Risk factors for eclampsia in pregnant women diagnosed with preeclampsia and positive neurosensory signs

Background. In Morocco, eclampsia remains the second major cause of maternal mortality. Conventionally, patients with preeclampsia and neurosensory signs (NSS) (headaches and hyperreflexia,...) are considered at high risk of worsening and progressing to eclampsia. However, this specific population is heterogeneous in terms of eclampsia occurrence.
Objective. We aimed to identify the risk factors for the development of eclampsia in preeclamptic women presenting with NSS at admission.
Materials and Methods. We performed a single-center, retrospective case-control study of preeclamptic patients with positive NSS from January 1, 2012 through December 31, 2015, to investigate predictive factors for eclamptic seizures. Case patients were pregnant women diagnosed with severe preeclampsia who had NSS before presenting an eclampsia. Control subjects were those with positive NSS without the development of seizures during their hospital stay. 138 eclampsia cases and 272 control patients were enrolled.
Results. Univariate analysis revealed that eclampsia was more likely to develop in patients with the following risk factors: maternal age ≤25 years (x2=9.58, p=0.002), primiparity (x2=6.38, p=0.011), inadequate prenatal care (x2=11.62, p=0.001), systolic hypertension ≥160 mmHg (x2=15.31, p<0.001), diastolic hypertension ≥110mmHg (x2=5.7, p=0.017), generalized acute edema (x2=14.66, p<0.001), hematocrit <35% (x2=11.16, p=0.001), serum creatinine >100µmol/L (x2=13.46, p<0.001), AST >70IU/L (x2=10.15, p=0.001), and thrombocytopenia (x2=22.73, p<0.001). Additionally, independent predictive factors for eclampsia on multivariate analysis included inadequate prenatal care (OR, 8.96 [95%CI: 3.9-20.5], p<0.001), systolic blood pressure ≥160 mmHg (OR, 3.130 [95%CI: 1.342-7.305], p=0.008), thrombocytopenia with a platelet count <50000 (OR, 13.106 [95%CI: 1.344-127.823], p=0.027), AST ≥70IU (OR, 3.575 [95%CI: 1.313-9.736], p=0.007), and ELLP syndrome which is an incomplete variant of HELLP syndrome (OR, 5.83 [95%CI: 2.43-13.9], p<0.001).
Conclusions. This work highlights two major risk factors in this patient population, inadequate prenatal care and ELLP syndrome, that can help early identification of patients at highest risk of developing eclampsia and guide preventive measures.