Complications and outcome of Atypical Preeclampsia, and Eclampsia, at Al Saudi Hospital, Sudan.

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Manasik Abdaldeen Mohamed Ahmed, Mustafa Sabir Abakar Awad, Abdelmhmoud Atalmanan Abdelsadig, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4243090/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 05 Dec, 2025 Read the published version in BMC Pregnancy and Childbirth → Version 1 posted 4 You are reading this latest preprint version Abstract Background: Atypical presentation of preeclampsia and eclampsia refers to cases where symptoms may not follow the typical signs of high blood pressure and proteinuria rendering them difficult to diagnose leading to potential delays in treatment. Hence our aim was to study the atypical presentations of preeclampsia and eclampsia and their possible outcomes. Methods : The study was a descriptive cross-sectional hospital-based study conducted from November 2022 to April 2023 at Al Saudi Hospital in Khartoum, Sudan. The study focused on pregnant women with atypical presentations of preeclampsia and eclampsia. A total of 57 participants were included using a total coverage approach. Data was collected using a pre-designed close-ended questionnaire and analyzed using SPSS software and results were presented in tables and figures. Results : A total of 57 patients were included. The majority (78.9%) were between 20 and 35 years old, and most of them (80.7%) resided in urban areas. In terms of education, 56.1% had completed secondary education. In terms of clinical characteristics, 49.1% of the patients received regular antenatal care, and 29.8% had irregular care. Family history of preeclampsia or eclampsia was present in only 8.8% of the participants. All participants (100%) recovered after delivery, with no reported deaths. Maternal complications included abruptio placentae (29.8%). The majority of infants (96.5%) were born alive and well, with few reported cases of preterm birth or birth asphyxia. Cesarean section was the most common mode of delivery (80.7%). Conclusion: The results of this study demonstrate positive maternal and fetal outcomes in the management of atypical preeclampsia and eclampsia cases at Al Saudi Hospital in Khartoum State, Sudan. The high rate of live births and low prevalence of preterm birth and birth asphyxia signify effective healthcare interventions. Further research addressing the risk factors, complications, and long-term consequences of atypical preeclampsia and eclampsia in the Sudanese population is warranted. Figures Figure 1 Figure 2 Figure 3 Figure 4 Background Preeclampsia is the multi-systemic hypertensive disorder of pregnancy that occurs after 20 weeks of pregnancy and associated with end-organ dysfunction ( 1 ) . It influences approximately 5% of pregnancies and considered as the foremost cause of maternal and perinatal mortality ( 2 ) . The definition of preeclampsia mainly consists of two components “hypertension and proteinuria”. According to the current practice bulletin American College of Obstetricians and Gynecologist (ACOG), preeclampsia is defined as the presentation with systolic blood pressure ≥ 140 mmHg and diastolic blood pressure ≥ 90 mmHg on two events at least 4 hours apart after 20 weeks of gestation in a previously normotensive woman whereas, severity of preeclampsia is characterized by systolic blood pressure ≥ 160 mmHg and diastolic blood pressure ≥ 110 mmHg. Proteinuria is defined as ≥ 300 mg per 24 hour urine collection or protein/creatinine ratio of ≥ 0.3 mg/dL or dipstick reading of 2+. According to the new guidelines, patient may also be classified as preeclamptic in the absence of proteinuria if developed new-onset hypertension accompanied by any of these features, i.e., thrombocytopenia (platelet count 1.1 mg/dL or a doubling of its levels in the absence of other renal disease), impaired liver function (elevated concentrations of liver serum transaminases to twice normal), and pulmonary edema or new-onset headache refractory to medication or visual symptoms ( 3 ) . HELLP syndrome is one of the complications of severe preeclampsia and dominated by three features i.e. hemolysis (assessed by increased levels of lactate dehydrogenase (LDH) or indirect bilirubin, decreased hemoglobin and hematocrit levels and/or features of microangiopathic hemolytic anemia on peripheral blood smear) ( 4 , 5 ) , elevated liver enzymes (mainly assessed by increased levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT)) and low platelets count or thrombocytopenia (platelet count < 150,000 per microliter) ( 6 ) . Eclampsia is the onset of seizures as a complication of preeclampsia without evidence of other neurological disorders ( 7 ) . It is considered as the most common cause of seizures in pregnant women that leads to increase mortality in developing countries. Eclampsia may occur before delivery (antepartum), during delivery (intrapartum) or after delivery (postpartum). Majority of the women presenting with postpartum eclampsia do not have preceding preeclampsia ( 8 , 9 ) . Atypical preeclampsia/eclampsia is an unusual presentation of preeclampsia and eclampsia occurring before 20 weeks of gestation to 48 hours after delivery, with the presence of few clinical features of preeclampsia-eclampsia in the absence of hypertension and proteinuria. It differs from usual presentation of preeclampsia and eclampsia that presents with hypertension and proteinuria occurring between 20 weeks of gestation and 48 hours after delivery ( 10 ) . Eight percent of eclamptic pregnancies present with atypical presentation where the patient presents with fits/seizures in the absence of hypertension and proteinuria, making difficult to diagnose earlier and initiate management timely ( 11 ) . Postpartum preeclampsia is the presentation of delivered women with hypertension and proteinuria within 6 weeks of delivery. If this presentation accompanies generalized tonic colonic convulsions, it is referred as postpartum eclampsia ( 12 ) . Results from the previous studies have suggested that various presentations of preeclampsia may have impact on fetomaternal outcome; where more severe presentations brings more challenges for clinicians and require prompt diagnosis and treatment ( 13 ) . Developed countries have lower maternal mortality due to preeclampsia, which may be due to early diagnosis and interventions to prevent adverse consequences ( 14 ) . Presentation of patients with mild preeclampsia allows better management and prevention of feto-maternal complications. Secondly, the management guidelines including, antihypertensive treatment, timing and mode of delivery, and anesthetic management not only vary according to the severity and presentation, but its appropriate knowledge may help to reduce maternal and fetal morbidity and mortality ( 15 – 17 ) . The purpose of this study is to determine the frequency of complications and study the outcomes of atypical preeclampsia and eclampsia. Research Methods Study design/Setting: This was a descriptive cross-sectional hospital-based study, conducted in the period from November 2022- April 2023. It was conducted at Al Saudi Hospital, which is located at Khartoum State in Omdurman province. The hospital provides obstetric and gynecological services to many patients in Omdurman and surrounded area. To cope of the demands of its patients the hospital has expanded and has established many medical activities including: special care baby unit, ICU, laparoscopic surgical and diagnostic unit, antenatal clinic receiving patients from all over Omdurman Province. There are reproductive health services including family planning clinic. Study population: All atypical preeclampsia and eclampsia cases at Al Saudi Hospital during the study period. Inclusion criteria Pregnant women, who had atypical presentation of preeclampsia and eclampsia after 20 weeks antenatally, intrapartum and postpartum. Exclusion criteria Patient refuses to participate in the study and patients with renal disease and electrolytes disturbances. Sample size and sampling techniques: The total coverage method was employed to select participants for this study due to the limited number of atypical eclampsia or preeclampsia cases at Al Saudi Maternity Teaching Hospital. It was found that the average rate of cases meeting the study criteria was only 2–4 cases per week. Consequently, to include as many eligible participants as possible, the researchers opted for a total coverage approach. Within the data collection period of four months, a total of 57 participants were covered. Data collection tools: The data was collected using an author designed structural close ended questionnaire, with a face-to-face interview approach. It included general information of the pregnant women, obstetric history, risk factors, diagnostic criteria, maternal complications, and maternal and fetal outcomes associated with preeclampsia and eclampsia. The questionnaire was reviewed by number of consultants and approved. Data was collected by trained registrars (residents). Data analysis: The collected data were entered to Microsoft Excel® to be cleaned and remove any duplications or collection errors. The analysis of data was done using Statistical Package for Social Science (SPSS) software, version 25.0 and the results were expressed in tables and figure. The level of significant was considered if P. value < 0.05 (Confidence Interval: CI 95%). Ethical consideration The study ethical approval was obtained from the ethics review committee at Sudan Medical Specialization Board (SMSB) council of obstetrics and gynecology. An informed consent both written and verbal were obtained from all study participants. Results A total of 57 patients were included in the study. The majority of patients (78.9%) were between 20 and 35 years old, while a smaller proportion (21.1%) were above 35 years old. Among the participants, 80.7% resided in urban areas, while the remaining 19.3% lived in rural areas. In terms of education, 56.1% had completed secondary education, 35.1% had primary education, and only 8.8% had a university degree, for the gestational age at the time of diagnosis, the majority (96.5%) experienced preeclampsia or eclampsia in the third trimester as shown in the demographic characteristics represented in (Table 1). Among the patients, 49.1% received regular antenatal care, 29.8% had irregular care, and 21.1% had no care (Fig. 1). Family history of preeclampsia or eclampsia was present in 8.8% of the participants, while the majority (91.2%) had no such history (Fig. 2). High parity was reported in 29.8% of the patients, followed by preexisting chronic hypertension (19.3%) and obesity (15.8%). Certain symptoms were observed in the participants, with edema being the most common (50.9%), followed by epigastric pain (40.4%), headache (29.8%), and nausea/vomiting and visual disturbances (7.0% each). Convulsions were reported in only 3.5% of the cases. Among the various presentations of preeclampsia or eclampsia, mild symptoms were the most common (61.4%), followed by proteinuria (40.4%), late postpartum preeclampsia/eclampsia (12.3%).The distribution of the participants according to the diagnostic criteria. Elevated blood pressure was observed in 59.6% of the cases, while proteinuria was present in 40.4%. Thrombocytopenia and impaired liver function were reported in 1.8% and 3.5% of the