Outcomes of pregnancy in women with preeclampsia from the 26-week period of gestation at the National Referral Hospital: A Cross-Sectional Study

Outcomes of pregnancy in women with preeclampsia from the 26-week period of gestation at the National Referral Hospital: A Cross-Sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Outcomes of pregnancy in women with preeclampsia from the 26-week period of gestation at the National Referral Hospital: A Cross-Sectional Study Sonam Dechen, Tshering Wangden, Yeshey Dorjey, Sonam Chhoden R This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7013535/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : Preeclampsia is a multisystem progressive disorder characterized by new-onset hypertension and proteinuria or new-onset hypertension and significant end-organ dysfunction with or without proteinuria in the last half of pregnancy or postpartum. Preeclampsia is the major cause of perinatal and maternal morbidity and mortality. The prevalence of preeclampsia is greater in primigravida and nullipara, and disease progression depends on gestational age. Many studies have been conducted worldwide on various maternal and fetal outcomes associated with preeclampsia. Objective : The primary objective: · To assess the maternal and perinatal outcomes of pregnancies complicated with preeclampsia from the ³ 26-week period of gestation at the National Referral Hospital of Bhutan. The secondary objective: · To study the prevalence of preeclampsia at 26 weeks of gestation at the National Referral Hospital. · To determine the sociodemographic factors associated with preeclampsia. · To assess the maternal complications associated with preeclampsia. · To assess the fetal complications associated with preeclampsia. Methods : This was a cross-sectional study with a purposive sampling method conducted with preeclampsia women who were ³ 26 weeks of gestation at the National Referral Hospital of Bhutan. The data were extracted into a structured questionnaire, entered into an Excel sheet and analysed via IBM SPSS STATISTICS version 23. Ethics approval was obtained from the Institutional Review Board, and administrative approval was obtained from the Ministry of Health and Hospital Administration. The study period was from 18 th May 2024 until 18 th April 2025. Results : The prevalence of preeclampsia in singleton preeclamptic patients ³ during the 26-week period of gestation was 5.9% (113/1900). Thirty-six (32%) patients had early-onset preeclampsia, and 77 (68%) had late-onset preeclampsia. One hundred percent of the patients with PE had ANC booking. The majority of PE patients were primigravida or nullipara. Cesarean deliveries were significantly more common in early-onset PE patients than in late-onset PE patients (92% vs. 52%, p < 0.001). The number of mothers referred to the NICU was found to have clinical significance. A total of 38.9% (44/113) were found to have maternal morbidity, with no maternal mortality. Over 38% (43/113) of the patients with PE had preterm deliveries (<37 weeks of gestation). A total of 38% (42/110) of the babies required NICU care; among them, 2.7% (3/110) of the babies died. A total of 5.3% (6/113) of perinatal deaths occurred; 2 were antepartum fetal deaths, 1 baby showed signs of life after birth but was declared dead on postoperative day 0 prior to NICU admission, and 3 babies expired in the NICU. Preeclampsia was associated with perinatal mortality in 53 per 1000 liveborn neonates at the national referral hospital. NICU care was required for the majority of the newborns born to mothers with early-onset PE compared with those born to mothers with late-onset PE (87.9% vs 16.9%, p<0.001). Conclusions : The prevalence of preeclampsia was 5.9% in the study population. Preterm labour and acute kidney injury are the two main complications associated with preeclampsia. Cesarean delivery was significantly more common in patients with early-onset preeclampsia than in those with late-onset preeclampsia. Respiratory distress syndrome was detected in 30% of the patients, and the perinatal mortality rate was 5.6%. The number of perinatal deaths was significantly greater in patients with early-onset preeclampsia. Thus, preeclampsia is associated with significant morbidity and mortality, especially in early preeclampsia patients. Preeclampsia maternal morbidity and mortality neonatal morbidity and mortality Figures Figure 1 Figure 2 Figure 3 Figure 4 1. INTRODUCTION Preeclampsia is defined as a multisystem progressive disorder characterized by blood pressure ≥ 140/90 mm Hg or more on two occasions at least 4 hours apart after 20 weeks of gestation in a woman with a previously normal blood pressure or single episode of blood pressure ≥ 160/110 mm Hg, and in a patient with new-onset hypertension without proteinuria, the new onset of any of the following is diagnostic of preeclampsia ( 1 ): Platelet count below 100,000/µL Serum creatinine level above 1.1 mg/dL or doubling of the serum creatinine level in the absence of other renal diseases Liver transaminase levels at least twice the normal concentrations Pulmonary edema New-onset headache unresponsive to medication and not accounted for by alterative diagnosis or Visual symptoms Preeclampsia is globally associated with maternal complications such as cesarean section, eclampsia, abruption, pulmonary edema, hemolysis elevated liver enzymes low platelet (HELLP) syndrome, postpartum hemorrhage, anuria, disseminated intravascular coagulopathy (DIC) and cardiac failure ( 2 ). Some of the perinatal outcomes associated with preeclampsia are low birth weight, preterm birth, meconium-stained amniotic fluid (MSAF), acute respiratory distress syndrome (ARDS), neonatal intensive care unit (NICU) admission, stillbirth and intrauterine fetal death (IUFD). Among hypertensive disorders during pregnancy, 2–8% of complications are preeclampsia worldwide ( 3 ). Preeclampsia is found in 2–5% of multiparas ( 4 ) and 3–10% of nulliparas ( 5 ). Preeclampsia and eclampsia are significant risk factors for poor maternal and perinatal outcomes. Preeclampsia is associated with increased risks, such as maternal death, perinatal death and low birthweight. Preeclampsia is associated with a prevalence of 5–18% preterm birth and 15–20% low birth weight( 6 ). In one of the studies, 31.7% of the maternal complications, such as placental abruption, HELLP syndrome, and even maternal death, were reported. Preeclampsia was also associated with 19.5% preterm delivery ( 8 ). Preeclampsia is also associated with perinatal mortality of 42.6 per 1000 live births, with approximately 12.5% of neonates having a birth weight of less than 2.5 kg and 36.6% of neonates admitted to NICUs( 8 ). Significance of the study No studies have been performed at Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) or Bhutan concerning maternal and perinatal outcomes in pregnant women with preeclampsia. It is important to determine maternal and perinatal outcomes among Bhutanese women with preeclampsia who are delivering at JDWNRH. Hence, this study was undertaken to identify common maternal and perinatal outcomes in pregnant women with PE who were delivering at Jigme Dorji Wangchuck National Referral Hospital. 