THE INAPRES (Indonesia Preeclampsia Study): impact of eclampsia on maternal and perinatal outcomes among women with preeclampsia: findings from a National Multicenter Cohort.

Background: Hypertension during pregnancy, including preeclampsia (PE) and its severe complication, eclampsia, remains a primary cause of maternal mortality globally. Eclampsia is a critical complication of PE that severely impacts maternal and neonatal health. Evidence regarding outcomes in pregnancies complicated by eclampsia, especially in developing nations, is limited. Objective: This study aimed to compare the maternal and perinatal outcomes in patients with preeclampsia, both with and without eclampsia. Study Design: This was a national, multicenter, observational, retrospective cohort study conducted in Indonesia. Data were gathered from medical records of patients who delivered at 30 hospitals across five principal islands in Indonesia between January 2022 and December 2023. The study included 1,808 cases with complete data who met the inclusion criteria, consisting of all pregnancies impacted by PE that culminated in delivery at the research sites. The sample was classified into 2 groups: the eclampsia group (n=151) and the non-eclampsia group (n=1657). Primary outcomes examined included maternal outcomes (eg, severe morbidity, maternal mortality), intrapartum management, labor complications, and perinatal outcomes (eg, preterm birth, neonatal morbidity, neonatal death). Statistical analysis utilized SPSS version 29, employing independent t-tests or Mann-Whitney U tests for continuous data, and Chi-square or Fisher's exact tests for categorical variables, with results expressed as numerical percentages, mean ± SD, or median (minimum-maximum). Results: The overall incidence of PE during the study period was 5.3% (6763 out of 127,604 births). Among PE patients with complete data (n=1808), the incidence of eclampsia was 8.35% (151 cases). Pregnant women with eclampsia were significantly younger, more frequently nulliparous, and had elevated diastolic blood pressure compared to the noneclamptic cohort ( Conclusions: In this Indonesian multicenter cohort, preeclamptic pregnancies complicated by eclampsia were associated with significantly higher severe maternal and perinatal morbidity compared to those without eclampsia. These findings underscore the critical importance of early detection and prompt management of preeclampsia, including the timely use of MgSO4 for seizure prophylaxis, strict blood pressure control, and timely delivery of patients with severe preeclampsia, to prevent progression to eclampsia and mitigate adverse outcomes.