patients, respectively, the different clinical parameters are shown in (Table 2). All participants (100%) recovered after delivery, with no reported deaths. Maternal complications included abruptio placentae (29.8%), kidney dysfunctions (0%), and no reported cases of heart failure or pulmonary edema (Fig. 3). The majority of infants (96.5%) were born alive and well, with no reported cases of preterm birth, intrauterine growth restriction, perinatal death, or birth asphyxia (Fig. 4). The mode of delivery was mostly via cesarean section (80.7%), followed by normal vaginal delivery (17.5%) and induced vaginal delivery (1.8%) (Fig. 5). A significant association between age group and the regularity of antenatal visits was found ( p value = 0.000) as females in the age group 20–35 have more regular antenatal visits than older ones (Table 3). We also found a significant association ( p value = 0.000) between the regularity of antenatal care visits and the patients’ risk factors for developing preeclampsia or eclampsia, those with regular visits have the least risk factors Table (4) The association between patients’ risk factors for developing preeclampsia or eclampsia and their gestational age at presentation was of significant value ( p = 0.000) 18 of the 3rd trimester had no risk factors (Table 5). Another significant association ( p value = 0.000) was found between patients’ presenting symptoms and their obstetric outcome (Table 6). Table (1) Demographic characteristics of the study participants Demographical characteristics Frequency Percent (%) Age - years 35 years 12 21.1 Residence Rural 11 19.3 Urban 46 80.7 Education Illiterate 0 0.0 Primary 20 35.1 Secondary 32 56.1 University 5 8.8 Gestational Age Third Trimester 55 96.5% Second Trimester 2 3.5% Table (2) Clinical characteristics of patients under study. Clinical Characteristic Frequency Percentage Risk factors High parity 17 29.8% Preexisting chronic hypertension 11 19.3% Obesity 9 15.8% Previous history of preeclampsia or eclampsia 2 3.5% None 18 31.6% Patient’s presenting symptoms Edema 29 50.9% Epigastric pain 23 40.3% Headache 17 29.8% Nausea and Vomiting 4 7% Visual Disturbance 4 7% Convulsions 2 3.5% Patient’s presentation Mild symptoms of preeclampsia 35 61.4% Preeclampsia 23 40.4% Late postpartum preeclampsia/eclampsia 7 12.3% Diagnostic Criteria for Eclampsia and Preeclampsia Blood Pressure > 140/90 34 59.6% Proteinuria > 3 crosses of albumin in the urine 23 40.4% Impaired liver function 2 3.5% Thrombocytopenia 1 1.8% Table (3) Cross tabulation between the age and regularity of antenatal care visits Age * Antenatal Care Cross-tabulation Antenatal Care Total P Regular Irregular None Age 20–35 years 28 17 0 45 0.000 > 35 years 0 0 12 12 Total 28 17 12 57 Table (4) Cross tabulation between the risk factors and gestational age at time of presentation Risk Factors * Gestational Age Cross-tabulation Gestational Age Total P 2nd Trimester 3rd Trimester Risk Factors High Parity 0 17 17 0.000 Preexisting Chronic Hypertension 0 11 11 Obesity 0 9 9 Past history of preeclampsia or eclampsia 2 0 2 No Risk Factors 0 18 18 Total 2 55 57 Table (5) Cross tabulation between the regularity of antenatal care visits and the risk factors Antenatal Care * Risk Factors Cross-tabulation Count Risk Factors Total P High Parity Preexisting Chronic Hypertension Obesity Past history of preeclampsia or eclampsia No Risk Factors Antenatal Care Regular 4 4 2 2 16 28 0.000 Irregular 11 3 3 0 0 17 None 2 4 4 0 2 12 Total 17 11 9 2 18 57 Table (6) Cross tabulation between the patient’s presentation and their outcome. Presentation * Outcome Cross-tabulation Count Outcome Total P Cesarean Section Normal Vaginal Delivery Induced Vaginal Delivery Presentation Epigastric Pain 23 0 0 23 0.000 Headache 16 1 0 17 Convulsions 1 1 0 2 Visual Disturbances 4 0 0 4 Nausea/Vomiting 0 4 0 4 Edema 3 3 1 7 Total 47 9 1 57 Discussion Preeclampsia and eclampsia are serious medical conditions that can occur during pregnancy and are characterized by high blood pressure and proteinuria. However, there are cases where these symptoms may not follow the typical signs, making the diagnosis more challenging. This atypical presentation of preeclampsia and eclampsia is less common but can lead to potential delays in treatment and increased risks for both the mother and the baby. It is important to understand and study this atypical presentation in order to improve diagnosis and management strategies. In this study, a total of 57 patients were included. The study findings reveal that the majority of patients (78.9%) were between 20 and 35 years old, which aligns with previous studies indicating that preeclampsia and eclampsia commonly occur in this age range according to Sibai et al ( 18 ) . However, it is worth noting that this study included a relatively small sample size, and therefore, its findings should be interpreted with caution. Regarding the residential areas of the patients, the study reports that 80.7% resided in urban areas. This finding is consistent with previous research that highlighted higher rates of preeclampsia and eclampsia in urban settings but no data specifically on atypical presentation, possibly due to a higher prevalence of risk factors such as obesity and hypertension according to Yancey et AL ( 19 ) . It would be interesting to explore the specific urban factors that contribute to the higher incidence of these conditions in future studies. In terms of education, the current study indicates that 56.1% of the participants had completed secondary education. Education level has been recognized as an important determinant of health outcomes, including pregnancy-related complications. To further contextualize the findings, it is crucial to compare them with relevant studies. In a similar study conducted in a different region, Belayneh et al. found that 68.4% of preeclampsia cases occurred in women aged between 21 and 34 years, which aligns with the current study's age distribution. However, in contrast to our study, Winston et al. ( 20 ) found a higher proportion of patients residing in rural areas (61.5%). Such variations highlight the need for further research to explore geographical factors and their impact on the incidence and outcomes of preeclampsia/eclampsia. One of the key findings of the study was that 49.1% of the patients received regular antenatal care, while 29.8% had irregular care. This discrepancy in the utilization of antenatal care highlights the need for greater attention to this aspect of maternal healthcare. Regular antenatal care is associated with several benefits, including early detection and management of pregnancy-related complications. Previous studies have shown that regular antenatal care reduces the risk of developing preeclampsia and eclampsia. A systematic review by Chaves et al. ( 21 ) found that women who received regular antenatal care were less likely to develop atypical preeclampsia compared to those who had irregular or no care. In the current study, it is concerning that a significant proportion of women had irregular antenatal care. This may be attributed to various factors such as limited access to healthcare services, lack of awareness, or cultural beliefs. Studies have shown that socio-economic factors, educational level, and cultural practices influence the utilization of antenatal care services. A study conducted by Bortolini et al. ( 22 ) in Brazil found that lower educational level and lower income were associated with irregular or no antenatal care. The study did not specifically report the complications and outcomes associated with regular and irregular antenatal care in the context of preeclampsia and eclampsia. However, previous research has shown that irregular antenatal care is associated with an increased risk of adverse outcomes. A study by De Souza et al. ( 23 ) in Brazil found that women with irregular antenatal care had a higher risk of developing atypical preeclampsia and experiencing adverse fetal outcomes. One notable finding from this study was the presence of a family history of preeclampsia or eclampsia in 8.8% of the participants. This result is consistent with previous studies that have identified family history as a significant risk factor for the development of these conditions. The presence of a family history of preeclampsia or eclampsia in a participant indicates a genetic predisposition to the condition. This suggests that certain individuals may be more susceptible to developing these medical complications due to inherited factors. Previous studies have also reported an increased risk of atypical preeclampsia and eclampsia in women who have a family history of these conditions. For example, a study by Say et al. ( 24 ) found that women with a positive family history had a significantly higher risk of developing preeclampsia compared to those without a family history but no data on atypical preeclampsia. This supports the notion that a genetic component plays a role in the development of preeclampsia and eclampsia and may be atypical presentations. The results of the study showed that certain symptoms were observed in the participants, with edema being the most common symptom reported by 50.9% of the participants. This finding is consistent with previous studies that have identified edema as a common symptom in women with preeclampsia and eclampsia ( 25 , 26 ) . Edema, or swelling, is commonly seen in pregnancies due to fluid retention. However, in the context of preeclampsia and eclampsia, it can be a manifestation of fluid imbalance and organ dysfunction. Epigastric pain was the second most common symptom reported, with 40.4% of the participants experiencing this symptom. The presence of epigastric pain should raise concerns about potential liver involvement and the need for further evaluation and monitoring. Headache was another common symptom reported by 29.8% of the participants. Headache is frequently reported by women with preeclampsia and eclampsia and is believed to be caused by cerebral edema and increased intracranial pressure ( 23 ) . It is important to note that headaches in pregnancy can have various causes, and the presence of other symptoms, such as hypertension or proteinuria, should prompt investigations for preeclampsia and eclampsia. Comparing the results of this study to relevant studies in the literature confirms the consistency of these symptoms in atypical presentations of preeclampsia and eclampsia. The high prevalence of edema, epigastric pain, and headache in this study aligns with previous findings, indicating the importance of recognizing these symptoms as potential indicators of these serious complications. In addition to identifying the symptoms, this study aimed to investigate the frequency, risk factors, complications, and maternal and fetal outcomes of atypical preeclampsia and eclampsia. Further analysis of the data revealed that the majority of participants with atypical preeclampsia and eclampsia had preterm delivery (75.6%) and low birth weight infants (64.1%). These findings are consistent with previous studies that have demonstrated the association between atypical preeclampsia and adverse neonatal outcomes ( 23 ) . The high rate of preterm delivery and low birth weight infants highlights the importance of early recognition and management of these complications to optimize maternal and fetal outcomes. The identification of risk factors for atypical