Eclampsia is defined as the development of convulsions and/or unexplained coma during pregnancy or postpartum in patients with signs and symptoms of preeclampsia1. Worldwide eclampsia is one of the leading causes of maternal and perinatal mortality and morbidity2. The development of eclampsia is associated with increased risk of adverse outcome for both mother and fetus, particularly in the developing nations. Preeclampsia and eclampsia are a continuum of multisystemic progressive disorder3. Women with a history of eclampsia are at increased risk of eclampsia (1–2%) and preeclampsia (22–35%) in subsequent pregnancies1. Eclamptic convulsions can be due to cerebral vasospasm, hypertensive encephalopathy, cerebral edema or infarction, cerebral hemorrhage, and metabolic encephalopathy. However, these findings could be causes or an effect of the convulsions. Imminent symptoms like occipital or frontal headaches, blurred vision, photophobia and epigastric pain may occur before the onset of convulsions. Cerebral pathology in cortical and subcortical white matter in the form of edema, infarction, and hemorrhage (microhemorrhage and intracerebral parenchymal hemorrhage) is also seen in many cases. Hence the importance of continued efforts in reviewing each woman with eclampsia and to analyze factors affecting the outcome. Aims of this study is to evaluate maternal and fetal outcome in patients of eclampsia and analyse factors affecting the outcome.

A Retrospective observational study was conducted at the Department of Obstetrics and Gynecology at a Tertiary Care Teaching Institute in India over the course of 2 years from January 2023 to December 2024 at Belagavi Institute of Medical Sciences, Belagavi, South India. This study involved 35 patients aged 18 to 36 years. Case records of all patients admitted with Antepartum and Post partum Eclampsia admitted at BIMS Belagavi from January 2023 to December 2024 and patients developing Antepartum, Intrapartum or Post partum eclampsia during the course of treatment at BIMS Belagavi were collected and the maternal characterstics including demography, clinical features, investigations, mode of delivery, complications and maternal-perinatal outcomes were studied and anlysed.

The study observed maternal ages spanning from 18 to 36 years. The most prevalent age group was 20-30 years, comprising 54%(n=19) of the population, while 37%(n=13) were between 18 -20 years age group. Table 1: Demographic Details Variable Category n % Age group <20 years 13 37.14 20-30 years 19 54.29 30-35 years 2 5.71 >35 years 1 2.86 Parity Primiparous 6 17.14 Multiparous 4 11.43 Nulliparous 25 71.43 Booking Status Booked 31 88.57 Unbooked 4 11.43 Residence Rural 32 91.43 Urban 3 8.57 71 %( n=25) of our patients were primigravidas and 91 %( n=32) were from rural areas. 88 %(n=31) were not booked at our institution. Table 2: Clinical Profile at Admission (Multiple responses possible for symptoms) Variable Category n % BP at admission <140/90 8 22.86 >=140/90 27 77.14 Symptoms Headache 3 8.57 Blurring of vision 3 8.57 Convulsions 33 94.29 Pedal edema 1 2.86 POG (weeks) <34 3 8.57 34-36+6 10 28.57 >=37 22 62.86 Convulsion episodes 1 21 60 >=2 14 40 Only17 %(n=6) gave history of prodromal symptoms in our study. 71.5%(n=25) of patients presented with antepartum eclampsias and 28.5% had postpartum eclampsia. Only 22%(n=9) had BP recording of less than 140 systolic or 90 diastolic at admission. 57%(n=20) patients had BP readings of more than 160 systolic or 110 diastolic at admission. 66.8%(n=22) patients were term and 23% were preterm. 14% patients in our study hade multiple convulsions before admission. Table 3: Investigations Investigation Category n % Platelet count >1.5 lakh 30 85.71 <1.5 lakh 5 14.29 Coagulation profile Normal 35 100 Deranged 0 0 Urine albumin Nil 13 37.14 Trace 13 37.14 1+ 8 22.86 >=2+ 1 2.86 LFT Normal 24 68.57 Deranged 11 31.43 RFT Normal 29 82.86 Deranged 6 17.14 Uric acid Normal 21 67.74 Elevated 10 32.26 In our study, derangements in liver function (31%) and renal function (17%) were relatively common, reflecting the systemic involvement of eclampsia. Similar patterns of hepatic and renal impairment have been described in other tertiary center studies, highlighting their importance as prognostic indicators of maternal morbidity.⁶˒⁹ Table 4: Neonatal Outcome Outcome Category n % LBW (<2.5 kg) Yes 20 57.14 No 15 42.86 Neonatal resuscitation Required 1 2.86 Not Required 34 97.14 NICU admission Yes 7 20 No 28 80 Neonatal death Yes 3 8.57 No 32 91.43 Stillbirth Yes 3 8.57 No 32 91.43 Perinatal outcomes were significantly affected, with over half of neonates being low birth weight (57%) and one-fifth requiring NICU admission. This finding parallels other Indian and Nigerian studies, where intrauterine growth restriction and prematurity were major contributors to poor neonatal survival.⁸˒¹⁴˒¹⁵ Despite timely interventions, stillbirths and early neonatal deaths remained notable, underscoring the continued vulnerability of this group.¹³ Table 5: Maternal Outcome Complication Present (n, %) Absent (n, %) HELLP Syndrome 1 (2.9) 34 (97.14) AKI 0 (0.00) 35 (100) PPH 0 (0.00) 35 (100) DIC 1 (2.86) 34 (97.14) Abruption 0 (0.00) 35 (97.14) Maternal mortality 0 (0.00) 35 (100) 51%(n=18) had PRES on CNS imaging, and one patient each had Cortical Venous Thrombosis, Sub arachnoid haemorrhage, DIC and Acute kidney injury. There was no maternal mortality in our study but there were 3 stillbirths (8.5%). Table 6: Mode of Delivery Mode n % FTND 3 8.57 FTVD 1 2.86 LSCS 25 71.43 PTVD 6 17.14 Cesarean section was the predominant mode of delivery (71%), consistent with global evidence supporting operative delivery as the safer and quicker option in most eclamptic patients when vaginal delivery is not imminent.⁷˒¹⁰˒¹¹ High cesarean rates in eclampsia cases have similarly been reported in African, South Asian, and Middle Eastern cohorts, reaffirming the role of timely surgical intervention in optimizing maternal and perinatal outcomes.¹²˒¹⁶