2. METHODOLOGY This was a cross-sectional study of pregnancies complicated by preeclampsia from 26 weeks of gestation delivered at Jigme Dorji Wangchuck National Referral Hospital between 18th May 2024 and 18th April 2025. Bhutan is a lower middle-income country in Southeast Asia at the eastern end of the Himalayas bordering north China and south, east and west India. Bhutan occupies an area of 38,394 km 2, with an estimated population of 777,224 in 2024 (National Statistical Bureau). Bhutan has 55 hospitals, including the National Traditional Medicine Hospital, 187 primary health centers, 51 subposts and 555 outreach clinics, as per the annual health bulletin of 2024. Women with obstetric complications can access and be referred to specialist services at the three tertiary hospitals in Thimphu, Mongar and Gelephug and other emergency maternal and obstetric centers in Samtse, Phuntsholing, Tsirang, Samdrupjongkhar, Lungtenphu military, Dewathang military and Trashigang hospitals, where emergency and elective caesarean section services are provided. This cross-sectional study was conducted in the maternity ward and birthing unit of the Department of Obstetrics and Gynecology, JDWNRH, the tertiary referral hospital of Bhutan. The study included all singleton pregnant women with preeclampsia for more than 26 weeks admitted to the maternity ward and birthing center of JDWNRH for delivery. The 26-week period of gestation was based on the criteria for minimal gestational age for admission to the neonatal intensive care unit in JDWNRH. The study was carried out over a period of eleven months between 18th May 2024 and 18th April 2025. The purposive sampling method was used to collect the samples in this study. All pregnant women with preeclampsia admitted to the maternity ward and those at the birthing unit for delivery who fulfilled the inclusion criteria were included. The women in the study were followed up until birth, and the neonates were followed up until perinatal day 07. Inclusion criteria : All singleton pregnancies were performed. Period of gestation: 26 weeks and above. A woman who was diagnosed with preeclampsia and who came to our hospital at delivery was included. Exclusion criteria : All pregnant women with preeclampsia were younger than 25 weeks at 6 days of gestation. All pregnant women with preeclampsia were less than 18 years of age. All patients had preeclampsia with a twin pregnancy. All pregnant women had gestational hypertensive disorders or chronic hypertension. All pregnant women had chronic hypertension with superimposed PE. Administrative clearance was sought from the Jigme Dorji Wangchuck National Referral Hospital and the Policy and Planning Division, Ministry of Health, Thimphu, Bhutan. The ethical clearance was approved by the Institutional Review Board (Reference no. IRB/Approval/PN/2023-027/1192) dated 26th April 2024, KGUMSB, Thimphu, Bhutan in accordance with the declaration of Helsinki. The funding for this thesis research was provided by Royal Bhutan Army, Thimphu, Bhutan. The clinical trial number was not applicable for this research. Study participants were given complete autonomy to participate in this study, with the freedom to discontinue participation at any time during the study period, without coercion. The participants were informed that their care would not be affected irrespective of their participation status, as their management would be per the standard operating procedure of the Department of Obstetrics and Gynecology, JDWNRH. The participants were informed about the study procedure, and the information sheet and consent form were read in the language they understood. Data collection was initiated after written informed consent was obtained. Privacy was ensured by not using the names of the participants in the questionnaire. The participants were identified by their citizenship identity card number and contact number to keep track of them during hospital admission, data entry, data analysis and follow-up. Confidentiality was maintained by keeping the data collection forms securely in a lockable cabinet, and the electronic data file was kept in a password-protected computer accessible only to the principal investigator. The citizenship identity card number and the contact number were confidently maintained and were used only for follow-up purposes. Data sets will be maintained securely for five years after the completion of the study. The participants were made aware of their rights to discontinue study participation at any point. Their medical care and management and psychological support were not compromised in this study. The participants were informed that their data would not be used for analysis if they discontinued their participation in this study. Data collection : The data were collected by the principal investigator and intern medical doctors. The interns were briefed on the objectives of this study and trained on the data collection procedures. Participants fulfilling the inclusion criteria who came to deliver at the national referral hospital were identified and invited to participate in the study. Human ethics and consent to participate declarations were taken from the participants in the presence of a witness using the structured designed Pro-forma made for this study, and the data collected were transferred into an Excel sheet. Some of the socioclinico-demographic details and antenatal records were retrieved via antenatal care cards, maternity wards, birth records, and direct interviews. The data were collected anytime the patients were admitted with preeclampsia, and the final participants were those who delivered at JDWNRH. The period of gestation (POG) was calculated on the basis of the reliable last normal monthly period (LMP), which is consistent with early ultrasound dating within 7 days. If the difference between LMP and ultrasound dating was more than 7 days, the ultrasound date was considered for POG determination. The diagnosis of PE was made on the basis of the fulfilment of the criteria of ACOG practice bulletin number 222, in accordance with international and hospital protocols. The participants’ treatment and investigations were managed as per the standard operating protocol of the national referral hospital. The timing of delivery was determined by the combined management of the senior oncall consultant and the maternal fetal medicine specialist. The decision regarding the mode of delivery was made by the emergency obstetrician on duty as per standard and hospital protocols. The APGAR score was measured at 5 minutes from the time of birth. The baby was weighed after 90 minutes of Kangaroo Mother Care in the standard weighing machine ‘TANITA’ by the nurses. Data on the APGAR score and birthweight were collected from the neonatal discharge summary sheet. The mothers and the baby were followed up on day 7 with those still admitted and via telephone conversations with those who were discharged. The data collected were reviewed monthly or