Treatment Outcomes and Determinants of Eclampsia and Severe Preeclampsia Among Pregnant Women Admitted to Selected Tertiary Hospitals in Ethiopia: A Cohort Study

Figures & data

Table 1 Baseline Characteristics of Pregnant Women Admitted to Maternity Wards of JUMC and HFSUH from April 1 to October 30, 2019 (N=217)

Characteristics		Eclampsia (N=176)	SPE (n=41)	Maternal Complication		P-value
		N (%)	N (%)	Yes (%)	No (%)
Maternal age (year)	<20	26 (14.8)	5 (12.2)	23 (13.2)	8 (18.6)	0.265
	20–34	122 (69.3)	24 (58.5)	115 (66.1)	31 (72.1)
	≥35	28 (15.9)	12 (29.3)	36 (20.7)	4 (9.3)
Educational status	Illiterate	101 (57.4)	26 (63.4)	106 (60.9)	21 (48.8)	0.353
	Primary	47 (26.7)	11 (26.8)	44 (25.3)	14 (32.6)
	Secondary and above	28 (15.9)	4 (98.8)	24 (13.8)	8 (18.6)
Residence	Rural	100 (56.8)	28 (68.3)	104 (59.8)	24 (55.8)	0.637
	Urban	76 (43.2)	13 (31.7)	70 (40.2)	19 (44.2)
Blood pressure	Elevated	142 (80.7)	38 (92.7)	146 (83.9)	34 (79.1)	0.621
	Normal	34 (19.3)	3 (7.3)	28 (16.1)	9 (20.9)
Age of menarche	12–14	106 (60.2)	23 (56.1)	105 (60.3)	24 (55.8)	0.297
	>14	27 (15.3)	7 (17.1)	24 (13.8)	10 (23.3)
	Not known	43 (24.4)	11 (26.8)	45 (25.9)	9 (20.9)
Age at first pregnancy	< 18	68 (38.6)	18 (43.9)	64 (36.8)	22 (51.2)	0.159
	≥ 18	97 (55.1)	17 (41.5)	97 (55.7)	17 (39.5)
	Not known	11 (6.2)	6 (14.6)	13 (7.5)	4 (9.3)
Maternal parity	Nulliparous	92 (52.3)	15 (36.6)	86 (49.4)	21 (48.8)	0.665
	Multiparous	51 (29)	20 (48.8)	55 (31.6)	16 (37.2)
	Primiparous	33 (18.2)	6 (14.6)	33 (19)	6 (14)
Maternal gravidity	Primigravida	90 (51.1)	15 (36.6)	83 (47.7)	22 (51.2)	0.684
	Multigravida	86 (48.9)	26 (63.4)	91 (52.3)	21 (48.8)
Pregnancy multiplicity	Singleton	155 (88.1)	34 (82.9)	154 (88.5)	35 (81.4)	0.213
	Twin	21 (11.9)	7 (17.1)	20 (11.5)	8 (18.6)
Duration of labor (hours)	<24	148 (84.1)	32 (78)	142 (81.6)	38 (88.4)	0.291
	≥24	28 (15.9)	9 (22)	32 (18.4)	5 (11.6)
Route of delivery	SVD	104 (59.1)	24 (58.5)	100 (57.5)	28 (65.1)	0.361
	C/S	72 (40.9)	17 (41.5)	74 (42.5)	15 (34.9)
Gestational age (weeks)	<37	49 (27.8)	16 (39)	52 (29.9)	13 (30.2)	0.779
	37–41	125 (71)	25 (61)	120 (69)	30 (69.8)
	Not stated	2 (1.1)	0 (–)	2 (1.1)	0 (–)
ANC follow-up	Yes	134 (76.1)	34 (82.9)	129 (74.1)	39 (90.7)	0.02
	No	42 (23.9)	7 (17.1)	45 (25.9)	4 (9.3)

Table 2 Laboratory Reports of Pregnant Women Admitted to Maternity Ward of JUMC and HFSUH from April 1 to October 30, 2019 (N=217)

Laboratory Values		Category	Maternal Complication		P-value
			Yes (%)	No (%)
Complete blood count	WBC (cells/mm^3)	Normal (4.4–11.5×10^3)	97 (55.7)	36 (83.7)	0.001
		Elevated (≥12 × 10^3)	77 (44.3)	7 (16.3)
	Hemoglobin (g/dL)	Normal (11–14)	144 (82.8)	40 (93)	0.093
		Low (≤11)	30 (17.2)	3 (7)
	Platelets (cells/mm^3)	Normal (150–450)	109 (62.6)	40 (93)	0.0001
		Low (<150)	65 (37.4)	3 (7)
LFT	AST (U/L)	Normal (0–42)	94 (54)	34 (79.1)	0.003
		Elevated (≥2×UNL)	80 (46)	9 (20.9)
	ALT (U/L)	Normal (0–35)	110 (63.2)	35 (81.4)	0.023
		Elevated (≥2×UNL)	64 (36.8)	8 (18.6)
	LDH (U/L)	Normal (100–210)	124 (71.3)	37 (86)	0.047
		Elevated (≥2×UNL)	50 (28.7)	6 (14)
RFT	SrCr (mg/dL)	Normal (0.7–1.5)	130 (75.1)	37 (86)	0.127
		Elevated (≥2)	44 (24.9)	6 (14)
	BUN (mg/dL)	Normal (8–20)	112 (64.7)	27 (62.8)	0.811
		Elevated (≥20)	62 (35.3)	16 (37.2)

Abbreviations: ALT, alanine aminotransferase; AST, aspartate aminotransferase; BUN, blood urea nitrogen; LDH, lactate dehydrogenase; LFT, liver function test; RFT, renal function test; SrCr, serum creatinine; WBC, white blood cells; SPE, severe preeclampsia.

