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CME Credit Offered
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Abstract Award
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Poster Session 2

(661) Maternal Outcomes Associated with Antepartum versus Postpartum Eclampsia

Thursday, January 30, 2025
4:00 PM – 6:00 PM  

    Submitting Author and Presenting Author(s)

  • Yossi Bart, MD

    MFM fellow
    McGovern Medical School at UTHealth Houston
    Houston, Texas, United States

    • Coauthor(s)

  • Farah H. Amro, MD

    Assistant Professor
    McGovern Medical School at UTHealth Houston
    Bellaire , TX, United States

  • Ghamar Bitar, MD

    Assistant Professor
    McGovern Medical School at UTHealth Houston
    Houston, TX, United States

  • SS

    Sandra Sadek, MD

    University of Texas Health Science Center in Houston, McGovern Medical School
    Houston, Texas, United States

  • Sean C. Blackwell, MD

    Professor and Chair
    McGovern Medical School at UTHealth Houston
    Houston, Texas, United States

  • Baha M. Sibai, MD

    Professor
    McGovern Medical School at UTHealth Houston
    Houston, Texas, United States

Objective:

The data on eclampsia-related outcomes in the literature relies mainly on studies performed over two decades ago. Our objective was to compare maternal outcomes associated with the timing of eclampsia using a contemporary dataset.

Study Design:

We conducted a retrospective cohort study of all patients diagnosed with eclampsia between June 2011 and June 2024 at a tertiary medical center. Patients with antepartum eclampsia (AE) were compared to those with postpartum eclampsia (PPE). The primary outcome was defined as a composite maternal morbidity including stroke, neurologic deficits at discharge, cardiac arrest, myocardial infarction, liver infarction or rupture, pulmonary edema, acute kidney injury, HELLP, disseminated intravascular coagulation, or death. Maternal outcomes were reported using Chi-Square or Fisher’s exact tests.

Results:

Overall, 80 patients met the inclusion criteria; 39 (49%) had AE, and 41 (51%) had PPE. Baseline maternal characteristics (age, race, BMI, chronic hypertension, diabetes mellitus) were similar between the groups. Four out of every five patients reported symptoms before the seizure, including headache (70%) and visual symptoms (31%), evenly distributed between groups. Simultaneous severe range blood pressure at the time of eclampsia diagnosis was reported in 52 (73%) of the patients, with similar rates between groups. PPE occurred >2 days after delivery in 90% of the cases and >7 days after delivery in 32%. Patients with AE had higher rates of composite maternal morbidity (59.0% vs. 31.7%, p=0.01), driven mainly by higher rates of acute kidney injury and hemolysis, elevated liver enzymes, and low platelets syndrome (Table). There were also higher rates of post-seizure intubation (30.8% vs. 7.3%, p=0.01) and intensive care unit admission (51.3% vs. 26.8%, p=0.02) among patients who had AE.

Conclusion:

Eclampsia continues to serve as an important contributor to maternal morbidity and mortality nowadays. Compared to postpartum eclampsia, antepartum eclampsia was associated with higher rates of maternal morbidity.