whenever needed. Data collection tool : A structurally designed pro-forma was used, which consisted of four sections: 1- sociodemographic profile, 2- obstetric/clinical profile, 3- maternal outcome and 4- perinatal outcome. The first section of the questionnaire focused on sociodemographic data, including age, education status and current occupation. The second section of the questionnaire focused on the following obstetric/clinical profile: ANC booking, total number of ANC visits, gravidity, blood pressure at the time of diagnosis, POG at the time of diagnosis, urine protein status, medical comorbidities, POG at the time of delivery and birth weight of the babies born. The third section on maternal outcomes included the mode of delivery, postpartum hemorrhage, heart failure/cardiomyopathy, oliguria (AKI), abruptio, DIC, cortical blindness, HELLP syndrome and maternal mortality. The fourth section on the perinatal outcome focused on antepartum fetal demise/livebirth/intrapartum stillbirth, preterm birth, low birth weight, APGAR within 5 minutes, meconium-stained amniotic fluid, neonatal respiratory distress syndrome, NICU admission and perinatal status on day 7. Data confidentiality All data collected from patients were securely stored on a password-protected computer with access only to the principal investigator. Names and citizenship identity cards were used only for correlation and to avoid double entry. Electronic data were kept in a confidential file accessible to the principal investigator. Hard copy data collection forms were secured in a lockable cabinet. All the provided and electronic data files will be stored for 5 years, after which they will be discarded. The results and findings were presented to relevant forums without personal identifiers. Statistical analysis The data were reviewed, edited and double entered into a password-protected personal computer in an Excel spreadsheet and analysed via IBM SPSS (version 23). Frequencies and percentages were used for descriptive analysis. Descriptive statistics were computed for all variables according to type, frequency, mean and standard deviation for continuous variables, and the categorical variables were computed via simple frequency tables. The crude odds ratio, adjusted odds ratio and 95% confidence interval (CI) for each variable of interest were calculated. Chi-square tests and Fisher’s exact tests were performed for categorical variables to compare outcomes between the groups; a p value < 0.05 was considered to indicate statistical significance. Statistical tests were performed to estimate the odds ratios (ORs) of maternal and perinatal outcomes. The overall and specific complications are presented as frequencies and percentages. Declaration of Interests : The principal investigator, supervisor and cosupervisor had no conflicts of interest, financial or otherwise, for the overall study or study site. 3. RESULTS Study sample population During the study period between 18 th May 2024 and 18 th April 2025, the national referral hospital of Bhutan had 1900 deliveries. Among these, 113 fulfilled the inclusion criteria and consented to participate in this study. The prevalence of PE was 5.9% (113/1900). Among the 113 singleton preeclamptic patients, 32% (36/113) had early-onset preeclampsia, and over 68% (77/113) had late-onset preeclampsia. The details are shown in Figure 1. Sociodemographic characteristics Among the 113 preeclamptic patients, 50.4% (57/113) were between the ages of 21 and 30. The median age was 30 years. A total of 66.4% (75/113) had attained higher education or higher, and more than 47% were housewives. Additionally, 44 (40%) of the patients were referred from other hospitals in Bhutan. The sociodemographic details are provided in Table 1. Table 1 : Sociodemographic characteristics of patients with preeclampsia managed at the national referral hospital of Bhutan (n=113) Variables Total, n=113(%) Early onset PE, n=36(%) Late onset PE, n=77(%) P value Age (years) 18-20 3 (2.7) 1 (2.8) 2 (2.6) 0.681 21-30 57 (50.4) 16 (44.4) 41 (53.2) >30 53 (46.9) 19 (52.8) 34 (44.2) Education Illiterate 12 (10.6) 2 (5.5) 10 (13.0) 0.587 Primary 2 (1.8) 1 (2.8) 1 (1.3) Secondary 24 (21.2) 9 (25.0) 15 (19.5) Higher and above 75 (66.4) 24 (66.7) 51 (66.2) Occupation Housewives 54 (47.8) 18 (50.0) 36 (46.8) 0.846 Business 26 (23.0) 9 (25.0) 17 (22.0) Civil servant 23 (20.4) 7 (19.4) 16 (20.8) Private 10 (8.8) 2 (5.6) 8 (10.4) Referred in No 68 (60.2) 22 (61.1) 46 (59.7) 0.529 Yes 45 (39.8) 14 (38.9) 31 (40.3) Obstetric characteristics As shown in Table 2, 100% of the patients with PE had ANC booking. However, only over 81% (92/113) had attended 4–8 ANC visits. Compared with patients with late-onset preeclampsia, those with early-onset preeclampsia had significantly fewer ANC visits (<4 visits) (36% vs 5%, p<0.001). The majority of PE patients were primigravida or nullipara. Table 2 : Obstetric characteristics of patients with preeclampsia at the national referral hospital of Bhutan (n=113) Variables Total, n=113(%) Early onset, n=36(%) Late onset, n=77(%) P value ANC booking Yes 113 (100.0) 36 (100.0) 77 (100.0) - No 0.0% 0.0% 0.0% Total ANC visits <4 visits 17 (15.0) 13 (36.1) 4 (5.2) 8 visits 4 (3.5) 0 4 (5.2) Gravidity Primigravida 65 (57.5) 19 (52.8) 46 (59.7) 0.310 Multigravida 48 (42.5) 17 (47.2) 31 (40.3) Parity Nullipara 70 (63.3) 21 (60.0) 49 (64.9) 0.849 Primipara 18 (16.5) 6 (17.1) 12 (16.2) Multipara 25 (20.2) 9 (25) 16 (20.8) ANC: antenatal care; POG*: period of gestation at diagnosis Blood pressure Overall, systolic blood pressure greater than 160 mmHg was recorded in 26.5% (30/113) of the patients, whereas diastolic blood pressure was in the severe range in 21.2% (24/113) of the patients. The diastolic mean pressure was significantly greater in early-onset PE than in late-onset PE. Urine albumin was positive in more than 71% (81/113) of the patients. The details are presented in Table 3. Table 3 : Blood pressure levels and presence of urine albumin status in patients with preeclampsia at the national referral hospital of Bhutan (n=113) Variables Total, n=113(%) Early onset, n=36(%) Late onset, n=77(%) P value sBP BP<160 83 (73.5) 24 (66.7) 59 (76.6) 0.187 BP≥160 30 (26.5) 12 (33.3) 18 (23.4) sBP mean ± SD 153.4 ± 13.5 148.3 ± 14.9 0.067 dBP <110 mmHg 89 (78.8) 25 (69.4) 64 (83.1) 0.081 ≥110 mmHg 24 (21.2) 11 (30.6) 13 (16.9) dBP mean ± SD 104.8 ± 15.1 98.8 ± 9.4 0.011 Presence of urine albumin Yes 81 (71.7) 30 (83.3) 51 (66.2) 0.046 No 32 (28.3) 6 (16.7) 26 (33.8) BP: blood pressure; dBP: diastolic blood pressure; sBP: systolic blood pressure; SD: Standard deviation Both the mean systolic and diastolic BP were greater in early-onset PE patients than in late-onset PE patients (Figure 2). Comorbidities Among the 113 patients, 11% (12/113) were either overweight or obese, and we detected frequent urinary tract infections (8%) and anaemia (5.3%). The details are shown in Table 4. Table 4 : Medical comorbidities present in the patients with preeclampsia at the national referral hospital of Bhutan (n=113) Comorbidities Frequency (n) Percent (%) Gestational