Once convulsions occur, maternal prognosis becomes uncertain. Prognosis includes immediate maternal risks, recovery and subsequent pregnancy outcomes, and fetal survival.
Factors associated with an unfavorable immediate prognosis
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Delayed treatment after the onset of fits, including late referral, adversely affects prognosis.
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Antepartum eclampsia, particularly with onset before 28 weeks, more than ten fits, and coma between fits are unfavorable features.
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Temperature above 102°F with a pulse rate above 120/minute, pulmonary edema, and jaundice are additional unfavorable features.
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Oliguria below 400 mL/24 hours with proteinuria above 5 g/24 hours and failure to respond to treatment are unfavorable features.
Maternal mortality and complications
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The passage reports maternal mortality in eclampsia in India as 2–20%. Prevention and treatment of pre-eclampsia with severe features and early treatment of eclampsia are important measures.
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Causes of maternal death include cardiac failure, pulmonary edema, aspiration and/or septic pneumonia, cerebral hemorrhage, acute renal failure, and cardiopulmonary arrest.
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Other listed causes are adult respiratory distress syndrome, pulmonary embolism, postpartum shock, and HELLP syndrome.
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Maternal complications are more frequent in antepartum eclampsia.
Recovery and subsequent pregnancy
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Women who recover from the acute illness are likely to recover rapidly within 2–3 weeks.
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Recurrence of eclampsia in subsequent pregnancies is uncommon, although the chance of pre-eclampsia is about 30%.
Fetal prognosis
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Perinatal mortality is approximately 10–20%.
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Causes include spontaneous or induced prematurity and intrauterine asphyxia from placental insufficiency associated with infarction or retroplacental hemorrhage.
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Effects of drugs used to control convulsions also contribute to perinatal mortality.