Clinical presentation and predictors of eclampsia among women with hypertensive disorders of pregnancy in Ghana

Objectives: Eclampsia is a leading contributor to global maternal morbidity and mortality. Past studies demonstrate varying relationships between demographic and antenatal factors and subsequent development of eclampsia. This study sought to identify predictors of eclampsia in a tertiary hospital in Ghana. Study design: Participants were women admitted to Korle Bu Teaching Hospital in Ghana with a diagnosis of preeclampsia with severe features or eclampsia. Medical and obstetric history were extracted from medical records. Clinical information, including vital signs and maternal complications, was prospectively collected. Main outcome measures: Bivariate analysis compared demographic, antenatal, obstetric history, and clinical characteristics between patients presenting with eclampsia and preeclampsia. Multivariable logistic regression identified independent predictors of eclampsia. Results: Among 1,176 participants, 116 (9.9 %) had a diagnosis of eclampsia. The majority of women with eclampsia experienced their first seizure antepartum (68.7 %), in a location outside a health facility (56.5 %), and witnessed by a family member (55.9 %). Women with eclampsia had a median of 1.0 seizure (IQR 1.0, 2.0). Only 15 (12.9 %) had a prior diagnosis of preeclampsia. There was a nearly threefold increased odds of eclampsia in women aged <20 (aOR 2.75, 95 % CI 1.10–6.89, p = 0.03) and those with twin pregnancy (aOR 2.59, 95 % CI 1.26–5.32, p = 0.01). Decreased odds of eclampsia was observed with age ≥35 (aOR 0.32, 95 % CI 0.15–0.67, p = 0.002), obesity (aOR 0.44, 95 % CI 0.25–0.77, p = 0.004), and chronic hypertension (aOR 0.38, 95 % CI 0.17–0.86, p = 0.02). Conclusions: Understanding predictors of eclampsia is important to identify high-risk patients and make informed decisions about antenatal care.