rank among the leading causes of maternal and perinatal morbidity and mortality.4,5 Despite advancements in obstetric management, eclampsia still contributes substantially to maternal deaths, especially in resource-limited settings where fatality rates can reach up to 14%, compared to less than 2% in developed nations.5,6 The World Health Organization estimates that preeclampsia and eclampsia are responsible for approximately 63,000 maternal deaths annually, underscoring their critical impact on global maternal health.7

In India, for instance, eclampsia affects approximately 1.56% of pregnancies, with negative outcomes often tied to delayed medical intervention, poor antenatal coverage, and ineffective treatment protocols.3,8

Maternal complications linked to eclampsia are often severe and may include stroke, acute renal failure, HELLP syndrome, pulmonary edema, and disseminated intravascular coagulation.3 Adverse fetal outcomes are also common and include intrauterine growth restriction, prematurity, low birth weight, fetal hypoxia, and stillbirth.9 Delivery of the fetus remains the only definitive treatment, which, while necessary, often results in complications associated with preterm birth.10,11

Given the high incidence and serious consequences of eclampsia, there is a critical need to understand its clinical profile and associated outcomes. This retrospective study was designed to evaluate the maternal and fetal outcomes related to eclampsia.

Study Setting and Design

This retrospective study was conducted in the Department of Obstetrics and Gynecology at Government Medical College, Siddipet, Telangana, India. The research period extended over 18 months, from November 2023 to April 2025. The study was initiated following approval from the Institutional Ethics Committee.

Study Population

The study included 30 women, either pregnant or in the postpartum period, who were diagnosed with eclampsia. Participants either presented with eclampsia on admission or developed it during hospitalization. All neonates born to these women were also evaluated to determine fetal outcomes. Data sources included hospital medical records, labor ward registers, and postnatal care documents.

Inclusion Criteria

• Women aged 18 years or older.
• Confirmed diagnosis of eclampsia, characterized by new-onset generalized tonic-clonic seizures occurring after 20 weeks of gestation, during labor, or postpartum, in the presence of clinical or laboratory evidence of preeclampsia (e.g., hypertension and/or proteinuria).
• Complete and accessible medical records.

Exclusion Criteria

• History of epilepsy, hypoglycemia, head trauma, meningitis, or cerebral malaria.
• Incomplete or missing clinical records, or absence of informed consent.
• Women with chronic hypertension or renal disorders identified prior to pregnancy.

Data Collection Procedure

A structured data abstraction form was used to collect patient information retrospectively from institutional records. The variables collected are categorized below:

Demographic Details

• Maternal age
• Gravidity and parity

Clinical Profile

• Type of eclampsia (antepartum, intrapartum, or postpartum)
• Number of seizures
• Blood pressure on admission
• Proteinuria status (≥ +1 by dipstick)

Hospital Management

• Anticonvulsants: Magnesium sulfate, Diazepam
• Antihypertensives: Labetalol, Nifedipine
• Mode of delivery

Maternal Outcomes Assessed

Complications were thoroughly documented and included:

• Pulmonary edema
• Acute renal failure (ARF)
• HELLP syndrome
• Disseminated intravascular coagulation (DIC)
• Posterior reversible encephalopathy syndrome (PRES)
• Postpartum hemorrhage (PPH)
• Antepartum hemorrhage (APH)
• Sepsis
• Maternal death
• Additionally, critical care interventions such as ICU admission, mechanical ventilation, and blood transfusion were recorded.

Fetal Outcomes Assessed

Neonatal outcomes were assessed based on:

• Gestational age at birth
• Mode of delivery
• Apgar scores at 1 and 5 minutes
• Birth weight
• Intrauterine growth restriction (IUGR)
• Preterm delivery (<37 weeks)
• Birth asphyxia
• Stillbirth
• NICU admission
• Neonatal mortality

Operational Definitions

• Gestational Hypertension: Blood pressure ≥140/90 mmHg on two separate occasions, at least 4 hours apart.
• Severe Hypertension: Blood pressure ≥160/110 mmHg.
• Low Birth Weight (LBW): Birth weight between 500g and <2500g.
• Stillbirth: Fetal death occurring at or beyond 20 weeks of gestation or with birth weight ≥500g and no signs of life.

Data Analysis

The data were compiled using Microsoft Excel and analyzed with IBM SPSS Statistics version 21.0. Descriptive statistics such as mean, standard deviation, frequencies, and percentages were used.