In our study, eclampsia was observed most frequently in women below 30 years of age. This trend has been consistently reported across global literature. Ugwu3 in Nigeria, Zahoor15 in Pakistan, and Indian studies by Mor16, Agarwal17, and Pannu9 all highlighted that the majority of eclampsia cases occur in young mothers. These women are often in their first pregnancy and biologically more vulnerable due to abnormal placentation and endothelial dysfunction. Flávio-Reis7 in Brazil offered a different perspective, noting that while most cases still occurred in younger women, maternal deaths were disproportionately higher in the 40–49 year age group. This suggests that while eclampsia primarily affects the young, age extremes carry additional risks. Parity was another significant factor. Our findings of higher incidence in primigravidas mirror those from Nigeria, India, and Pakistan. Mor16, Agarwal17, and Pannu9 all emphasized Primigravidity as a key risk group, while Ugwu’s3 Nigerian study also confirmed the predominance of first pregnancies. This points to a universal biological susceptibility in Primigravidas, reinforcing the need for focused antenatal counseling and monitoring in first pregnancies. Antenatal care status played a central role in determining outcomes. In our series, most women were unbooked, and this strongly influenced complications and adverse outcomes. Ugwu3and Zahoor15 also found that lack of booking was closely tied to poor prognosis. Indian studies likewise observed that unbooked cases fared worse than booked women. Flávio-Reis7, however, showed how Brazil achieved a reduction in maternal deaths through robust antenatal programs, demonstrating the transformative potential of preventive healthcare. This highlights the importance of system-level investments in maternal health services. Blood pressure levels at admission in our patients were often very high, usually exceeding 160/110 mmHg. This finding is consistent with Ugwu7, Zahoor15, and Agarwal17, all of whom reported severe hypertension on arrival. Zahoor specifically noted that elevated blood pressure was present long before seizures but went undetected due to inadequate antenatal follow-up. High blood pressure at presentation is not just diagnostic—it is prognostic, predicting adverse maternal and fetal outcomes including HELLP syndrome, renal failure, pulmonary edema, intrauterine growth restriction, and perinatal mortality. The timing of seizures in our patients was predominantly antepartum. This is similar to Agarwal17 (81% antepartum) and Pannu9 (73% antepartum). However, Zahoor’s Pakistani study reported a larger share of postpartum seizures, reflecting missed antenatal diagnoses and inadequate follow-up. These differences illustrate how health system efficiency affects the distribution of seizure timing. Regardless of timing, the presence of seizures represents advanced disease and necessitates immediate action. Gestational age at the time of presentation was often preterm in our study. This agrees with Mor16 (48% preterm), Zahoor15 (62%), and Pannu9 (54%), all of whom reported high rates of prematurity in eclampsia. Preterm delivery is both a consequence of the disease and a contributor to poor neonatal outcome. Early termination, though lifesaving for the mother, increases neonatal vulnerability, underscoring the dual challenge of balancing maternal and fetal risks. Referral delay was a striking contributor to complications. In our study, some patients experienced delays before reaching tertiary care. Pannu9 observed that only 15% of women reached within six hours, and delays over 24 hours were associated with renal failure, intrauterine deaths, and HELLP syndrome. Zahoor15 also reported that many patients arrived late, often postpartum and in unstable condition. These findings emphasize that referral systems and early