Prevalence, clinical presentations, and feto-maternal outcomes of eclampsia in a teaching hospital setting in Tigray region, Ethiopia: A five-year review

Abstract

Background Hypertensive disorders of pregnancy remain a leading cause of preventable maternal and perinatal mortality, particularly in low‑ and middle‑income countries (LMICs). Eclampsia, the most severe manifestation, is responsible for a disproportionate share of maternal deaths in sub‑Saharan Africa, yet contemporary data from Tigray, Ethiopia are scarce. Objective To determine the prevalence, clinical presentation, and factors associated with adverse feto‑maternal outcomes among women managed for eclampsia at Ayder Comprehensive Specialized Hospital (ACSH), Tigray, Ethiopia, between 1 January 2017 and 31 December 2021. Methods We conducted a retrospective cross‑sectional review of all women with a discharge diagnosis of eclampsia. A piloted extraction tool, adapted from recent studies, was used to abstract socio‑demographic, obstetric, clinical, laboratory, management, and outcome variables from medical charts. EpiData v4.6 was used for data entry, and data were analysed with Stata v16. Descriptive statistics summarised prevalence and presentation. Multivariate logistic regression identified independent predictors of (i) maternal end‑organ injury and (ii) perinatal death, reporting adjusted odds ratios (aOR) with 95% confidence intervals (CI). Model fitness was assessed with the Hosmer–Lemeshow test (p > 0.05). Results Of 23,090 deliveries during the study period, 252 women (1.1%, 95% CI 1.0–1.2%) were diagnosed with eclampsia; 240 charts were analysed. The case‑fatality rate was 3.3% and perinatal mortality 20.1%. Antepartum eclampsia accounted for 63.8%, intrapartum 9.6%, and postpartum 26.7%. Headache (77.5%), visual disturbance (53.8%), and epigastric/right‑upper‑quadrant pain (46.3%) were the most frequent prodromal symptoms. Independent predictors of maternal end-organ injury were referral from another facility (aOR 4.9, 95% CI 1.8–13.9) and having perinatal death (aOR 2.7, 95% CI 1.2–6.1). Vaginal delivery (aOR 5.5, 95% CI 2.3–13.3), and pregnancies complicated with postpartum haemorrhage (aOR 3.2, 95% CI 1.2–8.3), acute respiratory distress syndrome (aOR 3.2, 95% CI 1.1–9.3), and dialysis‑requiring acute kidney injury (aOR 24.7, 95% CI 5.6–109.9) were independent predictors of perinatal death. Conclusions Eclampsia prevalence at ACSH remains high and is associated with substantial maternal and perinatal mortality. Strengthening antenatal surveillance, streamlining referral pathways, and ensuring timely definitive delivery are critical to improving outcomes. Context-specific quality‑improvement initiatives should prioritise the prevention and aggressive management of hypertensive disorders of pregnancy.