diabetes 1 0.9 Heart disease 1 0.9 Urinary tract infection 9 8.0 Anemia 6 5.3 Overweight or obese 12 10.6 Intrahepatic cholestasis of pregnancy 3 2.7 Depression 1 0.9 Systemic Lupus Erythematosus 2 1.8 Hepatitis 1 0.9 Thyroid disorders 2 1.8 Rheumatoid arthritis 1 0.9 Modes of delivery Compared with patients with vaginal deliveries, the majority of patients with PE underwent cesarean deliveries. Cesarean deliveries were significantly more common in early-onset PE patients than in late-onset PE patients (91.7% vs. 51.9%, p < 0.001). Cesarean section was performed on an emergency basis in 78.1% (57/113) of the patients. The details are provided in Table 5. Table 5 : Modes of delivery in patients with preeclampsia at the national referral hospital of Bhutan (n=113) Variables Total Early onset Late onset P value Modes of delivery Vaginal 40 (35.4) 3 (8.3) 37 (48.1) <0.001 Cesarean 73 (64.6) 33 (91.7) 40 (51.9) Cesarean section type Emergency 57 (78.1) 29 (87.9) 28 (70.0) 0.058 Elective 16 (21.9) 4 (12.1) 12 (30.0) Types of vaginal delivery Spontaneous vaginal delivery 18 (45.0) 2 (66.7) 16 (43.3) 0.698 Induced vaginal delivery 19 (47.5) 1 (33.3) 18 (48.6) Assisted vaginal delivery 3 (7.5) 0 3 (8.1) Indications for cesarean delivery As shown in multiple response Table 6, caesarean sections were performed for foetal distress in 47.9% (35/73), foetal growth restriction in 30.1% (22/73), severe preeclampsia in 30.1% (22/73) and prior caesarean sections in 13.7% (10/73). Table 6 : Indications for cesarean delivery in patients with preeclampsia at the national referral hospital of Bhutan (n=73) Indications for cesarean delivery* Frequency n Percent (%) Fetal distress 35 47.9 Severe preeclampsia 22 30.1 Fetal growth restriction 22 30.1 Prior cesarean section 10 13.7 Failed induction 9 12.3 Acute kidney injury 4 5.5 Fetal macrosomia 4 5.5 Prolong labor 2 2.7 Oligohydramnios 5 6.8 Malpresentation 3 4.1 Abruptio placenta 1 1.4 * Some of the patients had more than one indication for a cesarean section Maternal outcomes Approximately three-quarters of patients with PE develop acute kidney injury, followed by postpartum hemorrhage, abruption, HELLP syndrome and cortical blindness. A total of 38.9% (44/113) of preeclamptic mothers were found to have maternal morbidity, with no maternal mortality. The details are provided in Table 7. Table 7 : Maternal outcomes of patients with preeclampsia Maternal outcomes Total, n=113(%) Early onset, n=36(%) Late onset, n=77(%) Postpartum hemorrhage 7 (6.2) 2 (5.6) 5 (6.5) Acute kidney injury 27 (23.9) 16 (44.4) 11 (14.3) Abruptio placenta 6 (5.3) 5 (13.9) 1 (1.3) HELLP syndrome Cortical blindness Heart failure DIC 2 (1.8) 2 (1.8) 0 0 1(2.8) 2 (5.6) 0 0 1 (1.3) 0 0 0 Maternal mortality 0 0 0 HELLP: hemolysis, elevated liver enzymes, low platelet levels; DIC: disseminated intravascular coagulation Perinatal outcomes Thirty-eight percent (43/113) of patients had preterm deliveries (<37 weeks of gestation), with 18% (20/113) having low birth weights. Preterm deliveries occurred more frequently in early-onset PE than in late-onset PE (p7 points). Approximately 30% (33/111) of the babies developed RDS, and meconium was present in more than 23% of the babies. Among the 5.3% (6/113) of perinatal deaths, 1.8% (2/113) were antepartum fetal deaths, and over 38% (42/111) of the babies required NICU care; among them, 2.7% (3/110) of the babies expired, and 3 babies never reached the NICU. One baby had expired on postoperative day 0 before NICU admission, and 2 had antenatal fetal deaths. NICU care was required for the majority of the newborns with early-onset PE compared with those with late-onset PE (87.9% vs 16.9%, p<0.001). Additional details are shown in Table 8 and Table 9. Table 8 : Perinatal outcomes of patients with preeclampsia at the national referral hospital Perinatal outcome Total, N=113(%) Early onset, n=36(%) Late onset, n-77(%) P value POG at delivery (weeks) <37 43 (38.1) 33 (91.7) 10 (13.0) <0.001 37 and above 70 (61.9) 3 (8.3) 67 (87.0) Newborn outcome Alive* 111 (98.2) 34 (94.4) 77 (100.0) 0.037 IUFD 2 (1.8) 2 (5.6) 0 Birth weight (grams) <1000 11 (9.7) 11 (30.6) 0 2500 57 (50.4) 4 (11.1) 53 (68.8) Apgar score at 5 minutes ≥7 90 (81.1) 19 (55.9) 71 (92.2) <0.001 <7 21 (18.9) 15 (44.1) 6 (7.8) Acute RDS Yes 33 (29.7) 24 (70.6) 9 (11.7) <0.001 No 78 (70.3) 10 (29.4) 68 (88.3) Meconium present Yes 26 (23.4) 5 (14.7) 21 (27.3) 0.088 No 85 (76.6) 29 (85.3) 56 (72.7) NICU admission Yes 42 (37.8) 29 (85.3) 13 (16.9) <0.001 No 69 (62.2) 5 (14.7) 64 (83.1) Baby status on day 7 of delivery Alive 107 (96.4) 30 (88.2) 77 (100.0) 0.002 Death* 4 (3.6) 4 (11.8) 0 IUFD: Intrauterine antepartum fetal death; POG: period of gestation; RDS: respiratory distress syndrome; NICU: neonatal intensive care unit *2 antepartum fetal death, 1 neonatal death prior to NICU admission Table 9 : Details of perinatal fetal death due to preeclampsia. Serial number Referred/not referred POG at delivery Body weight (gm) Remarks 01 Not referred 27 weeks 4 days 820 Death in D4, impending HELLP 02 Referred 33 weeks 3 days 1550 IUFD 03 Not referred 29 weeks 2 days 150 IUFD 04 Referred 27 weeks 3 days 610 Death in D2 , impending HELLP 05 Referred 27 weeks 5 days 720 Death in D4, cortical blindness 06 Not referred 30 weeks 5 day 895 Death in D0, not shifted to NICU, impending eclampsia with cortical blindness Period of gestation at diagnosis and delivery The median gestational age at the time of PE diagnosis and delivery was significantly greater in the late-onset PE group than in the early-onset PE group (Figure 3). Factors associated with poor perinatal outcomes The Apgar score assessed at 5 minutes after delivery was used to determine perinatal outcomes and was considered an independent variable. Newborns with an abnormal Apgar score (<7) were classified as having poor perinatal outcomes, whereas those with a score ≥7 were classified as having good perinatal outcomes. Multiple dependent variables were analysed via multivariable logistic regression to identify factors associated with poor perinatal outcomes. Patients referred to the national referral hospital from peripheral hospitals were 6.6 times more likely to experience unfavourable perinatal outcomes (aOR 6.6, 95% CI 1.0–42.13; p=0.047). The number of mothers referred to the NICU was found to have clinical significance (45/113). Among the factors associated with poor outcomes, early-onset preeclampsia (PE), gravida status, fewer antenatal care (ANC) visits than recommended (160 mmHg, a diastolic blood pressure >110 mmHg, and cesarean delivery were associated with an increased likelihood of unfavourable perinatal outcomes. However, the association was not statistically significant (p>0.05). Additional details are provided in Table 10. Table 10 : Factors associated with poor perinatal outcomes at the national referral hospital Factors cOR (95%CI) P value aOR (95%CI) P value Early onset PE 0.1 (0.04 - 0.31) 0.001 1.4 (0.15 - 13.55) 0.756 Age 1.0 (0.91 - 1.06) 0.608 1.0 (0.86 - 1.20) 0.860 Gravida 1.2 (0.77 - 1.88) 0.414 3.2 (0.22 - 45.84) 0.394 Para 1.2 (0.74 - 2.04) 0.424 0.4 (0.02 -10.18) 0.611 ANC visits < 8 6.8 (0.86 - 53.53) 0.069 1.7 (0.08 - 34.01) 0.742 Medical comorbidities 0.7 (0.25 - 1.73) 0.400 0.7 (0.11 - 3.93) 0.635 Urine albumin 0.9 (0.32 - 2.60) 0.868 7.9 (0.83 - 75.51) 0.073 sBP≥160 0.9 (0.29 - 2.48) 0.783 3.2 (0.24 - 42.16) 0.375 sBP≥110 0.6 (0.20 - 1.80) 0.371 1.7 (0.15 - 20.45) 0.665 Cesarean delivery 3.1 (0.96 - 9.90) 0.058 1.9 (0.30 - 12.95) 0.476 Meconium-stained amniotic fluid 1.4 (0.41 - 4.49) 0.610 0.9 (0.14 - 6.14) 0.925 ANC: antenatal care; aOR: adjusted odds ratio; cOR: crude odds ratio; PE: preeclampsia; RDS: respiratory distress syndrome Correlation between systolic BP and birth weight A correlation was analysed between the systolic BP and birth weight of newborns via Pearson’s correlation coefficient. There was a significant negative correlation between systolic BP and the birth weight of babies (r = -0.2, p = 0.020), as shown in Figure 4. 