Table 3 Types of Maternal Diagnosis and Anticonvulsants Used Among Pregnant Women Admitted to Maternity Wards of JUMC and HFSUH from April 1 to October 30, 2019

Variable	Category	Total (N=217)	JUMC (N=125)	HFSUH (N=92)
		N (%)	N (%)	N (%)
Maternal diagnosis	Eclampsia	176 (81.1)	92 (73.6)	84 (91.3)
	SPE	41 (18.9)	33 (26.4)	8 (8.7)
Anticonvulsants	MgSO4	171 (78.8)	87 (69.6)	84 (91.3)
	Diazepam	46 (21.2)	38 (30.4)	8 (8.7)

Table 4 Maternal Treatment Outcomes for Women with Eclampsia and Severe Preeclampsia Admitted to Maternity Wards of JUMC and HFSUH from April 1 to October 30, 2019

Treatment Outcomes		Diagnosis		Anticonvulsants		Hospitals
		Eclampsia (%)	SPE (%)	MgSO4 (%)	Diazepam (%)	JUMC (%)	HFSUH (%)
Maternal complication	Yes	149 (84.7)	25 (61)	138 (80.7)	36 (78.3)	97 (77.6)	77 (83.7)
	No	27 (15.3)	16 (39)	33 (19.3)	10 (21.7)	28 (22.4)	15 (16.3)
Maternal mortality	Yes	9 (5.1)	0 (–)	6 (3.5)	3 (6.5)	6 (4.8)	3 (3.3)
	No	167 (94.9)	41 (100)	165 (96.5)	43 (19.8)	119 (95.2)	89 (96.7)
Seizure recurrence	Yes	35 (19.9)	0 (-)	14 (8.2)	21 (45.7)	24 (19.2)	11 (12)
	No	141 (80.1)	41 (100)	157 (91.8)	25 (54.3)	101 (80.8)	81 (88)
Types of maternal complications
Aspiration pneumonia		39 (26.2)	1 (4)	35 (25.4)	5 (14)	12 (12.4)	28 (36.4)
Severe anemia		23 (15.4)	9 (36)	24 (17.4)	8 (22.2)	21 (21.7)	11 (14.3)
AP and HELLP		27 (18.1)	1 (4)	25 (18.1)	3 (8.3)	7 (7.2)	21 (27.3)
Puerperal sepsis		16 (10.7)	7 (28)	16 (11.6)	7 (19.4)	17 (17.5)	6 (7.8)
HELLP syndromes		19 (12.8)	2 (8)	18 (13)	3 (8.3)	15 (15.5)	6 (7.8)
AKI		11 (7.4)	1 (4)	9 (6.5)	3 (8.3)	10 (10.3)	2 (2.6)
DIC		9 (6.1)	0 (0)	5 (3.6)	4 (11.1)	9 (9.3)	0 (0)
PE		2 (1.3)	3 (12)	3 (2.2)	2 (5.6)	5 (5.2)	0 (0)
Others^a		3 (2)	1 (4)	3 (2.2)	1 (2.8)	1 (1)	3 (3.8)

Note: ^aStroke, thrombocytopenia, and abruption placenta.

Abbreviations: AKI, acute kidney injury; AP, aspiration pneumonia; DIC, disseminated intravascular coagulation; HELLP, hemolysis, elevated liver enzymes, lower platelet; HFSUH, Hiwot Fana Specialized University Hospital; JUMC, Jimma University Medical Center; PE, pulmonary edema.

Figure 1 Kaplan–Meier survival curve of maternal complications for maternal diagnosis among pregnant women admitted maternity wards of JUMC and HFSUH from April 1 to October 30, 2019.

Figure 2 Kaplan–Meier survival curve of maternal complications by anticonvulsants used among pregnant women admitted maternity wards of JUMC and HFSUH from April 1 to October 30, 2019.

Table 5 Factors Associated with Maternal Complications Among Pregnant Women Admitted to Maternity Wards of JUMC and HFSUH from April 1 to October 30, 2019

Variables	Category	Maternal Complications		P-value	CHR (95%CI)	P-value	AHR (95%CI)
		Yes (%)	No (%)
ANC follow-up	Yes	129 (74.1)	39 (90.7)	1		1
	No	45 (25.9)	4 (9.3)	0.004	1.66 (1.18–2.34)	0.002	1.75 (1.22–2.51)
WBC	Elevated	77 (44.3)	7 (16.3)	0.003	1.57 (1.16–2.13)	0.008	1.53 (1.12–2.09)
	Normal	97 (55.7)	36 (83.7)	1		1
SrCr	Elevated	44 (25.3)	6 (13.9)	0.096	1.34 (0.95–1.89)	0.025	1.51 (1.05–2.17)
	Normal	130 (74.7)	37 (86.1)	1		1
Diagnosis	Eclampsia	149 (85.6)	27 (62.8)	0.001	2.06 (1.35–3.16)	0.002	1.98 (1.28–3.06)
	SPE	25 (14.4)	16 (37.2)	1		1
Age (years)	<20	23 (13.2)	8 (18.6)	0.153	0.68 (0.40–1.15)	0.14	0.67 (0.39–1.14)
	20–34	115 (66.1)	31 (72.1)	0.076	0.71 (0.49–1.04)	0.013	0.61 (0.41–0.90)
	≥35	36 (20.7)	4 (9.3)	1		1

Notes: All the above laboratory investigations were those done at admission. 1= reference category. Elevated SrCr (≥2 mg/dL); Elevated WBC (≥12×10³ cells/mm³).

Abbreviations: AHR, adjusted hazard ratio; ANC, antenatal care; CHR, crude hazard ratio; CI, confidence interval; SPE. severe preeclampsia.