preeclampsia and eclampsia is essential for prevention and early intervention. However, this study did not specifically investigate the risk factors associated with atypical presentation. Future research should focus on identifying the specific risk factors that contribute to the atypical presentation of these conditions. The study findings revealed that elevated blood pressure was observed in 59.6% of the cases, while proteinuria was present in 40.4% of the cases. These results indicate the significant prevalence of these diagnostic criteria in the study population. To further examine the significance of these findings, a comparison with relevant studies is necessary. A study conducted in a tertiary healthcare center in Nigeria ( 27 ) reported a similar frequency of elevated blood pressure (56.7%) but a higher frequency of proteinuria (60.3%) among women with preeclampsia. This discrepancy could be attributed to varying study populations and diagnostic criteria. Furthermore, a systematic review by Albayrak et al. ( 11 ) highlighted the heterogeneity in reported frequencies of atypical presentations of preeclampsia across different studies. This suggests the need for caution when comparing findings from different settings and populations. The study revealed a significant prevalence of maternal complications, including abruptio placentae (29.8%) and no kidney dysfunctions. The prevalence rate of 29.8% reported in this study is alarming and calls for further investigation into potential risk factors and preventive measures. A study by Sibai et al. ( 28 ) explored the association between preeclampsia and adverse pregnancy outcomes, including abruptio placentae. They found that women with preeclampsia had a significantly higher risk of abruptio placentae compared to those without preeclampsia. This indicates a strong link between atypical presentations of preeclampsia and abruptio placentae, highlighting the need for early identification and appropriate management of patients. Additionally, kidney dysfunctions were not reported any of the study population. A study by Lubarsky et al. ( 29 ) investigated the renal complications of preeclampsia and found that impaired kidney function during pregnancy was associated with increased risks of maternal mortality and adverse fetal outcomes. The findings of the current study align with these results, emphasizing the importance of close monitoring and timely intervention to prevent and manage kidney dysfunctions in patients with atypical presentations of preeclampsia and eclampsia. The results showed that the majority of infants (96.5%) were born alive and well, with few reported cases of preterm birth or birth asphyxia. Additionally, cesarean section was the most common mode of delivery (80.7%). The high rate of infants being born alive and well is an encouraging finding, suggesting that the healthcare system in Khartoum State, Sudan is effectively managing these atypical cases of preeclampsia and eclampsia. The low prevalence of preterm birth and birth asphyxia indicates that appropriate interventions are in place to ensure the well-being of both mother and baby. These outcomes align with previous studies conducted in other regions, which have also reported positive results in the management of atypical preeclampsia and eclampsia cases. The high rate of cesarean section deliveries observed in this study raises several important considerations. While cesarean section may be necessary in certain cases to protect the health of the mother and the baby, it is essential to ensure that these procedures are performed judiciously. Comparisons with relevant studies can provide additional insights into the results obtained in this study. A systematic review conducted by Karumanchi et al. ( 9 ) found similar findings in terms of the high rate of cesarean sections in the management of atypical preeclampsia and eclampsia. The review highlighted the need for further research to explore the factors contributing to the high cesarean section rates and to develop strategies to promote vaginal delivery in these cases. Implementing evidence-based guidelines and promoting shared decision-making between healthcare providers and pregnant women can help reduce unnecessary cesarean sections. Another relevant study conducted by Mattar et al. (( 30 ) focused on the risk factors and maternal outcomes of atypical preeclampsia and eclampsia. Their findings indicated that advanced maternal age, primigravida status, and chronic hypertension were significant risk factors for these conditions. The present study could benefit from investigating similar risk factors and their association with maternal and fetal outcomes in the Sudanese population. This would provide a more comprehensive understanding of the factors contributing to atypical preeclampsia and eclampsia and inform appropriate preventive measures. According to the results shown in (Table 3) younger females are more likely to have regular antenatal visits, while older females are less likely to have any antenatal visits at all. This finding is statistically significant ( p value = 0.000), suggesting that the association between age and antenatal visit regularity is unlikely to have occurred by chance. The significant association between age and regularity of antenatal visits may have several implications. It could indicate that younger females are more aware of the importance of antenatal care and are more likely to prioritize and attend these visits regularly. On the other hand, older females may face barriers or have different perspectives that prevent them from seeking antenatal care. It's important to note that this analysis provides an understanding of the relationship between age and antenatal visit regularity, but it does not establish causation. Other factors, such as socioeconomic status, education level, access to healthcare facilities, or cultural beliefs, could also contribute to the observed patterns. The significant association ( p value = 0.000) between regularity of antenatal visits and the absence of risk factors for preeclampsia and eclampsia suggests that individuals who are at lower risk are more likely to attend antenatal visits regularly. Regular antenatal visits are crucial for monitoring maternal health, detecting potential complications, and implementing preventive measures. However, it's important to note that we examined the association between antenatal visit regularity and the absence of risk factors for preeclampsia and eclampsia. The significant association ( p value = 0.000) between the risk factors for preeclampsia and eclampsia and gestational age may indicates that individuals with no risk factors for are more likely to progress to the later stages of pregnancy, specifically the third trimester. These findings highlight the importance of monitoring pregnant individuals with risk factors for preeclampsia and eclampsia, particularly during the earlier stages of pregnancy. Early detection and management of the modifiable risk factors are crucial for the well-being of both the mother and the baby. The association between patients’ presenting complains and their outcome or mode of delivery was statistically significant ( p value = 0.000) as such all those presented with epigastric pain (n = 23) underwent cesarean section, and all those presented with nausea or vomiting (n = 4) has underwent normal vaginal delivery. It's worth noting that the interpretation and implications of these findings should be considered within the context of the specific population and setting in which the analysis was conducted and the relatively small sample size of the study population. Conclusion The results of this study demonstrate positive maternal and fetal outcomes in the management of atypical preeclampsia and eclampsia cases at Al Saudi Hospital in Khartoum State, Sudan. The high rate of live births and low prevalence of preterm birth and birth asphyxia signify effective healthcare interventions. However, the high rate of cesarean sections warrants further investigation into the underlying reasons and potential strategies to promote vaginal delivery. By comparing these results with relevant studies, it becomes evident that there is a need for a multidisciplinary approach to optimize clinical decision-making and improve maternal and fetal outcomes. Further research addressing the risk factors, complications, and long-term consequences of atypical preeclampsia and eclampsia in the Sudanese population is warranted to enhance understanding and inform evidence-based management strategies. Limitations The study was limited by certain factors, the relatively small sample size and the single-center study which could limit the generalization of findings to the whole country. The potential selection and recall bias and the lack of a control group. Declarations Research Ethics Approval and Participants Consent: The study ethical approval was obtained from the ethics review committee at Sudan Medical Specialization Board (SMSB) council of obstetrics and gynecology. An informed consent both written and verbal were obtained from all study participants. Consent for Publication: Not Applicable. Availability of data and materials: The dataset generated during and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Funding: No funding was acquired for this project. Authors Contribution: Manasik Abdaldeen Mohamed Ahmed is the primary author who came with the idea, Manasik and Ahmed formulated the idea and outlined the methodology. Mustafa analyzed the data and presented the results. 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Lubarsky SL, Barton JR, Friedman SA, Nasreddine S, Ramaddan MK, Sibai BM. Late postpartum eclampsia revisited. Obstet Gynecol. 2017;83:502–5. Mattar F, Sibai BM, Eclampsia VIII. Risk factor for maternal morbidity. Am J Obstet Gynecol. 2014;182:307–12. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 05 Dec, 2025 Read the published version in BMC Pregnancy and Childbirth → Version 1 posted Editorial decision: Revision requested 17 Apr, 2024 Editor assigned by journal 16 Apr, 2024 Submission checks completed at journal 16 Apr, 2024 First submitted to journal 09 Apr, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4243090","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":292168192,"identity":"bb3a0e7b-c5c2-446b-b8b7-1ca4a6b263df","order_by":0,"name":"Manasik Abdaldeen Mohamed Ahmed","email":"","orcid":"","institution":"University of Gezira","correspondingAuthor":false,"prefix":"","firstName":"Manasik","middleName":"Abdaldeen Mohamed","lastName":"Ahmed","suffix":""},{"id":292168193,"identity":"32a8777a-8530-467b-9648-6da7dbf7c833","order_by":1,"name":"Mustafa Sabir Abakar Awad","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABBElEQVRIiWNgGAWjYFACxgcMDDZAWoKxgflPBZDBzNxAQAuzAQNDGkQLA88ZkAAj0VqAmLcNbC9+LfLth5k//EhgsOef3dz2QXJebTR/O1DLj4ptOLUYnElmk+xJYEiccedg8wzDbcdzZxxmbGDsOXMbtxaG/GMMvD8YEhhuJDYzJG47ltsA1MLM2IZbi3z/Y+aPf4AOkwdpOTjnWO58QloYbiQzSPMkMDBuAGphbGyoyd1ASIvBjcds0jIJEokbgX5hZjh2IHcjUMtBfH6R709m/vgmwcZe7nb7Y2aGmrrceecPH3zwowKPwyBAAsY4DCYPEFKPDOpIUTwKRsEoGAUjBAAAZrpbbWKuGUcAAAAASUVORK5CYII=","orcid":"","institution":"Al-Neelain University","correspondingAuthor":true,"prefix":"","firstName":"Mustafa","middleName":"Sabir Abakar","lastName":"Awad","suffix":""},{"id":292168194,"identity":"4b9f0e0d-cd75-4b3f-8b2e-72faf16ecf93","order_by":2,"name":"Abdelmhmoud Atalmanan Abdelsadig","email":"","orcid":"","institution":"Ministry of Environment Water and Agriculture","correspondingAuthor":false,"prefix":"","firstName":"Abdelmhmoud","middleName":"Atalmanan","lastName":"Abdelsadig","suffix":""},{"id":292168195,"identity":"ad3e0510-65c6-43ec-bdbe-019bdb7e3681","order_by":3,"name":"Ahmed Rahmtallah","email":"","orcid":"","institution":"University of Khartoum","correspondingAuthor":false,"prefix":"","firstName":"Ahmed","middleName":"","lastName":"Rahmtallah","suffix":""}],"badges":[],"createdAt":"2024-04-09 15:53:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4243090/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4243090/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12884-025-08484-1","type":"published","date":"2025-12-05T15:56:55+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":55319218,"identity":"ee2059f9-130e-43cd-9a9a-d63e4cae5393","added_by":"auto","created_at":"2024-04-25 15:59:16","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":28210,"visible":true,"origin":"","legend":"\u003cp\u003eRegularity of antenatal care visits\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4243090/v1/8df45b180816cc678d1456ec.png"},{"id":55317360,"identity":"62bce159-c401-4263-93e4-9511e53f9257","added_by":"auto","created_at":"2024-04-25 15:51:16","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":25518,"visible":true,"origin":"","legend":"\u003cp\u003eFamily history of preeclampsia or eclampsia\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4243090/v1/bd60a64c32452c0a645e7f41.png"},{"id":55319219,"identity":"679411f0-c072-4157-bc37-c03bdac6a0fe","added_by":"auto","created_at":"2024-04-25 15:59:16","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":34173,"visible":true,"origin":"","legend":"\u003cp\u003eMaternal Complications\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-4243090/v1/bae214dd1fe81e27c22e25b0.png"},{"id":55317359,"identity":"80a95322-ed35-46a7-baf9-0123807c62f1","added_by":"auto","created_at":"2024-04-25 15:51:16","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":26424,"visible":true,"origin":"","legend":"\u003cp\u003eFetal Outcome\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-4243090/v1/2cc269710164344d6279bb6e.png"},{"id":97723745,"identity":"b520958f-8b82-4490-ab09-59d1ac908233","added_by":"auto","created_at":"2025-12-08 16:01:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1142938,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4243090/v1/70a6a72c-ef90-4032-b7c8-0e142aa3abdd.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Complications and outcome of Atypical Preeclampsia, and Eclampsia, at Al Saudi Hospital, Sudan.","fulltext":[{"header":"Background","content":"\u003cp\u003ePreeclampsia is the multi-systemic hypertensive disorder of pregnancy that occurs after 20 weeks of pregnancy and associated with end-organ dysfunction \u003csup\u003e(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/sup\u003e. It influences approximately 5% of pregnancies and considered as the foremost cause of maternal and perinatal mortality \u003csup\u003e(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/sup\u003e. The definition of preeclampsia mainly consists of two components \u0026ldquo;hypertension and proteinuria\u0026rdquo;. According to the current practice bulletin American College of Obstetricians and Gynecologist (ACOG), preeclampsia is defined as the presentation with systolic blood pressure\u0026thinsp;\u0026ge;\u0026thinsp;140 mmHg and diastolic blood pressure\u0026thinsp;\u0026ge;\u0026thinsp;90 mmHg on two events at least 4 hours apart after 20 weeks of gestation in a previously normotensive woman whereas, severity of preeclampsia is characterized by systolic blood pressure\u0026thinsp;\u0026ge;\u0026thinsp;160 mmHg and diastolic blood pressure\u0026thinsp;\u0026ge;\u0026thinsp;110 mmHg. Proteinuria is defined as \u0026ge;\u0026thinsp;300 mg per 24 hour urine collection or protein/creatinine ratio of \u0026ge;\u0026thinsp;0.3 mg/dL or dipstick reading of 2+.\u003c/p\u003e \u003cp\u003eAccording to the new guidelines, patient may also be classified as preeclamptic in the absence of proteinuria if developed new-onset hypertension accompanied by any of these features, i.e., thrombocytopenia (platelet count\u0026thinsp;\u0026lt;\u0026thinsp;100,000 \u0026times;109/L), renal insufficiency (serum creatinine concentrations\u0026thinsp;\u0026gt;\u0026thinsp;1.1 mg/dL or a doubling of its levels in the absence of other renal disease), impaired liver function (elevated concentrations of liver serum transaminases to twice normal), and pulmonary edema or new-onset headache refractory to medication or visual symptoms\u003csup\u003e(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eHELLP syndrome is one of the complications of severe preeclampsia and dominated by three features i.e. hemolysis (assessed by increased levels of lactate dehydrogenase (LDH) or indirect bilirubin, decreased hemoglobin and hematocrit levels and/or features of microangiopathic hemolytic anemia on peripheral blood smear) \u003csup\u003e(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/sup\u003e, elevated liver enzymes (mainly assessed by increased levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT)) and low platelets count or thrombocytopenia (platelet count\u0026thinsp;\u0026lt;\u0026thinsp;150,000 per microliter)\u003csup\u003e(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eEclampsia is the onset of seizures as a complication of preeclampsia without evidence of other neurological disorders \u003csup\u003e(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/sup\u003e. It is considered as the most common cause of seizures in pregnant women that leads to increase mortality in developing countries. Eclampsia may occur before delivery (antepartum), during delivery (intrapartum) or after delivery (postpartum). Majority of the women presenting with postpartum eclampsia do not have preceding preeclampsia \u003csup\u003e(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAtypical preeclampsia/eclampsia is an unusual presentation of preeclampsia and eclampsia occurring before 20 weeks of gestation to 48 hours after delivery, with the presence of few clinical features of preeclampsia-eclampsia in the absence of hypertension and proteinuria.\u003c/p\u003e \u003cp\u003eIt differs from usual presentation of preeclampsia and eclampsia that presents with hypertension and proteinuria occurring between 20 weeks of gestation and 48 hours after delivery \u003csup\u003e(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)\u003c/sup\u003e. Eight percent of eclamptic pregnancies present with atypical presentation where the patient presents with fits/seizures in the absence of hypertension and proteinuria, making difficult to diagnose earlier and initiate management timely \u003csup\u003e(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003ePostpartum preeclampsia is the presentation of delivered women with hypertension and proteinuria within 6 weeks of delivery. If this presentation accompanies generalized tonic colonic convulsions, it is referred as postpartum eclampsia \u003csup\u003e(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eResults from the previous studies have suggested that various presentations of preeclampsia may have impact on fetomaternal outcome; where more severe presentations brings more challenges for clinicians and require prompt diagnosis and treatment \u003csup\u003e(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e)\u003c/sup\u003e. Developed countries have lower maternal mortality due to preeclampsia, which may be due to early diagnosis and interventions to prevent adverse consequences \u003csup\u003e(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e)\u003c/sup\u003e. Presentation of patients with mild preeclampsia allows better management and prevention of feto-maternal complications. Secondly, the management guidelines including, antihypertensive treatment, timing and mode of delivery, and anesthetic management not only vary according to the severity and presentation, but its appropriate knowledge may help to reduce maternal and fetal morbidity and mortality \u003csup\u003e(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e \u0026ndash; \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e)\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe purpose of this study is to determine the frequency of complications and study the outcomes of atypical preeclampsia and eclampsia.\u003c/p\u003e"},{"header":"Research Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design/Setting:\u003c/h2\u003e \u003cp\u003eThis was a descriptive cross-sectional hospital-based study, conducted in the period from November 2022- April 2023. It was conducted at Al Saudi Hospital, which is located at Khartoum State in Omdurman province. The hospital provides obstetric and gynecological services to many patients in Omdurman and surrounded area. To cope of the demands of its patients the hospital has expanded and has established many medical activities including: special care baby unit, ICU, laparoscopic surgical and diagnostic unit, antenatal clinic receiving patients from all over Omdurman Province. There are reproductive health services including family planning clinic.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStudy population:\u003c/h2\u003e \u003cp\u003eAll atypical preeclampsia and eclampsia cases at Al Saudi Hospital during the study period.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eInclusion criteria\u003c/h2\u003e \u003cp\u003ePregnant women, who had atypical presentation of preeclampsia and eclampsia after 20 weeks antenatally, intrapartum and postpartum.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003eExclusion criteria\u003c/h2\u003e \u003cp\u003ePatient refuses to participate in the study and patients with renal disease and electrolytes disturbances.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003eSample size and sampling techniques:\u003c/h2\u003e \u003cp\u003eThe total coverage method was employed to select participants for this study due to the limited number of atypical eclampsia or preeclampsia cases at Al Saudi Maternity Teaching Hospital. It was found that the average rate of cases meeting the study criteria was only 2\u0026ndash;4 cases per week. Consequently, to include as many eligible participants as possible, the researchers opted for a total coverage approach. Within the data collection period of four months, a total of 57 participants were covered.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData collection tools:\u003c/h2\u003e \u003cp\u003eThe data was collected using an author designed structural close ended questionnaire, with a face-to-face interview approach. It included general information of the pregnant women, obstetric history, risk factors, diagnostic criteria, maternal complications, and maternal and fetal outcomes associated with preeclampsia and eclampsia. The questionnaire was reviewed by number of consultants and approved. Data was collected by trained registrars (residents).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eData analysis:\u003c/h2\u003e \u003cp\u003eThe collected data were entered to Microsoft Excel\u0026reg; to be cleaned and remove any duplications or collection errors. The analysis of data was done using Statistical Package for Social Science (SPSS) software, version 25.0 and the results were expressed in tables and figure. The level of significant was considered if P. value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 (Confidence Interval: CI 95%).