4. DISCUSSION AND CONCLUSIONS During my study period at Jigme Dorji Wangchuck National Referral Hospital, there were a total of 1900 deliveries, of which 1787 pregnant women were excluded. A total of 113 samples were collected from patients who fulfilled the inclusion criteria during the study period. The prevalence of preeclampsia was 5.9% of the total deliveries conducted during the study period. This may be due to good ANC visits in the capital city of Bhutan and the good quality of care provided at the national referral hospital. Our prevalence is comparable to findings from a study in India by Vaibhav Shandilya et al. (6.2%, 31/500)(09) but lower than the prevalence reported in Bangladesh (9.9%, 11/111)(10). This may be because compared with the study group in Bangladesh, the pregnant women in this study were seeking medical help on time and had good medical compliance. In this study, approximately 50.4% of patients were between the ages of 21 and 30 years, while the majority were found to have late-onset preeclampsia (53.2%, 41/113) rather than early-onset preeclampsia (44.4%, 16/113). The median age was 30 years. A study conducted in a tertiary care center by Rajalakshmi Subburam et al. in Chennai, India, reported that the majority of preeclampsia cases in 80% of the population were 21--30 years old, and 60% were primigravida (11). This may be because of the larger sample size of 113 patients in this study than of 65 patients. Two-thirds (66.4%, 75/113) had attained higher education or higher in this study; however, more than 47% (75/113) were housewives, which is similar to the 52.3% of patients who were housewives reported in the study of Bisman Khan et al. (12). This study revealed that the majority of the pregnant women visiting the national referral hospital were educated housewives (66.4% (75/113)), with our baseline literacy rate being 72.1% according to the national survey for the year 2022 in the Bhutan literacy rate. Businesses such as online-based home businesses were not accepted as part of the occupation by the participants. There is no domestic care support that they choose to remain unemployed. Additionally, approximately 40% (45/113) of the patients had been referred from other hospitals in Bhutan. The number of mothers referred for NICU care shows the clinical significance of perinatal outcomes. This finding shows that the delivery center for high-risk patients is the national referral hospital. The ANC care provided is efficient in detecting preeclampsia, thus providing better quality healthcare. With all preeclampsia women having 100% ANC booking, only approximately 81% had attended 4–8 ANC visits. This may be due to free health care access to the Bhutanese population. Compared with patients with late-onset PE, significantly more patients with early-onset PE had fewer ANC visits (<4 visits) (36% vs 5%, p<0.001). This may be because pregnant women with preeclampsia are admitted to the ward and monitored for PE symptoms and fetal monitoring via Doppler. This could subsequently result in termination of pregnancy in cases of severe preeclampsia, fetal distress and abnormal Doppler findings. Hence, this explains the lower number of ANC visits during early-onset PE. With 100% ANC booking, zero maternal morbidity and mortality can also be attributed to early intervention before the disease progresses. The majority of PE patients were primigravida (18%) or nullipara (70%), and there was no difference between early-onset and late-onset PE. Late-onset preeclampsia was more common in primigravida individuals (59.7%, 46/77) than in multigravida individuals (40.3%, 31/77). According to a study by Pooja Wadhwani et al. in India in primigravida, 55.3% of patients had late-onset preeclampsia, whereas 42.7% had early-onset preeclampsia (13). These findings indicate that nullipara, primigravida and young age groups are at risk for developing late-onset preeclampsia. Systolic blood pressure was in the severe range (sBP ³ 160 mmHg) in approximately one quarter of the patients (26.5%, 30/113), whereas diastolic blood pressure (dBP³110 mmHG) was in the severe range in approximately one-fifth of them (21.2%, 24/113). The diastolic mean pressure was significantly greater in early-onset PE than in late-onset PE. This may be affected by the use of antihypertensive medicines during the detection and transition of gestational hypertension to preeclampsia. Among the 113 patients with PE, more than 11% (12/113) were either overweight or obese, followed by those with urinary tract infection (8%, 9/113) and anaemia (5.3%, 6/113). This finding is similar to the findings of a study by James M Roberts et al., who reported a 3-fold increased risk of developing PE in obese women who became pregnant (14). This may be due to the lack of awareness about the implications of obesity during pregnancy, as they do not seek preconception care. Pregnant women should be aware of the increased risk of PE in obese individuals, as this is a modifiable risk factor that could be prevented. Similarly, a meta-analysis revealed that pregnant women with UTIs have a 1.31 (95% CI: 1.22–1.40) increased risk (RR) of developing PE (15). Urine albumin was positive in more than 71% of the patients. Many cases of asymptomatic bacteriuria are unnoticed during pregnancy, which leads to the development of PE. With respect to UTIs, even asymptomatic bacteriuria must be treated during pregnancy to prevent the risk of PE. In Bhutan, we do not practice screening for asymptomatic bacteriuria. The prevalence of anaemia during pregnancy in Bhutan according to UNICEF records is 27.3%. Hence, 5.3% of anaemia cases are associated with PE. The presence of anaemia during pregnancy is a risk factor for PE, which may be due to poor compliance with iron supplements by patients and may be due to side effects associated with nausea and/or the use of iron supplements with dairy products. This requires further studies. Compared with patients with vaginal deliveries, the majority of patients with PE underwent cesarean deliveries. Cesarean deliveries were significantly more common in early-onset PE patients than in late-onset PE patients (91.7% vs. 51.9%, p < 0.001). Additionally, most cesarean