stabilization with magnesium sulphate at primary centers are essential to prevent deterioration. Onset-to-delivery interval also influenced maternal and perinatal survival. We observed that timely delivery after seizure control improved outcomes. Mor demonstrated that deliveries within five hours were linked to better neonatal survival. Pannu9 showed that delays beyond 24 hours were associated with severe complications such as DIC and ARF. Our findings therefore support the global consensus that expedited delivery is a cornerstone of eclampsia management once maternal stabilization is achieved. Mode of delivery in our study was predominantly cesarean section (around 70%). This is comparable to Agarwal17 (77%), Zahoor15 (59%), and Pannu9 (65%), who all reported high cesarean rates. Ugwu3 similarly favored cesarean for rapid termination in high-risk cases. The global pattern clearly supports cesarean delivery as the preferred mode in eclampsia when vaginal delivery is not imminent, especially with unfavorable cervix or fetal compromise. While vaginal delivery may be attempted in selected cases, cesarean often offers the safest and quickest resolution. Maternal complications were relatively infrequent in our series compared to many reports. HELLP syndrome was rare in our cohort, whereas Zahoor15 reported 26% and Mor16 6%. Disseminated intravascular coagulation (DIC) was less common for us but reached 22% in Zahoor’s study and higher in Ugwu’s Nigerian cohort. Renal failure, often linked to prolonged uncontrolled hypertension and delays, was also less frequent in our series. Pulmonary edema, the leading complication in Agarwal’s17 series, was rare in our patients. These differences highlight the impact of timely magnesium sulphate therapy, ICU availability, and standardized protocols in reducing complications. Maternal mortality was absent in our study. This is in sharp contrast to Ugwu3 and Zahoor15, where maternal mortality was high, largely due to referral delays, lack of ICU support, and limited access to drugs. Flávio-Reis7 demonstrated that Brazil successfully lowered maternal mortality with system-wide improvements, although vulnerable groups such as older women and the socioeconomically disadvantaged still faced higher risks. The absence of maternal deaths in our study illustrates what is achievable with timely and effective hospital care. Fetal outcomes, however, remain more challenging. More than half of our neonates were of low birth weight, similar to Ugwu3, Zahoor15, and Indian studies. This is attributable to both prematurity and growth restriction from placental insufficiency. Approximately one-fifth of our neonates required NICU admission, reflecting respiratory distress and prematurity-related complications. Stillbirths were fewer in our study compared to Ugwu3 and Zahoor15, but neonatal deaths, while lower, still occurred, consistent with Indian findings. Flávio-Reis7 highlighted that Brazil’s national programs improved perinatal survival, showing how systemic investment in neonatal care can shift outcomes.

Overall, our findings confirm the global picture of eclampsia: it predominantly affects young, unbooked primigravidas, with severe hypertension at presentation and frequent need for cesarean delivery. Maternal mortality can be drastically reduced with structured hospital care, but perinatal outcomes remain less favorable due to prematurity and low birth weight. The comparison with six diverse studies reinforces universal lessons: invest in antenatal care, ensure early referral, stabilize with magnesium sulphate, expedite delivery, and strengthen neonatal care. Our study adds to the evidence that with comprehensive hospital-based management, maternal survival can approach 100%, but perinatal outcomes still demand greater attention.

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