Among a total of 2,200 obstetric admissions, a subset of 30 patients was diagnosed with eclampsia, yielding an institutional incidence of 1.36%. The mean age of affected individuals was 25.93 ± 4.042 years, with ages ranging from 20 to 36 years, reflecting the disease's predominance in younger reproductive age groups. Parity distribution showed a slight predominance of primiparous women, with 53.3% of cases occurring in those experiencing their first pregnancy, compared to 46.7% in multiparous women. Eclampsia was further categorized based on the timing of seizure onset—Antepartum eclampsia was the most frequently observed subtype, accounting for 83.4% of cases, while postpartum and intrapartum eclampsia constituted 13.3% and 3.3%, respectively. (Graph 1)

Among 30 eclampsia patients, 90% experienced a single seizure, while 6.7% had two and 3.3% had more than three. Systolic blood pressure was elevated in most cases: 30% had SBP of 151–160 mmHg, 26.7% had 141–150 mmHg, and 23.3% had 161–170 mmHg. Diastolic pressure was also elevated, with 53.3% between 101–110 mmHg and 20% between 111–120 mmHg. Proteinuria was present in 93.3%, underscoring its strong diagnostic association. (Table 1)

Among the eclamptic patients, 38.2% experienced maternal complications. The most frequently observed was pulmonary edema (13.3%), followed by HELLP syndrome, postpartum hemorrhage (PPH), and posterior reversible encephalopathy syndrome (PRES)—each reported in 10% of cases. Less common but serious complications included acute renal failure (ARF), disseminated intravascular coagulation (DIC), antepartum hemorrhage (APH), sepsis, and maternal death, each affecting 3.3% of patients. ICU admission was required in 10% of cases, and mechanical ventilation was necessary in 6.7%. (Table 2)

Among eclamptic patients, 46.7% delivered before 34 weeks, while 50% delivered between 34–39+6 weeks; only 3.3% were post-term. Vaginal delivery was the most common mode (70%), followed by cesarean section (23.3%) and instrumental delivery (6.7%). Adverse fetal outcomes were frequent: preterm birth occurred in 60%, low birth weight in 26.7%, and IUGR in 23.3%. Birth asphyxia was observed in 40%, with Apgar <7 at 5 minutes in 16.7%. NICU admission was required for 20% of neonates. There were five stillbirths (16.7%) and one neonatal death (3.3%). (Table 3)

TABLE 1: CLINICAL PROFILE AMONG ECLAMPTIC PATIENTS

TABLE 2: MATERNAL OUTCOMES AMONG ECLAMPTIC PATIENTS

TABLE 3: FETAL OUCOMES AMONG ECLAMPTIC PATIENTS

Eclampsia remains a major contributor to maternal and neonatal morbidity in under-resourced settings, despite significant global advancements in obstetric care.12 the current study reported an incidence of 1.36%, consistent with findings from available literature. Incidence rates across multiple studies reflect the persistent burden of the condition. Dora S.K. et al. reported an incidence of 1.48%, Choudhury et al., reported 1.5%, Jido T.A. documented 1.2%, and Onuh reported rate of 1.32% in Nigeria.1,5,9,13Other studies further illustrate regional variability: 1.37% in Tanzania (Ndaboine et al.), 3.2% in Eastern India (Kumar et al.), 2.2% in Uttar Pradesh, and 1.82% in Karnataka (Yaliwal et al.). A notably high incidence of 7.8% was reported by Efetie et al. in Nigeria, highlighting stark disparities in healthcare access and quality.14-17

The consistently elevated incidence of eclampsia in these regions is closely linked to inadequate or absent antenatal care. A significant proportion of pregnant individuals either do not receive any prenatal check-ups or undergo insufficient monitoring, leading to missed opportunities for early detection and management of preeclampsia. This gap in care often results in the progression to eclampsia, with severe implications for both maternal and fetal outcomes.