procedures were performed on an emergency basis (78.1%, 57/113). Smita Dubey et al., Kritpol Pasolpuckdee et al. and Gautam SK et al. reported 15.4%, 51.2% and 54% cesarean rates of preeclampsia, respectively (16,17,18). In the majority of cases, cesarean sections in preeclampsia (PE) patients were performed for fetal distress, followed by fetal growth restriction, severe preeclampsia and prior cesarean sections. This explains the zero data on intrapartum stillbirth. Early intervention is made in the timing and mode of delivery as a result of early recognition of suspicion of fetal distress in CTG. However, there was a perinatal rate of 53 per 1000 livebirths in this study. Similarly, Minal A. Kalambe et al reported that the majority of cesarean sections were affected by fetal distress (19.15%) in patients with preeclampsia (19). The use of cardiotocography, Doppler for foetal monitoring and the quality of intrapartum monitoring may have contributed to the increased rate of emergency caesarean delivery. Approximately three-quarters of patients with PE develop acute kidney injury followed by postpartum hemorrhage, abruption, HELLP and cortical blindness. A total of 38.9% (44/113) of preeclamptic mothers were found to have maternal morbidity, with no maternal mortality. However, in the study by Subrat Panda et al., 7.4% of the patients experienced abruption, 5.7% of the patients experienced postpartum hemorrhage, and 0.7% of the patients experienced ARF (20). This may be due to close monitoring of the blood parameters in the ward. Hence, early detection of PE-related complications, such as acute kidney injury, is needed. The rate of abruption may be lower in my study because of early intervention in the timing of delivery, and with respect to PPH, it may either be unrecognized or be due to active management of the third stage of labor. This explains the lack of maternal mortality due to preeclampsia. Compared with the Thangappah Radha Bai Prabhu study(21), which reported 0.17% (16/9199) cortical blindness, cortical blindness was found in 1.8% of the participants in this study. It is a transient loss of vision that can be treated with termination of pregnancy. In this study, approximately 38% (43/113) of the patients with PE had preterm deliveries, with approximately 18% (20/113) having low birth weights. Preterm deliveries were significantly more common in early-onset PE than in late-onset PE (p7 points). Many perinatal outcomes were recorded, and 30% of the babies developed RDS, more than 23% had meconium, and over 38% (42/111) of the babies required NICU care; among them, 2.7% (3/110) of the babies had expired and were under NICU care. Among the 5.3% (6/113) perinatal deaths, 2 were antepartum fetal deaths, 1 baby died prior to NICU admission, and 3 died in the NICU. NICU care was required for the majority of the newborns with early-onset PE compared with those with late-onset PE (87.9% vs 16.9%, p<0.001). This explains early intervention during the close monitoring of the PE symptoms of the mother and the Doppler profile of the foetus that has led to preterm deliveries with low birth weight and 98% survival of the baby. Strengths of the study As this is a tertiary care hospital, the majority of severe preeclampsia cases are referred to here. There was 100% follow-up performed on perinatal day 7. This study provides baseline data on the maternal and perinatal outcomes of preeclampsia. Limitations of the study The study sample was calculated for a year with no previous published records on the incidence of PE in the national referral hospital. The study sample size could not be accomplished due to several factors, such as, as mentioned earlier, the duration of the study period for sample collection being eleven months in total. The total number of deliveries decreased over the year. The study sample size was small. This study was hospital-based at Thimphu National Hospital, and the results are not representative of the entire Bhutanese population. Conclusion of the study The prevalence of preeclampsia was 5.9% in the study population. Preterm labour and acute kidney injury are the two main complications associated with preeclampsia. Cesarean delivery was significantly more common in patients with early-onset preeclampsia than in those with late-onset preeclampsia. Respiratory distress syndrome was detected in 30% of the patients, and the perinatal mortality rate was 5.6%. The number of perinatal deaths was significantly greater in patients with early-onset preeclampsia. Thus, preeclampsia is associated with significant morbidity and mortality, especially in early preeclampsia patients. General recommendations On the basis of the findings of the study, I would like to recommend the following: Initiation of aspirin in primigravida and nulliparous individuals irrespective of risk factors. Strengthening of NICU care at the national referral hospital. Initiation of treatment for asymptomatic bacteriuria during pregnancy. Strengthening of preconception care. Declarations Ethical approval and consent to participate Ethical approval was obtained from the Institute Research Board, Thimphu, Bhutan. Consent to participate was obtained from the patients. Consent for publication Written informed consent was obtained from the patients for use in this study. Availability of data and materials Availability of data and materials are available from the corresponding author on reasonable request. Competing interest The author(s) declare(s) no conflicts of interest with respect to the research, authorship, and/or publication of this article. Funding The author received no financial support for the publication of this article. Author contributions 1 st author SD: Conceptualized and wrote the manuscript, interpreted the data, and was involved in data collection and interpretation. 2 nd author TW: Conceptualized the manuscript and interpreted the data. 3 rd author YD: Analysed and interpreted the data. 4 th author SCR: Conceptualized the manuscript and interpreted the data. All the authors read and approved the final manuscript. Acknowledgements Deepest gratitude to the Department of Obstetrics and gynecology, Jigme Dorji Wangchuck National Referral Hospital, Faculty of Postgraduate Medicine, Interim Institutional Review Board (I-IRB), Dr. Sanagy Tshering, Associate Professor, Obstetrics and Gynecology, Dr. Thinley Dorji, Medical Specialist, interns who helped in the process of thesis completion. References Espinoza J, Vidaeff A, Pettker CM, Simhan H. ACOG practice bulletin Clinical Management Guidelines for Obstetrician-Gynecologists. 2020;135, No.6:2–3. Ma’ayeh M, Costantine MM. Prevention of preeclampsia. Semin Fetal Neonatal Med. 2020;25(5). Magee LA, Nicolaides KH, Von Dadelszen P, Preeclampsia. N Engl J Med. 2022;386(19):1817–32. Jim B, Karumanchi SA, Preeclampsia. Pathogenesis, Prevention, and Long-Term Complications. Semin Nephrol. 2017;37(4):386–97. Wójtowicz A, Zembala-Szczerba M, Babczyk D, Kołodziejczyk-Pietruszka M, Lewaczyńska O, Huras H. Early- and Late-Onset Preeclampsia: A Comprehensive Cohort Study of Laboratory and Clinical Findings according to the New ISHHP Criteria. Int J Hypertens. 