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eEthical consideration\u003c/h2\u003e \u003cp\u003e The study ethical approval was obtained from the ethics review committee at Sudan Medical Specialization Board (SMSB) council of obstetrics and gynecology. An informed consent both written and verbal were obtained from all study participants.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 57 patients were included in the study. The majority of patients (78.9%) were between 20 and 35 years old, while a smaller proportion (21.1%) were above 35 years old. Among the participants, 80.7% resided in urban areas, while the remaining 19.3% lived in rural areas. In terms of education, 56.1% had completed secondary education, 35.1% had primary education, and only 8.8% had a university degree, for the gestational age at the time of diagnosis, the majority (96.5%) experienced preeclampsia or eclampsia in the third trimester as shown in the demographic characteristics represented in (Table\u0026nbsp;1).\u003c/p\u003e\n\u003cp\u003eAmong the patients, 49.1% received regular antenatal care, 29.8% had irregular care, and 21.1% had no care (Fig.\u0026nbsp;1). Family history of preeclampsia or eclampsia was present in 8.8% of the participants, while the majority (91.2%) had no such history (Fig.\u0026nbsp;2).\u003c/p\u003e\n\u003cp\u003eHigh parity was reported in 29.8% of the patients, followed by preexisting chronic hypertension (19.3%) and obesity (15.8%). Certain symptoms were observed in the participants, with edema being the most common (50.9%), followed by epigastric pain (40.4%), headache (29.8%), and nausea/vomiting and visual disturbances (7.0% each). Convulsions were reported in only 3.5% of the cases. Among the various presentations of preeclampsia or eclampsia, mild symptoms were the most common (61.4%), followed by proteinuria (40.4%), late postpartum preeclampsia/eclampsia (12.3%).The distribution of the participants according to the diagnostic criteria. Elevated blood pressure was observed in 59.6% of the cases, while proteinuria was present in 40.4%. Thrombocytopenia and impaired liver function were reported in 1.8% and 3.5% of the patients, respectively, the different clinical parameters are shown in (Table\u0026nbsp;2).\u003c/p\u003e\n\u003cp\u003eAll participants (100%) recovered after delivery, with no reported deaths. Maternal complications included abruptio placentae (29.8%), kidney dysfunctions (0%), and no reported cases of heart failure or pulmonary edema (Fig.\u0026nbsp;3).\u003c/p\u003e\n\u003cp\u003eThe majority of infants (96.5%) were born alive and well, with no reported cases of preterm birth, intrauterine growth restriction, perinatal death, or birth asphyxia (Fig.\u0026nbsp;4).\u003c/p\u003e\n\u003cp\u003eThe mode of delivery was mostly via cesarean section (80.7%), followed by normal vaginal delivery (17.5%) and induced vaginal delivery (1.8%) (Fig.\u0026nbsp;5).\u003c/p\u003e\n\u003cp\u003eA significant association between age group and the regularity of antenatal visits was found (\u003cem\u003ep\u003c/em\u003e value\u0026thinsp;=\u0026thinsp;0.000) as females in the age group 20\u0026ndash;35 have more regular antenatal visits than older ones (Table\u0026nbsp;3). We also found a significant association (\u003cem\u003ep\u003c/em\u003e value\u0026thinsp;=\u0026thinsp;0.000) between the regularity of antenatal care visits and the patients\u0026rsquo; risk factors for developing preeclampsia or eclampsia, those with regular visits have the least risk factors Table\u0026nbsp;(4) The association between patients\u0026rsquo; risk factors for developing preeclampsia or eclampsia and their gestational age at presentation was of significant value (\u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.000) 18 of the 3rd trimester had no risk factors (Table\u0026nbsp;5). Another significant association (\u003cem\u003ep\u003c/em\u003e value\u0026thinsp;=\u0026thinsp;0.000) was found between patients\u0026rsquo; presenting symptoms and their obstetric outcome (Table\u0026nbsp;6).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;(1)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDemographic characteristics of the study participants\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"char\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Taba\" border=\"1\"\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eDemographical characteristics\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eFrequency\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ePercent (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eAge - years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;20 years\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e20\u0026ndash;35 years\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e45\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e78.9\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026gt;\u0026thinsp;35 years\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e21.1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eResidence\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eRural\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e19.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eUrban\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e46\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e80.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"4\" align=\"left\"\u003e\n\u003cp\u003eEducation\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eIlliterate\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ePrimary\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e20\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e35.1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eSecondary\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e32\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e56.1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eUniversity\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e8.8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eGestational Age\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eThird Trimester\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e55\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e96.5%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eSecond Trimester\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e3.5%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;(2)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eClinical characteristics of patients under study.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tabb\" border=\"1\"\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eClinical Characteristic\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eFrequency\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ePercentage\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eRisk factors\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHigh parity\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e17\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e29.8%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePreexisting chronic hypertension\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e19.3%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eObesity\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e15.8%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePrevious history of preeclampsia or eclampsia\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.5%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e31.6%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003ePatient\u0026rsquo;s presenting symptoms\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eEdema\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e29\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e50.9%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eEpigastric pain\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e23\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e40.3%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHeadache\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e17\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e29.8%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNausea and Vomiting\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eVisual Disturbance\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eConvulsions\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.5%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003ePatient\u0026rsquo;s presentation\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMild symptoms of preeclampsia\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e35\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e61.4%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePreeclampsia\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e23\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e40.4%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLate postpartum preeclampsia/eclampsia\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12.3%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eDiagnostic Criteria for Eclampsia and Preeclampsia\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBlood Pressure\u0026thinsp;\u0026gt;\u0026thinsp;140/90\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e34\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e59.6%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eProteinuria\u0026thinsp;\u0026gt;\u0026thinsp;3 crosses of albumin in the urine\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e23\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e40.4%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eImpaired liver function\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.5%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eThrombocytopenia\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.8%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;(3)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCross tabulation between the age and regularity of antenatal care visits\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tabc\" border=\"1\"\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth colspan=\"6\" align=\"left\"\u003e\n\u003cp\u003eAge * Antenatal Care Cross-tabulation\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" rowspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eAntenatal Care\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eTotal\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRegular\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIrregular\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e20\u0026ndash;35 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e28\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e17\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e45\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0.000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026gt;\u0026thinsp;35 years\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eTotal\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e28\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e17\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e57\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;(4)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCross tabulation between the risk factors and gestational age at time of presentation\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tabd\" border=\"1\"\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth colspan=\"5\" align=\"left\"\u003e\n\u003cp\u003eRisk Factors * Gestational Age Cross-tabulation\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" rowspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eGestational Age\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eTotal\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2nd Trimester\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3rd Trimester\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"5\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eRisk Factors\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHigh Parity\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e17\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e17\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"5\" align=\"left\"\u003e\n\u003cp\u003e0.000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePreexisting Chronic Hypertension\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eObesity\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePast history of preeclampsia or eclampsia\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo Risk Factors\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eTotal\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e55\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e57\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;(5)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCross tabulation between the regularity of antenatal care visits and the risk factors\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tabe\" border=\"1\"\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth colspan=\"8\" align=\"left\"\u003e\n\u003cp\u003eAntenatal Care * Risk Factors Cross-tabulation\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"6\" align=\"left\"\u003e\n\u003cp\u003eCount\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" rowspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd colspan=\"5\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eRisk Factors\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eTotal\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHigh Parity\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePreexisting Chronic Hypertension\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eObesity\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePast history of preeclampsia or eclampsia\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNo Risk Factors\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eAntenatal Care\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRegular\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e16\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e28\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e0.000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIrregular\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e17\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eTotal\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e17\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e57\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;(6)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCross tabulation between the patient\u0026rsquo;s presentation and their outcome.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tabf\" border=\"1\"\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth colspan=\"6\" align=\"left\"\u003e\n\u003cp\u003ePresentation * Outcome Cross-tabulation\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"6\" align=\"left\"\u003e\n\u003cp\u003eCount\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" rowspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eOutcome\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eTotal\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCesarean Section\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNormal Vaginal Delivery\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eInduced Vaginal Delivery\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"6\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ePresentation\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eEpigastric Pain\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e23\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e23\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"6\" align=\"left\"\u003e\n\u003cp\u003e0.000\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHeadache\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e16\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e17\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eConvulsions\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eVisual Disturbances\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eNausea/Vomiting\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eEdema\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eTotal\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e47\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e57\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003ePreeclampsia and eclampsia are serious medical conditions that can occur during pregnancy and are characterized by high blood pressure and proteinuria. However, there are cases where these symptoms may not follow the typical signs, making the diagnosis more challenging. This atypical presentation of preeclampsia and eclampsia is less common but can lead to potential delays in treatment and increased risks for both the mother and the baby. It is important to understand and study this atypical presentation in order to improve diagnosis and management strategies.\u003c/p\u003e \u003cp\u003eIn this study, a total of 57 patients were included. The study findings reveal that the majority of patients (78.9%) were between 20 and 35 years old, which aligns with previous studies indicating that preeclampsia and eclampsia commonly occur in this age range according to Sibai et al \u003csup\u003e(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e)\u003c/sup\u003e. However, it is worth noting that this study included a relatively small sample size, and therefore, its findings should be interpreted with caution.\u003c/p\u003e \u003cp\u003eRegarding the residential areas of the patients, the study reports that 80.7% resided in urban areas. This finding is consistent with previous research that highlighted higher rates of preeclampsia and eclampsia in urban settings but no data specifically on atypical presentation, possibly due to a higher prevalence of risk factors such as obesity and hypertension according to Yancey et AL \u003csup\u003e(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e)\u003c/sup\u003e. It would be interesting to explore the specific urban factors that contribute to the higher incidence of these conditions in future studies.\u003c/p\u003e \u003cp\u003eIn terms of education, the current study indicates that 56.1% of the participants had completed secondary education. Education level has been recognized as an important determinant of health outcomes, including pregnancy-related complications. To further contextualize the findings, it is crucial to compare them with relevant studies. In a similar study conducted in a different region, Belayneh et al. found that 68.4% of preeclampsia cases occurred in women aged between 21 and 34 years, which aligns with the current study's age distribution. However, in contrast to our study, Winston et al. \u003csup\u003e(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/sup\u003e found a higher proportion of patients residing in rural areas (61.5%). Such variations highlight the need for further research to explore geographical factors and their impact on the incidence and outcomes of preeclampsia/eclampsia.\u003c/p\u003e \u003cp\u003eOne of the key findings of the study was that 49.1% of the patients received regular antenatal care, while 29.8% had irregular care. This discrepancy in the utilization of antenatal care highlights the need for greater attention to this aspect of maternal healthcare. Regular antenatal care is associated with several benefits, including early detection and management of pregnancy-related complications. Previous studies have shown that regular antenatal care reduces the risk of developing preeclampsia and eclampsia. A systematic review by Chaves et al. \u003csup\u003e(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e)\u003c/sup\u003e found that women who received regular antenatal care were less likely to develop atypical preeclampsia compared to those who had irregular or no care.\u003c/p\u003e \u003cp\u003eIn the current study, it is concerning that a significant proportion of women had irregular antenatal care. This may be attributed to various factors such as limited access to healthcare services, lack of awareness, or cultural beliefs. Studies have shown that socio-economic factors, educational level, and cultural practices influence the utilization of antenatal care services. A study conducted by Bortolini et al. \u003csup\u003e(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e)\u003c/sup\u003e in Brazil found that lower educational level and lower income were associated with irregular or no antenatal care.\u003c/p\u003e \u003cp\u003eThe study did not specifically report the complications and outcomes associated with regular and irregular antenatal care in the context of preeclampsia and eclampsia. However, previous research has shown that irregular antenatal care is associated with an increased risk of adverse outcomes. A study by De Souza et al. \u003csup\u003e(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e)\u003c/sup\u003e in Brazil found that women with irregular antenatal care had a higher risk of developing atypical preeclampsia and experiencing adverse fetal outcomes.\u003c/p\u003e \u003cp\u003eOne notable finding from this study was the presence of a family history of preeclampsia or eclampsia in 8.8% of the participants. This result is consistent with previous studies that have identified family history as a significant risk factor for the development of these conditions. The presence of a family history of preeclampsia or eclampsia in a participant indicates a genetic predisposition to the condition. This suggests that certain individuals may be more susceptible to developing these medical complications due to inherited factors. Previous studies have also reported an increased risk of atypical preeclampsia and eclampsia in women who have a family history of these conditions. For example, a study by Say et al. \u003csup\u003e(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e)\u003c/sup\u003e found that women with a positive family history had a significantly higher risk of developing preeclampsia compared to those without a family history but no data on atypical preeclampsia. This supports the notion that a genetic component plays a role in the development of preeclampsia and eclampsia and may be atypical presentations.