Exploring maternal and fetal outcomes in severe preeclampsia and eclampsia in a tertiary care rural hospital in Karnataka, India
Pregnancy, a period of joyful anticipation for millions of women, can unexpectedly transform into a life-threatening crisis when hypertensive disorders emerge. Among these conditions, severe preeclampsia and eclampsia represent some of the most formidable challenges in modern obstetrics, particularly in resource-limited settings.
of pregnancies affected by preeclampsia globally
maternal deaths annually from preeclampsia
Imagine a young expectant mother in rural Karnataka, eagerly awaiting the birth of her child, when suddenly she develops severe headaches, vision changes, and skyrocketing blood pressure. This medical emergency requires immediate specialized care, but what happens when such care is hours away over rough terrain? This scenario plays out repeatedly across rural India, where these conditions contribute significantly to the alarming rate of maternal and neonatal mortality.
Globally, preeclampsia affects 2-8% of all pregnancies, resulting in approximately 46,000 maternal deaths and 500,000 fetal or newborn deaths annually 1 . In developing regions, the picture is even grimmer—preeclampsia and eclampsia account for about 10% of maternal deaths in Asia and Africa 1 . The recent research from a tertiary care rural hospital in Karnataka provides crucial insights into this critical health issue, highlighting both the devastating outcomes and potential pathways toward better care for India's most vulnerable mothers and babies.
Preeclampsia is a complex multi-system disorder characterized by the new onset of high blood pressure (≥140/90 mm Hg) and protein in urine (proteinuria) after 20 weeks of pregnancy in a previously normotensive woman 1 9 . When the condition progresses to include severe features such as blood pressures exceeding 160/110 mmHg, visual disturbances, upper abdominal pain, or evidence of organ damage, it is classified as severe preeclampsia 3 .
The most dangerous development occurs when preeclampsia advances to eclampsia—the occurrence of seizures in a woman with preeclampsia that cannot be attributed to other causes 2 . These seizures represent a medical emergency that can lead to coma and even death for both mother and baby if not promptly treated.
Blood pressure ≥160/110 mmHg with evidence of organ damage, visual disturbances, or upper abdominal pain.
Seizures occurring in a woman with preeclampsia, representing a life-threatening emergency.
The symptoms of preeclampsia can be subtle initially but become more pronounced as the condition progresses:
In rural India, the challenges of managing severe preeclampsia and eclampsia are magnified by structural healthcare disparities. Research consistently shows that women in rural areas face significantly worse outcomes from hypertensive disorders of pregnancy . A study conducted in Ethiopia similarly found that rural residence was associated with a 2.1 times higher risk of unfavorable maternal outcomes from severe preeclampsia and eclampsia 3 .
Tertiary care hospitals with specialized obstetric services are often hours away from rural villages
Lack of reliable ambulance services or poor road conditions delay critical care
Symptoms may not be recognized as dangerous until complications develop
These systemic challenges contribute to the stark reality that women in rural communities are significantly more likely to experience severe complications and death from conditions that are manageable with proper medical attention.
Recent research from a tertiary care rural hospital in Karnataka provides sobering but valuable data on the actual outcomes of severe preeclampsia and eclampsia in this setting. The findings highlight the urgent need for improved detection and management strategies.
The Karnataka study revealed that 37.5% of women with severe preeclampsia experienced significant maternal complications 5 . These complications represent some of the most feared obstetric emergencies:
The study also identified several factors that increased the risk of poor maternal outcomes, including low educational attainment, nulliparity (first pregnancy), and lack of regular antenatal care 5 7 .
The impact of severe preeclampsia and eclampsia extends beyond the mother to her unborn child, with significant implications for fetal and neonatal health:
The need for early delivery to save the mother's life often results in premature births
A consequence of both preterm delivery and growth restriction
| Complication Type | Frequency | Impact on Maternal Health |
|---|---|---|
| Renal Dysfunction | Most common | Can lead to long-term kidney damage |
| Postpartum Hemorrhage | Frequent | Life-threatening blood loss |
| HELLP Syndrome | Less common but severe | Multi-organ failure risk |
| Placental Abruption | Emergency condition | Threatens both mother and fetus |
| Pulmonary Edema | Cardiac complication | Respiratory distress |
Emerging research reveals that the impacts of severe preeclampsia and eclampsia may extend far beyond the immediate pregnancy period, affecting both maternal and child health long-term.