The present study found that the mean age of patients with eclampsia was 25.93 ± 4.04 years, ranging from 20 to 36 years, underscoring the condition’s prevalence among women in the younger reproductive age group. This observation aligns with findings from multiple studies. Dora S.K. et al. reported a lower mean age of 22.58 years, Roy M. et al. documented a mean of 25.3 years (range: 19–41 years), Jido T.A. found 21.5 ± 5.48 years, and Choudhury et al. reported an average age of approximately 23 years.1,3,5,9 These consistent age patterns across various populations highlight that eclampsia disproportionately affects younger women, particularly those in their first or second decade of reproductive life. The susceptibility may be immunologically driven, with first-time exposure to placental antigens triggering maladaptive maternal immune responses that contribute to the development of hypertensive disorders during pregnancy.

Parity analysis in this study revealed a slight predominance of primiparous women (53.3%) over multiparous women (46.7%). This trend is corroborated by findings from Dora S.K. et al. (69.6% primiparas), Shah D et al. (64.7%), Roy M et al. (78.2%), Raji C et al. (69.2%), and Jido TA (55% nulliparas).1,3,4,9,18 Haque H, Thapa KK and Pal et al. similarly emphasized a strong association between eclampsia and primigravidity.19,20 The biological plausibility lies in the fact that primigravidae are exposed to placental tissue for the first time, which may provoke heightened immune reactions leading to endothelial dysfunction and subsequent preeclampsia. These findings reinforce the need for enhanced prenatal surveillance among young, first-time mothers, with a focus on early detection and management of hypertensive complications. Eclampsia was further categorized based on the timing of seizure onset. Antepartum eclampsia was the most prevalent subtype in this study, accounting for 83.4% of cases, followed by postpartum (13.3%) and intrapartum (3.3%) presentations. Similar distributions were reported by Dora S.K. et al. (91.07% antepartum), Roy M et al. (81.8%), Raji C et al. (77.4%), and Choudhury et al. (74%).1,3,5,18 The predominance of antepartum eclampsia highlights the critical need for timely and adequate antenatal care. Regular blood pressure monitoring, early identification of preeclampsia, and appropriate clinical interventions remain essential to preventing progression to eclampsia, particularly in the antepartum period, when maternal and fetal risks are highest.

In the present study, 90% of eclampsia patients experienced a single seizure, while 6.7% had two and 3.3% had more than three episodes. These findings are consistent with Shah D. et al., who reported 91.2% of patients experiencing a single convulsion, and Beyuo TK et al., who noted a median seizure count of one.4,21 The predominance of single convulsive episodes reflects typical clinical presentation and highlights the importance of prompt management to prevent recurrent seizures. Blood pressure recordings further emphasize the hypertensive nature of eclampsia. Elevated systolic blood pressure was common, with 30% of patients presenting values between 151–160 mmHg, 26.7% between 141–150 mmHg, and 23.3% between 161–170 mmHg. Diastolic pressure was also markedly raised, with 53.3% of cases falling between 101–110 mmHg and 20% between 111–120 mmHg. These values suggest a pattern of severe hypertension in the majority of cases. In comparison, Dora SK et al. reported that 87.5% of their patients had blood pressure readings exceeding 160/110 mmHg, reinforcing the role of significant hypertension as a key diagnostic and prognostic indicator in eclampsia.1

Proteinuria was present in 93.3% of patients in the current cohort, underscoring its strong diagnostic association with preeclampsia and its progression to eclampsia. This high prevalence of proteinuria supports its continued use as a critical marker in antenatal screening and monitoring protocols, particularly in resource-limited settings where laboratory capabilities may be restricted.

In this study, 38.2% of eclamptic individuals experienced maternal complications. The most frequently encountered was pulmonary edema (13.3%), followed by HELLP syndrome, postpartum hemorrhage (PPH), and posterior reversible encephalopathy syndrome (PRES), each affecting 10% of patients. Less frequent but severe complications included acute renal failure (ARF), disseminated intravascular coagulation (DIC), antepartum hemorrhage (APH), sepsis, and maternal death, each reported in 3.3% of cases. ICU admission was required in 10% of patients, and mechanical ventilation was needed in 6.7%.

