Eclampsia - VIII. Risk factors for maternal morbidity

OBJECTIVE: This study was undertaken to identify risk factors associated wi th adverse maternal outcome in pregnancies complicated by eclampsia. STUDY DESIGN: This was a descriptive study of 399 consecutive women with ec lampsia whose cases were managed at one perinatal center between August 197 7 and July 1998. Data were collected. Risk factors studied included materna l age, race, parity, preexisting medical complications, and clinical and la boratory findings. Outcome variables were maternal morbidities. Data were a nalyzed by either chi(2) analysis or the unpaired Student t test as appropr iate. RESULTS: In the entire cohort of women with eclampsia major maternal compli cations included abruptio placentae (10%), HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome (11%), disseminated intravascula r coagulopathy (6%), neurologic deficits and aspiration pneumonia (7%), pul monary edema (5%), cardiopulmonary arrest (4%), acute renal failure (4%), a nd death (1%, n = 2 patients with antepartum onset). Women with antepartum eclampsia had significantly higher incidences of abruptio placentae (12% vs 6%; P <.05) and HELLP syndrome (14% vs 4%; P=.005) than did those in whom eclampsia developed post partum. In contrast, women with postpartum eclamps ia were more likely to have neurologic deficits develop (9% vs 2%; P=.0006) than were those with antepartum eclampsia. In addition, women in whom ecla mpsia developed at less than or equal to 32 weeks' gestation had significan tly higher incidences of abruptio placentae (17% vs 8%; P=.011, HELLP syndr ome (20% vs 7%; P=.0005), and acute renal failure (8% vs 2%, P=.01) than di d those in whom eclampsia developed later. CONCLUSION: Eclampsia remains a significant complication of pregnancy that carries high maternal mortality and morbidity rates. Antepartum onset carri es greater risks, and onset at less than or equal to 32 weeks' gestation is particularly dangerous to both mother and fetus.