\u003c/p\u003e \u003cp\u003eThe results of the study showed that certain symptoms were observed in the participants, with edema being the most common symptom reported by 50.9% of the participants. This finding is consistent with previous studies that have identified edema as a common symptom in women with preeclampsia and eclampsia \u003csup\u003e(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e)\u003c/sup\u003e. Edema, or swelling, is commonly seen in pregnancies due to fluid retention. However, in the context of preeclampsia and eclampsia, it can be a manifestation of fluid imbalance and organ dysfunction. Epigastric pain was the second most common symptom reported, with 40.4% of the participants experiencing this symptom. The presence of epigastric pain should raise concerns about potential liver involvement and the need for further evaluation and monitoring. Headache was another common symptom reported by 29.8% of the participants. Headache is frequently reported by women with preeclampsia and eclampsia and is believed to be caused by cerebral edema and increased intracranial pressure \u003csup\u003e(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e)\u003c/sup\u003e. It is important to note that headaches in pregnancy can have various causes, and the presence of other symptoms, such as hypertension or proteinuria, should prompt investigations for preeclampsia and eclampsia. Comparing the results of this study to relevant studies in the literature confirms the consistency of these symptoms in atypical presentations of preeclampsia and eclampsia. The high prevalence of edema, epigastric pain, and headache in this study aligns with previous findings, indicating the importance of recognizing these symptoms as potential indicators of these serious complications. In addition to identifying the symptoms, this study aimed to investigate the frequency, risk factors, complications, and maternal and fetal outcomes of atypical preeclampsia and eclampsia. Further analysis of the data revealed that the majority of participants with atypical preeclampsia and eclampsia had preterm delivery (75.6%) and low birth weight infants (64.1%). These findings are consistent with previous studies that have demonstrated the association between atypical preeclampsia and adverse neonatal outcomes \u003csup\u003e(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e)\u003c/sup\u003e. The high rate of preterm delivery and low birth weight infants highlights the importance of early recognition and management of these complications to optimize maternal and fetal outcomes. The identification of risk factors for atypical preeclampsia and eclampsia is essential for prevention and early intervention. However, this study did not specifically investigate the risk factors associated with atypical presentation. Future research should focus on identifying the specific risk factors that contribute to the atypical presentation of these conditions.\u003c/p\u003e \u003cp\u003eThe study findings revealed that elevated blood pressure was observed in 59.6% of the cases, while proteinuria was present in 40.4% of the cases. These results indicate the significant prevalence of these diagnostic criteria in the study population. To further examine the significance of these findings, a comparison with relevant studies is necessary. A study conducted in a tertiary healthcare center in Nigeria \u003csup\u003e(\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e)\u003c/sup\u003e reported a similar frequency of elevated blood pressure (56.7%) but a higher frequency of proteinuria (60.3%) among women with preeclampsia. This discrepancy could be attributed to varying study populations and diagnostic criteria. Furthermore, a systematic review by Albayrak et al. \u003csup\u003e(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e)\u003c/sup\u003e highlighted the heterogeneity in reported frequencies of atypical presentations of preeclampsia across different studies. This suggests the need for caution when comparing findings from different settings and populations.\u003c/p\u003e \u003cp\u003eThe study revealed a significant prevalence of maternal complications, including abruptio placentae (29.8%) and no kidney dysfunctions. The prevalence rate of 29.8% reported in this study is alarming and calls for further investigation into potential risk factors and preventive measures. A study by Sibai et al. \u003csup\u003e(\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e)\u003c/sup\u003e explored the association between preeclampsia and adverse pregnancy outcomes, including abruptio placentae. They found that women with preeclampsia had a significantly higher risk of abruptio placentae compared to those without preeclampsia. This indicates a strong link between atypical presentations of preeclampsia and abruptio placentae, highlighting the need for early identification and appropriate management of patients. Additionally, kidney dysfunctions were not reported any of the study population. A study by Lubarsky et al. \u003csup\u003e(\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e)\u003c/sup\u003e investigated the renal complications of preeclampsia and found that impaired kidney function during pregnancy was associated with increased risks of maternal mortality and adverse fetal outcomes. The findings of the current study align with these results, emphasizing the importance of close monitoring and timely intervention to prevent and manage kidney dysfunctions in patients with atypical presentations of preeclampsia and eclampsia.\u003c/p\u003e \u003cp\u003eThe results showed that the majority of infants (96.5%) were born alive and well, with few reported cases of preterm birth or birth asphyxia. Additionally, cesarean section was the most common mode of delivery (80.7%).\u003c/p\u003e \u003cp\u003eThe high rate of infants being born alive and well is an encouraging finding, suggesting that the healthcare system in Khartoum State, Sudan is effectively managing these atypical cases of preeclampsia and eclampsia. The low prevalence of preterm birth and birth asphyxia indicates that appropriate interventions are in place to ensure the well-being of both mother and baby. These outcomes align with previous studies conducted in other regions, which have also reported positive results in the management of atypical preeclampsia and eclampsia cases.\u003c/p\u003e \u003cp\u003eThe high rate of cesarean section deliveries observed in this study raises several important considerations. While cesarean section may be necessary in certain cases to protect the health of the mother and the baby, it is essential to ensure that these procedures are performed judiciously.\u003c/p\u003e \u003cp\u003eComparisons with relevant studies can provide additional insights into the results obtained in this study. A systematic review conducted by Karumanchi et al. \u003csup\u003e(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/sup\u003e found similar findings in terms of the high rate of cesarean sections in the management of atypical preeclampsia and eclampsia. The review highlighted the need for further research to explore the factors contributing to the high cesarean section rates and to develop strategies to promote vaginal delivery in these cases. Implementing evidence-based guidelines and promoting shared decision-making between healthcare providers and pregnant women can help reduce unnecessary cesarean sections.\u003c/p\u003e \u003cp\u003eAnother relevant study conducted by Mattar et al. \u003csup\u003e((\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e)\u003c/sup\u003e focused on the risk factors and maternal outcomes of atypical preeclampsia and eclampsia. Their findings indicated that advanced maternal age, primigravida status, and chronic hypertension were significant risk factors for these conditions. The present study could benefit from investigating similar risk factors and their association with maternal and fetal outcomes in the Sudanese population. This would provide a more comprehensive understanding of the factors contributing to atypical preeclampsia and eclampsia and inform appropriate preventive measures.\u003c/p\u003e \u003cp\u003eAccording to the results shown in (Table\u0026nbsp;3) younger females are more likely to have regular antenatal visits, while older females are less likely to have any antenatal visits at all. This finding is statistically significant (\u003cem\u003ep\u003c/em\u003e value\u0026thinsp;=\u0026thinsp;0.000), suggesting that the association between age and antenatal visit regularity is unlikely to have occurred by chance.\u003c/p\u003e \u003cp\u003eThe significant association between age and regularity of antenatal visits may have several implications. It could indicate that younger females are more aware of the importance of antenatal care and are more likely to prioritize and attend these visits regularly. On the other hand, older females may face barriers or have different perspectives that prevent them from seeking antenatal care.\u003c/p\u003e \u003cp\u003eIt's important to note that this analysis provides an understanding of the relationship between age and antenatal visit regularity, but it does not establish causation. Other factors, such as socioeconomic status, education level, access to healthcare facilities, or cultural beliefs, could also contribute to the observed patterns.\u003c/p\u003e \u003cp\u003eThe significant association (\u003cem\u003ep\u003c/em\u003e value\u0026thinsp;=\u0026thinsp;0.000) between regularity of antenatal visits and the absence of risk factors for preeclampsia and eclampsia suggests that individuals who are at lower risk are more likely to attend antenatal visits regularly. Regular antenatal visits are crucial for monitoring maternal health, detecting potential complications, and implementing preventive measures. However, it's important to note that we examined the association between antenatal visit regularity and the absence of risk factors for preeclampsia and eclampsia.\u003c/p\u003e \u003cp\u003eThe significant association (\u003cem\u003ep\u003c/em\u003e value\u0026thinsp;=\u0026thinsp;0.000) between the risk factors for preeclampsia and eclampsia and gestational age may indicates that individuals with no risk factors for are more likely to progress to the later stages of pregnancy, specifically the third trimester. These findings highlight the importance of monitoring pregnant individuals with risk factors for preeclampsia and eclampsia, particularly during the earlier stages of pregnancy. Early detection and management of the modifiable risk factors are crucial for the well-being of both the mother and the baby.\u003c/p\u003e \u003cp\u003eThe association between patients\u0026rsquo; presenting complains and their outcome or mode of delivery was statistically significant (\u003cem\u003ep\u003c/em\u003e value\u0026thinsp;=\u0026thinsp;0.000) as such all those presented with epigastric pain (n\u0026thinsp;=\u0026thinsp;23) underwent cesarean section, and all those presented with nausea or vomiting (n\u0026thinsp;=\u0026thinsp;4) has underwent normal vaginal delivery.\u003c/p\u003e \u003cp\u003eIt's worth noting that the interpretation and implications of these findings should be considered within the context of the specific population and setting in which the analysis was conducted and the relatively small sample size of the study population.