Pulmonary edema was a commonly reported complication in several studies, with similar rates noted by Roy M (12.7%) and Dixit P (14.29%).3,22 However, substantially lower rates were seen in Dora SK (1.78%), Jha (4%), and Raji C (1.37%).1,7,18 Jido TA documented a moderate incidence of pulmonary edema or pneumonia (5%), highlighting variations that may reflect differences in fluid management and diagnostic vigilance.9 HELLP syndrome was observed in 10% of patients in the present study, closely aligning with Roy M (10.9%), Dora SK (10.71%), and Shah D (11.8%).1,3,4 Lower frequencies were noted in Jido TA (4.2%), Jha (6%), Choudhury (aggregated under systemic complications), and Raji C (3.42%).5,7,9 An elevated incidence of 14.29% reported by Dixit P may reflect a sicker patient cohort or differing diagnostic criteria.22 Postpartum hemorrhage (PPH) occurred in 10% of cases, mirroring findings from Jha (10%) and Roy M (9.1%).3,7 Shah D, however, reported a significantly higher incidence (70.6%), which may be attributable to variations in case definitions or underlying risk factors.4 Rates from Dixit P (9.52%) were consistent, while other studies, including Dora SK and Choudhury, grouped hemorrhagic events under broader categories.1,5,22 PRES was observed in 10% of patients, a rate consistent with Roy M (9.1%) and slightly higher than Shah D (5.9%).3,4 Dixit P reported a notably higher rate (16.67%), potentially reflecting increased recognition through imaging or inclusion of borderline neurological cases.22 ARF was identified in 3.3% of patients, which was comparable to Roy M (3.6%) and Raji C (2.05%), but lower than Dixit P (11.9%) and Jido TA (5%).3,9,18,22 The variation likely reflects differences in the timing of intervention and renal function monitoring. DIC was present in 3.3% of patients, similar to Dora SK (1.78%) and Raji C (0.68%), but considerably lower than the rate reported by Jha (8%), suggesting delayed referral or limited access to blood component therapy in certain cohorts.1,7,18

APH, including placental abruption, was noted in 3.3% of patients. Much higher rates were reported by Dora SK (14.28%) and Shah D (47.1%), whereas Roy M, Dixit P, and Jido TA documented APH in approximately 2–5% of cases.1,3,4,9,22 Choudhury reported an 8% incidence of hemorrhagic complications, reflecting wide inter-study variability.5 Sepsis was identified in 3.3% of patients, closely aligning with rates from Jha (4%), Dixit P (4.76%), and Choudhury (8.5%).5,7,22 Differences may stem from institutional infection control standards, prophylactic antibiotic use, and delays in labor or postpartum care.

Maternal mortality was recorded in 3.3% of cases. Comparable figures were reported by Roy M (3.6%), Dora SK (3.57%), and Shah D (2.9%).1,3,4 Higher mortality was observed in studies from lower-resource settings, including Jido TA (11.7%), Dixit P (9.52%), and Choudhury (13.5%).5,9,22 Notably, Katz et al., conducting research in a high-income setting, reported no maternal deaths, underscoring the profound impact of healthcare infrastructure and critical care availability.23 ICU admission was necessary in 10% of cases, comparable to Roy M (10.9%) and slightly higher than Choudhury (5.5%), indicating substantial need for high-dependency care in severe eclampsia.3,5 The need for mechanical ventilation (6.7%) was also notable, though lower than that reported by Dixit P (11.9%).22

Neurological complications, including cerebrovascular accidents (CVAs), occurred in 3.3% of patients. Similar incidences were reported by Jido TA (4.2%), Choudhury (9%), and Raji C (4.11%).5,9,18 Isolated cases of intracranial hemorrhage (ICH) were noted in both Jha and Shah D, reaffirming the central role of hypertensive crises in cerebrovascular compromise during eclampsia.4,7 In the study by Raji C et al., the recalculated maternal morbidity rate was 23.9% among 146 patients—lower than the 38.2% observed in the current study.18 Documented complications included ARDS (5.48%), CVA (4.11%), renal failure (2.05%), and composite morbidities such as HELLP with acute kidney injury (1.37%) and HELLP with intraventricular hemorrhage (0.68%). Despite a lower overall complication rate, the presence of complex, multi-organ dysfunction in several cases indicates a significant burden of severe morbidity.