2019;2019(1):1–9. BilanoVL, Ota E, Ganchimeg T, Mori R, Souza JP. Risk Factors of Pre-Eclampsia/Eclampsia and Its Adverse Outcomes in Low- and Middle-Income Countries: A WHO Secondary Analysis.Young RC. editor PLos One. 2014;9(3):e91198. Burton GJ, Redman CW, Roberts JM, Moffett A. Preeclampsia: pathophysiology and clinical implications. BMJ. 2019;366(366):12381. Chang KJ, Seow KM, Chen KH, Preeclampsia. Recent Advances in predicting, preventing, and managing the maternal and fetal life-threatening condition. Int J Environ Res Public Health. 2023;20(4):2994. Vaibhav Shandilya, Sinha N, Rani S, Preeclampsia. Prevalence, Risk Factors, and Impact on Mother and Fetus. Int J Cardiovasc Dis Women. 2023;8(3):193–9. Mou AD, Barman Z, Hasan M, Miah R, Hafsa JM, Das Trisha A et al. Prevalence of preeclampsia and the associated risk factors among pregnant women in Bangladesh. Sci Rep 2021;11(1). Rajalakshmi Subburam, Sharma N, Nimrah A. Insights into feto maternal outcomes in preeclampsia: A tertiary care center descriptive study. IJOGR. 2024;11(4):652–6. Khan B, Yar RA, Khakwani A, khan, Karim S, Ali HA. Preeclampsia incidence and its maternal and neonatal outcomes with associated risk factors. Cureus. 2022;14(11). Wadhwani P, Saha PK, Kalra JK, Gainder S, Sundaram V. A study to compare maternal and perinatal outcome in early vs. late onset preeclampsia. Obstet Gynecol Sci. 2020;63(3):270–7. Roberts JM, Bodnar LM, Patrick TE, Powers RW. The Role of Obesity in Preeclampsia. Pregnancy Hypertension: Int J Women’s Cardiovas Health. 2011;1(1):6–16. Yan L, Jin Y, Hang H, Yan B. The association between urinary tract infection during pregnancy and preeclampsia: A meta-analysis. Medicine. 2018;97(36):e12192. Dubey S, Sarkar R, Aditya V, Singh R, Dubey VK, Chauhan M. The outcome of preterm births in pregnant women with hypertensive disorders: an observational study. Int J Reprod Contracept Obstet Gynecol. 2023;12(10):3128–33. Pasokpuckdee K, Dittakarn Boriboonhirunsarn. Incidence of Preeclampsia and Cesarean Section Rate According to the Robson Classification. Cureus. 2023. Gautam SK, Paudel K. Management and Outcome of Preeclampsia/Eclampsia among patient admitted in maternity ward in tertiary hospital. JIOM Nepal. 2013;35(2):30–7. Kalambe MA, Soni NN, Ali S, Bankar NJ. An Observational Study of Maternal and Perinatal Outcome in Preeclampsia Cases in a Tertiary Care Center. Cureus. 2024;16(4):e59352. Panda S, Das R, Sharma N, Das A, Deb P, Singh K. Maternal and Perinatal Outcomes in Hypertensive Disorders of Pregnancy and Factors Influencing It: A Prospective Hospital-Based Study in Northeast India. Cureus. 2021. Radha Bai Prabhu T. Serious Visual (Ocular) Complications in Preeclampsia and Eclampsia. J Obstet Gynaecol India. 2017;67(5):343–8. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted 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. We do this by developing innovative software and high quality services for the global research community. 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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-7013535","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":495643720,"identity":"bf4dd324-4e67-48d0-8cc9-1bbcc09be91e","order_by":0,"name":"Sonam Dechen","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABE0lEQVRIiWNgGAWjYNACNgYGAxDN2GBjxw9iJBQQryUtWbIBpMWAeC2HGTccALHwaJFv7z346UaZjbw5e+/Bjz93HGY2Pr868cMDAwZ5frEDWLUYnDmXLJ1zLs1wZw+QwXsmnc/sxtvNEkCHGc6cnYBdi0SOgXRu2+EEgxs5ZsyMbdbMZjfObgBpSTC4jV2L/Iwc49+5bf8TDO6/MWP82cbMuHnG2c0/8GlhABoOtOUA0BYeMwbeNmfGDfy92/DaYnDmjJl1zrlkww1ncoyBfklLlrjBu80iwUACp1/k23uMb+eU2ckbHD9jCAwxYFT2n91880eFjTy/NA6HYQIJsEoJYpWDAP8BUlSPglEwCkbBCAAAMJJiJ/xv/1cAAAAASUVORK5CYII=","orcid":"","institution":"Khesar Gyalpo University of Medical Sciences of Bhutan","correspondingAuthor":true,"prefix":"","firstName":"Sonam","middleName":"","lastName":"Dechen","suffix":""},{"id":495643722,"identity":"260761ba-559c-4a61-962b-d7596ffdaabe","order_by":1,"name":"Tshering Wangden","email":"","orcid":"","institution":"Khesar Gyalpo University of Medical Sciences of 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18:53:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7013535/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7013535/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":88536793,"identity":"791a4e36-9a70-4b58-98a4-bc4753562c37","added_by":"auto","created_at":"2025-08-07 12:49:23","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":59162,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFlowchart showing the inclusion of preeclamptic patients in this study\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7013535/v1/c6f37134dbded38c0ba6df28.png"},{"id":88536792,"identity":"5a18f886-cab0-4640-a524-e273fcca7fd8","added_by":"auto","created_at":"2025-08-07 12:49:23","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":33050,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eBox plot illustrating the comparison of blood pressure between early-onset and late-onset preeclampsia\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7013535/v1/24a1b1defd58538d7e55a887.png"},{"id":88537676,"identity":"7fcbd53c-cd52-4b75-978d-d1cb65fa4f4d","added_by":"auto","created_at":"2025-08-07 12:57:23","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":40267,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eBox plot showing comparisons of gestational age at diagnosis of preeclampsia and gestational age at delivery between early-onset and late-onset preeclampsia\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7013535/v1/7e9f676b0b9be530bdef3a5e.png"},{"id":88539054,"identity":"3e044d91-4d82-4ab5-8ff9-f5aceefa439f","added_by":"auto","created_at":"2025-08-07 13:13:23","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":114048,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eScatter plot illustrating the correlation of systolic blood pressure (mmHg) with the birth weight (grams) of the newborn.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-7013535/v1/f4e772965001e68a447be2b8.png"},{"id":90947486,"identity":"ebe3301d-ad27-4af5-9290-4cf2aa9a8254","added_by":"auto","created_at":"2025-09-09 21:16:29","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2286823,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7013535/v1/57feef89-9c32-41cf-91b3-7c9e54519034.