Adverse maternal and perinatal outcomes of Eclampsia and its predictors among pregnant women attending at a tertiary hospital in Ethiopia: a 3-year retrospective review

Abstract

ABSTRACT Background: Eclampsia is one of the most serious obstetric emergencies and among the leading causes of maternal and perinatal mortality and morbidity. Although there were some similar studies that were previously conducted in Ethiopia little is known about the adverse maternal and perinatal outcomes of Eclampsia and its predictors in women attending at St. Paul’s Hospital Millennium Medical College (SPHMMC) in Addis Ababa. Objective: to determine the prevalence of adverse maternal and perinatal out comes of Eclampsia and its predictors in women attending at St Paul Hospital Millennium Medical College (SPHMMC) Methods: This was a three years (2021-2023) retrospective review of the clinical records on the adverse maternal and perinatal outcomes of Eclampsia and its predictors in women who attended at St. Paul’s Hospital Millennium Medical College. A convenience sampling technique was used and all the cases with Eclampsia who fulfill the inclusion criteria were reviewed. After obtaining Ethical clearance from Ethical Review Board of SPHMMC Data were collected retrospectively with electronic capture technique using Kobo tool box. Data were analyzed using SPSS version 27. Simple descriptive statistics, Chi-Squared test, and multiple logistic regression analysis were performed as appropriate. Odds ratio with 95% CI and P-value of <0.05 was used to present findings significance. Result: - Among the study participants, 68.6% of women experienced poor composite maternal outcomes. The most common maternal complications were HELLP or partial HELLP syndrome (51%), acute kidney injury (35.4%), severe persistent hypertension (25%), and placental abruption (19.8%). About 10 mothers (7.14%) require ICU admission, and there were 02 maternal deaths making the case fatality rate 1.43%. Lack of antenatal care (ANC) follow-up (AOR = 2.1, 95% CI: 1.24–6.42) and treatment delay ≥6 hours from seizure onset (AOR = 11.3, 95% CI: 1.35–95.32) were significant predictors of adverse maternal outcomes. Poor perinatal outcomes occurred in 45.7 % of neonates, with prematurity, low birth weight, and NICU admission being the most frequent ones. There were 33.5% (17 still birth and 32 early neonatal deaths) perinatal deaths making the overall Perinatal mortality rate 335 out of 1000 live births. Lack of ANC (AOR = 5.6, 95% CI: 1.69–18.59) and severe maternal hypertension (AOR = 5.7, 95% CI: 1.70–46.39) were independently associated with adverse perinatal outcomes. Conclusion: - The study revealed a high burden of adverse maternal and perinatal outcomes among the participants. More than two third of women experience Eclampsia associated adverse outcomes and Perinatal outcomes were also concerning, with nearly half of neonates experiencing poor outcomes, predominantly prematurity, low birth weight, NICU admission, and early neonatal death. Key factors associated with adverse maternal and perinatal outcomes were lack of ANC follow-up, treatment delay ≥6 hours from seizure onset, and severe maternal hypertension.  Finally we recommend Promotion of early and regular ANC attendance to identify and manage high-risk pregnancies.  Strengthening primary health care set ups for early recognition and timely pre-referral management of obstetric emergencies like Eclampsia. Keywords; Eclampsia, Maternal Outcome, Perinatal Outcome, St Paul’s Hospital Millennium Medical College