In the current study, adverse perinatal outcomes were prominent among eclamptic pregnancies. Preterm deliveries occurred in 60% of cases, with 46.7% delivering before 34 weeks and 50% between 34 and 39+6 weeks; only 3.3% were post-term. This trend aligns with findings from Shah D et al. (62.9% prematurity), Jha et al. (significant NICU utilization), and Raji C et al., where prematurity contributed to 41.4% of early neonatal deaths.4,7,18 Vaginal delivery was the predominant mode (70%) in this study, mirroring results from Choudhury et al. (70.5%) and Dora SK et al. (75%), while cesarean section accounted for 23.3%, consistent with Choudhury (23%) and Dora SK (25%).1,5 In contrast, higher cesarean rates were reported by Roy M (60%), Jido TA (55.8%), and Raji C et al. (61.65%), possibly indicating institutional differences in operative thresholds or fetal distress rates.3,9,18

Low birth weight (LBW) occurred in 26.7% of cases, which is lower than the rates observed in Shah D (64.9%), Choudhury (35.5%), Jha (16%), and Raji C (60%), but comparable to Jido TA (25.8%).4,5,7,9,18 Intrauterine growth restriction (IUGR) was reported in 23.3% of the present cohort, aligning with Dora SK (30.35%), Roy M (23.3%), and Jha (6%), while Raji C et al. identified IUGR as a contributing factor in 13.8% of early neonatal deaths.1,3,7,18 Birth asphyxia was documented in 40% of neonates, significantly higher than Shah D (22.9%), Roy M (1 case), and Raji C (13.8%), though Jido TA reported a comparable rate (39.1%).3,4,9,18 Apgar scores <7 at 5 minutes were observed in 16.7% of neonates in the current study, reinforcing the burden of neonatal hypoxia.

NICU admissions were required in 20% of cases, which is lower than Shah D (68.6%), Jha (58%), and Raji C (NICU-level care for all 110 live births).4,7,18 Dora SK reported 40.47% NICU (SNCU) admissions among live births, whereas Dixit P noted nursery admission in 5–13.63% depending on the delivery method.1,22 Stillbirths occurred in 16.7% of the current cohort, comparable to Roy M (16.7%), Dixit P (19%), and Jido TA (22.5%), but lower than Raji C (24.66%).3,9,18,22 Neonatal mortality was reported in 3.3% of cases, aligning with Roy M (5%) and Dixit P (2.5%), and markedly lower than Jha (22%) and Raji C (20%), the latter attributing most deaths to prematurity-related complications such as RDS and sepsis.3,7,18,22 Taken together, the present study reinforces the substantial dual burden of maternal and perinatal morbidity associated with eclampsia. Despite prompt anticonvulsant and antihypertensive management, the high rates of pulmonary edema, HELLP syndrome, PPH, and fetal complications such as prematurity and birth asphyxia illustrate the aggressive clinical course of the condition. The findings highlight that, even within tertiary care settings, gaps in early detection and timely referral remain pivotal challenges. Comparative data from similar regional and national studies further affirm that the maternal and fetal outcomes of eclampsia are intricately linked to healthcare system responsiveness, antenatal care coverage, and facility readiness to handle obstetric emergencies. Addressing these factors is critical to reducing the high morbidity and mortality associated with this preventable but life-threatening condition.

This study provides a comprehensive overview of the clinical profile and outcomes of eclampsia in a real-world tertiary care setting, capturing both maternal and neonatal parameters to offer a holistic perspective. The integration of comparative analysis with regional and national data enhances the contextual relevance of the findings. However, limitations include the retrospective design, which precludes causal inferences, a relatively small sample size that may limit generalizability, and reliance on medical records, which could introduce documentation bias. To improve outcomes, strengthening antenatal care services—particularly in rural and underserved areas—is imperative for early detection and risk stratification of preeclampsia. Standardized management protocols for hypertensive disorders of pregnancy should be uniformly implemented across healthcare tiers. Establishing efficient referral systems and emergency transport infrastructure can facilitate timely intervention. Additionally, investment in neonatal intensive care facilities and further prospective, multicentric research are recommended to better understand predictive factors and long-term outcomes associated with eclampsia.

Eclampsia remains a critical threat to maternal and neonatal health, particularly in resource-constrained settings. This study demonstrated that nearly 40% of affected women experienced serious maternal complications, while adverse fetal outcomes—including preterm birth (60%), low birth weight (26.7%), and birth asphyxia (40%)—were alarmingly frequent. The predominance of antepartum eclampsia, the high proportion of ICU admissions, and the occurrence of stillbirths and neonatal deaths highlight the severe clinical trajectory of the condition. These findings underscore the urgent need for system-level interventions. Early recognition, consistent and comprehensive antenatal care, and timely delivery continue to be the cornerstone strategies for improving outcomes and mitigating the impact of eclampsia on both mothers and their newborns.

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