Women who experience preeclampsia face increased lifetime risks of:
Groundbreaking research has uncovered that preeclampsia may have lasting effects on brain function for both mother and child:
with a history of preeclampsia show impairments in memory, executive function, and attention compared to women with normotensive pregnancies 2
exposed to preeclampsia in utero demonstrate higher rates of cognitive deficits and alterations in brain connectivity 2
These neurocognitive changes are thought to result from microvascular damage in the brain caused by high blood pressure and endothelial dysfunction 2 .
| Health Domain | Specific Conditions | Timeframe |
|---|---|---|
| Cardiovascular | Hypertension, heart failure, stroke | Years to decades after affected pregnancy |
| Renal | Chronic kidney disease, end-stage renal disease | 15-20 years post-pregnancy |
| Metabolic | Type 2 diabetes, dyslipidemia | Middle age |
| Neurocognitive | Memory deficits, executive dysfunction | Can be detected years later |
In the quest to improve early detection and treatment of severe preeclampsia, researchers are investigating novel biological markers that could signal danger long before clinical symptoms appear. One promising area of research focuses on ferroptosis—a specific type of programmed cell death related to iron metabolism—and its potential role in preeclampsia.
A 2025 Chinese study investigated the potential of FSP1 (ferroptosis suppressor protein 1) and CoQ10 (ubiquinone10) as biomarkers for severe preeclampsia 4 . The research was grounded in the understanding that the placenta of women with preeclampsia shows evidence of ferroptosis, which contributes to placental dysfunction and the clinical features of the disease.
The study employed a comprehensive experimental design:
198 pregnant women were enrolled, including 46 with severe preeclampsia and 152 with normal pregnancies
Researchers collected placental tissue, umbilical artery blood, and maternal blood samples
Multiple techniques were used to measure:
Comparison of results between the severe preeclampsia and normal pregnancy groups 4
The study revealed several critical findings:
Ferroptosis does occur in the placenta of women with severe preeclampsia
FSP1 and CoQ10 showed significantly lower levels in the placenta, maternal blood, and umbilical artery blood of women with severe preeclampsia
The NADPH utilization rate was reduced, indicating dysfunction in the protective pathway 4
These findings suggest that FSP1 and CoQ10 could serve as future biomarkers for monitoring disease progression and might even become new therapeutic targets for severe preeclampsia 4 .
| Research Tool | Function/Purpose | Application in Preeclampsia Research |
|---|---|---|
| FSP1 Antibodies | Detect FSP1 protein levels | Identify deficiency in protective pathway |
| CoQ10 Assays | Measure CoQ10 concentration | Assess antioxidant capacity |
| Fe2+ Colorimetric Kits | Quantify iron content | Evaluate iron-mediated placental damage |
| NADPH Utilization Assays | Measure pathway functionality | Determine compensatory mechanisms |
| Placental Tissue Samples | Study histological changes | Correlate molecular and structural changes |
While the statistics surrounding severe preeclampsia and eclampsia are concerning, significant progress has been made in prevention and management strategies that offer hope for reducing the burden of these conditions.
When initiated by 20 weeks of pregnancy (or when antenatal care begins), low-dose aspirin has been shown to reduce the risk of preeclampsia in high-risk women 1
In populations with low dietary calcium intake, calcium supplementation during pregnancy can help prevent preeclampsia 1
Maintaining a healthy weight and managing pre-existing conditions like chronic hypertension before pregnancy can reduce risks 9
Consistent monitoring of blood pressure and urine protein throughout pregnancy allows for early detection and intervention 1
Even in rural hospitals with limited resources, proven management strategies can significantly improve outcomes:
Reduces eclampsia risk by more than half
Controls severely elevated blood pressure
Accelerates fetal lung maturation
Balances maternal risks with fetal maturity
Novel care models show promise for addressing the specific challenges of rural populations:
Digital technologies allow healthcare providers to monitor pregnant women's blood pressure between clinic visits
Specialists can guide management in remote locations through virtual consultations
The challenge of severe preeclampsia and eclampsia in rural Karnataka—and similar settings worldwide—represents a critical test of our healthcare systems' ability to protect their most vulnerable members. The research from Karnataka's tertiary care rural hospital paints a sobering picture of the current reality, where too many mothers and babies suffer preventable complications and deaths from these disorders.
Yet within this challenge lies opportunity. The same study that documented concerning outcomes also provides crucial insights that can guide improvement efforts. The emerging research on biomarkers like FSP1 and CoQ10 offers hope for earlier detection and potentially new treatments. The proven strategies of low-dose aspirin, calcium supplementation, magnesium sulfate, and improved antenatal care provide a roadmap for immediate action.
Addressing the burden of severe preeclampsia and eclampsia in rural India will require a multifaceted approach that combines medical interventions with structural improvements in healthcare access, transportation systems, and health education. It will demand collaboration between policymakers, healthcare providers, researchers, and communities.
As we move forward, each step toward better understanding, earlier detection, and more effective management of these conditions represents not just a scientific advancement, but a potential life saved—a mother who survives to raise her children, a baby who grows to fulfill their potential. In the persistent shadow of preeclampsia and eclampsia, continued research and healthcare investment offer the brightest beacons of hope for rural communities in Karnataka and beyond.