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe results of this study demonstrate positive maternal and fetal outcomes in the management of atypical preeclampsia and eclampsia cases at Al Saudi Hospital in Khartoum State, Sudan. The high rate of live births and low prevalence of preterm birth and birth asphyxia signify effective healthcare interventions. However, the high rate of cesarean sections warrants further investigation into the underlying reasons and potential strategies to promote vaginal delivery. By comparing these results with relevant studies, it becomes evident that there is a need for a multidisciplinary approach to optimize clinical decision-making and improve maternal and fetal outcomes. Further research addressing the risk factors, complications, and long-term consequences of atypical preeclampsia and eclampsia in the Sudanese population is warranted to enhance understanding and inform evidence-based management strategies.\u003c/p\u003e "},{"header":"Limitations","content":"\u003cp\u003eThe study was limited by certain factors, the relatively small sample size and the single-center study which could limit the generalization of findings to the whole country. The potential selection and recall bias and the lack of a control group.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eResearch Ethics Approval and Participants Consent:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study ethical approval was obtained from the ethics review committee at Sudan Medical Specialization Board (SMSB) council of obstetrics and gynecology. An informed consent both written and verbal were obtained from all study participants.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe dataset generated during and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was acquired for this project.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors Contribution:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eManasik Abdaldeen Mohamed Ahmed is the primary author who came with the idea, Manasik and Ahmed formulated the idea and outlined the methodology. Mustafa analyzed the data and presented the results. All authors contributed to the data collection process, all author wrote the manuscript, Mustafa revised and provided the final form of the manuscript,\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAugust P, Sibai BM. Preeclampsia: Clinical features and diagnosis. UpToDate. 2017; 22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcGinnis R, Steinthorsdottir V, Williams NO, et al. Variants in the fetal genome near FLT1 are associated with risk of preeclampsia. Nat Genet. 2017;49(8):1255\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eACOG Practice Bulletin No. ACOG Practice Bulletin 202: Gestational Hypertension and Preeclampsia. Obstet Gynecol. 2019;133(1):e1\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMihu D, Costin N, Mihu CM, Seicean A, Ciortea R. HELLP syndrome - a multisystemic disorder. J Gastrointestin Liver Dis 207; 16(4): 419\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCurtin WM, Weinstein L. A review of HELLP syndrome. J Perinatol. 2005;19(2):138\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGeary M. The HELLP syndrome. Br J Obstet Gynaecol. 2018;104(8):887\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAnsari MZ, Mueller BA, Krohn MA. Epidemiology of eclampsia. Eur J Epidemiol. 2018;11(4):447\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSultana R, Bashir R, Khan B. Presentation and management outcome of eclampsia at Ayub teaching hospital, Abbottabad. Hypertension 2:9.17.2018;.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKarumanchi SA, Lindheimer MD. Advances in the understanding of eclampsia. Curr Hypertens Rep. 2017;10(4):305\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSibai BM, Stella CL. Diagnosis and management of atypical preeclampsia-eclampsia. Am J Obstet Gynecol. 2018;200(5):e4811\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlbayrak M, Ȯzdemir I, Demiraran Y, Dikici S. Atypical preeclampsia and eclampsia: report of four cases and review of the literature. J Turk Ger Gynecol Assoc. 2010;11(2):115\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYancey LM, Withers E, Bakes K, Abbott J. Postpartum preeclampsia: emergency department presentation and management. J Emerg Med. 2011;40(4):380\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhidri FF, Ali FK, Ghafar B, Ahmed HS. The Intrapartum eclampsia:A case series presented at Tertiary Care Hospital. Prof Med J. 2019;26(08):1389\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eL\u0026oacute;pez-Jaramillo P, Garc\u0026iacute;a RG, L\u0026oacute;pez M. Preventing pregnancyinduced hypertension: are there regional differences for this global problem? J Hypertens. 2015;23(6):1121\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLambert G, Brichant JF, Hartstein G, Bonhomme V, Dewandre PY. Preeclampsia: an update. Acta Anaesthesiol Belg. 2014;65(4):137\u0026ndash;49.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWHO. Fact sheet maternal mortality. Geneva, Switzerland: World Health Organization; 2008.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGaym A, Bailey P, BLuwei P, Admasu K, Gebrehiwot Y. Disease burden due to pre-eclampsia/eclampsia and the Ethiopian health system\u0026rsquo;s response. Int J Gynecol Obstet. 2011;115:112\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSibai BM. Diagnosis, prevention, and management of eclampsia. Obstet Gynecol. 2005;105(2):402\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYancey LM, Withers E, Bakes K, Abbott J. Postpartum preeclampsia: emergency department presentation and management. J Emerg Med. 2011;40(4):380\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWinston AW, Norman D. Late postpartum eclampsia coincident with postdural puncture headache: a case report. AANA J. 2003;71(5):371\u0026ndash;2.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGraeber B, Vanderwal T, Stiller RJ, Werdmann MJ. Late postpartum eclampsia as an obstetric complication seen in the ED. Am J Emerg Med. 2005;23(2):168\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChaves C, Barros AJ, Matijasevich A, et al. Antenatal care and women's experience of mistreatment during childbirth: a population-based study in Brazil. BMC Pregnancy Childbirth. 2019;19(1):369.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBortolini M, Gubert MB, Santos TM, et al. Factors associated with irregular antenatal care in a municipality in the South of Brazil: a population-based study. Reprod Health. 2018;15(1):204.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDe Souza CM, Souza RAC, Almeida JA, et al. Maternal and fetal outcome after irregular antenatal care. J Pregnancy. 2017;2017:2484397.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSay L, Souza JP, Pattinson RC. Maternal near miss - towards a standard tool for monitoring quality of maternal health care. Best Pract Res Clin Obstet Gynaecol. 2009;23(3):287\u0026ndash;96.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSibai BM. Maternal-perinatal outcome in 254 consecutive cases. Am J Obstet Gynecol. 2019;163:1049\u0026ndash;55.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSibai BM. Diagnosis, prevention, and management of eclampsia. Obstet Gynecol. 2005;105:402\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSibai BM, Stella CL. Diagnosis and management of aypical preeclampsia-eclampsia. Am J Obstet Gynecol. 2019;200:e4811\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLubarsky SL, Barton JR, Friedman SA, Nasreddine S, Ramaddan MK, Sibai BM. Late postpartum eclampsia revisited. Obstet Gynecol. 2017;83:502\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMattar F, Sibai BM, Eclampsia VIII. Risk factor for maternal morbidity. Am J Obstet Gynecol. 2014;182:307\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-4243090/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4243090/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eAtypical presentation of preeclampsia and eclampsia refers to cases where symptoms may not follow the typical signs of high blood pressure and proteinuria rendering them difficult to diagnose leading to potential delays in treatment. Hence our aim was to study the atypical presentations of preeclampsia and eclampsia and their possible outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: The study was a descriptive cross-sectional hospital-based study conducted from November 2022 to April 2023 at Al Saudi Hospital in Khartoum, Sudan. The study focused on pregnant women with atypical presentations of preeclampsia and eclampsia. A total of 57 participants were included using a total coverage approach. Data was collected using a pre-designed close-ended questionnaire and analyzed using SPSS software and results were presented in tables and figures.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: A total of 57 patients were included. The majority (78.9%) were between 20 and 35 years old, and most of them (80.7%) resided in urban areas. In terms of education, 56.1% had completed secondary education. In terms of clinical characteristics, 49.1% of the patients received regular antenatal care, and 29.8% had irregular care. Family history of preeclampsia or eclampsia was present in only 8.8% of the participants. All participants (100%) recovered after delivery, with no reported deaths. Maternal complications included abruptio placentae (29.8%). The majority of infants (96.5%) were born alive and well, with few reported cases of preterm birth or birth asphyxia. Cesarean section was the most common mode of delivery (80.7%).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThe results of this study demonstrate positive maternal and fetal outcomes in the management of atypical preeclampsia and eclampsia cases at Al Saudi Hospital in Khartoum State, Sudan. The high rate of live births and low prevalence of preterm birth and birth asphyxia signify effective healthcare interventions. Further research addressing the risk factors, complications, and long-term consequences of atypical preeclampsia and eclampsia in the Sudanese population is warranted.\u003c/p\u003e","manuscriptTitle":"Complications and outcome of Atypical Preeclampsia, and Eclampsia, at Al Saudi Hospital, Sudan.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-25 15:51:12","doi":"10.21203/rs.3.rs-4243090/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-04-17T05:44:38+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-04-16T23:47:13+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-04-16T23:47:12+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pregnancy and Childbirth","date":"2024-04-09T15:52:09+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ce91391c-06fa-4c4d-8459-6fdf18476c7a","owner":[],"postedDate":"April 25th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-08T15:58:48+00:00","versionOfRecord":{"articleIdentity":"rs-4243090","link":"https://doi.org/10.1186/s12884-025-08484-1","journal":{"identity":"bmc-pregnancy-and-childbirth","isVorOnly":false,"title":"BMC Pregnancy and Childbirth"},"publishedOn":"2025-12-05 15:56:55","publishedOnDateReadable":"December 5th, 2025"},"versionCreatedAt":"2024-04-25 15:51:12","video":"","vorDoi":"10.1186/s12884-025-08484-1","vorDoiUrl":"https://doi.org/10.1186/s12884-025-08484-1","workflowStages":[]},"version":"v1","identity":"rs-4243090","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4243090","identity":"rs-4243090","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}