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Outcomes of pregnancy in women with preeclampsia from the 26-week period of gestation at the National Referral Hospital: A Cross-Sectional Study","fulltext":[{"header":"1. INTRODUCTION","content":"\u003cp\u003ePreeclampsia is defined as a multisystem progressive disorder characterized by blood pressure \u0026ge; 140/90 mm Hg or more on two occasions at least 4 hours apart after 20 weeks of gestation in a woman with a previously normal blood pressure or single episode of blood pressure \u0026ge; 160/110 mm Hg, and in a patient with new-onset hypertension without proteinuria, the new onset of any of the following is diagnostic of preeclampsia (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e):\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003ePlatelet count below 100,000/\u0026micro;L\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eSerum creatinine level above 1.1 mg/dL or doubling of the serum creatinine level in the absence of other renal diseases\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eLiver transaminase levels at least twice the normal concentrations\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003ePulmonary edema\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eNew-onset headache unresponsive to medication and not accounted for by alterative diagnosis or\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eVisual symptoms\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003ePreeclampsia is globally associated with maternal complications such as cesarean section, eclampsia, abruption, pulmonary edema, hemolysis elevated liver enzymes low platelet (HELLP) syndrome, postpartum hemorrhage, anuria, disseminated intravascular coagulopathy (DIC) and cardiac failure (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Some of the perinatal outcomes associated with preeclampsia are low birth weight, preterm birth, meconium-stained amniotic fluid (MSAF), acute respiratory distress syndrome (ARDS), neonatal intensive care unit (NICU) admission, stillbirth and intrauterine fetal death (IUFD).\u003c/p\u003e\u003cp\u003eAmong hypertensive disorders during pregnancy, 2\u0026ndash;8% of complications are preeclampsia worldwide (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Preeclampsia is found in 2\u0026ndash;5% of multiparas (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) and 3\u0026ndash;10% of nulliparas (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Preeclampsia and eclampsia are significant risk factors for poor maternal and perinatal outcomes. Preeclampsia is associated with increased risks, such as maternal death, perinatal death and low birthweight. Preeclampsia is associated with a prevalence of 5\u0026ndash;18% preterm birth and 15\u0026ndash;20% low birth weight(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn one of the studies, 31.7% of the maternal complications, such as placental abruption, HELLP syndrome, and even maternal death, were reported. Preeclampsia was also associated with 19.5% preterm delivery (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Preeclampsia is also associated with perinatal mortality of 42.6 per 1000 live births, with approximately 12.5% of neonates having a birth weight of less than 2.5 kg and 36.6% of neonates admitted to NICUs(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eSignificance of the study\u003c/strong\u003e\u003cp\u003eNo studies have been performed at Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) or Bhutan concerning maternal and perinatal outcomes in pregnant women with preeclampsia. It is important to determine maternal and perinatal outcomes among Bhutanese women with preeclampsia who are delivering at JDWNRH. Hence, this study was undertaken to identify common maternal and perinatal outcomes in pregnant women with PE who were delivering at Jigme Dorji Wangchuck National Referral Hospital.\u003c/p\u003e\u003c/p\u003e"},{"header":"2. METHODOLOGY","content":"\u003cp\u003eThis was a cross-sectional study of pregnancies complicated by preeclampsia from 26 weeks of gestation delivered at Jigme Dorji Wangchuck National Referral Hospital between 18th May 2024 and 18th April 2025. Bhutan is a lower middle-income country in Southeast Asia at the eastern end of the Himalayas bordering north China and south, east and west India. Bhutan occupies an area of 38,394 km\u003csup\u003e2,\u003c/sup\u003e with an estimated population of 777,224 in 2024 (National Statistical Bureau). Bhutan has 55 hospitals, including the National Traditional Medicine Hospital, 187 primary health centers, 51 subposts and 555 outreach clinics, as per the annual health bulletin of 2024. Women with obstetric complications can access and be referred to specialist services at the three tertiary hospitals in Thimphu, Mongar and Gelephug and other emergency maternal and obstetric centers in Samtse, Phuntsholing, Tsirang, Samdrupjongkhar, Lungtenphu military, Dewathang military and Trashigang hospitals, where emergency and elective caesarean section services are provided. This cross-sectional study was conducted in the maternity ward and birthing unit of the Department of Obstetrics and Gynecology, JDWNRH, the tertiary referral hospital of Bhutan. The study included all singleton pregnant women with preeclampsia for more than 26 weeks admitted to the maternity ward and birthing center of JDWNRH for delivery. The 26-week period of gestation was based on the criteria for minimal gestational age for admission to the neonatal intensive care unit in JDWNRH. The study was carried out over a period of eleven months between 18th May 2024 and 18th April 2025. The purposive sampling method was used to collect the samples in this study. All pregnant women with preeclampsia admitted to the maternity ward and those at the birthing unit for delivery who fulfilled the inclusion criteria were included. The women in the study were followed up until birth, and the neonates were followed up until perinatal day 07.\u003c/p\u003e\u003cp\u003e\u003cb\u003eInclusion criteria\u003c/b\u003e:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eAll singleton pregnancies were performed.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003ePeriod of gestation: 26 weeks and above.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eA woman who was diagnosed with preeclampsia and who came to our hospital at delivery was included.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eExclusion criteria\u003c/b\u003e:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eAll pregnant women with preeclampsia were younger than 25 weeks at 6 days of gestation.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eAll pregnant women with preeclampsia were less than 18 years of age.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eAll patients had preeclampsia with a twin pregnancy.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eAll pregnant women had gestational hypertensive disorders or chronic hypertension.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eAll pregnant women had chronic hypertension with superimposed PE.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eAdministrative clearance was sought from the Jigme Dorji Wangchuck National Referral Hospital and the Policy and Planning Division, Ministry of Health, Thimphu, Bhutan. The ethical clearance was approved by the Institutional Review Board (Reference no. IRB/Approval/PN/2023-027/1192) dated 26th April 2024, KGUMSB, Thimphu, Bhutan in accordance with the declaration of Helsinki. The funding for this thesis research was provided by Royal Bhutan Army, Thimphu, Bhutan. The clinical trial number was not applicable for this research.\u003c/p\u003e\u003cp\u003eStudy participants were given complete autonomy to participate in this study, with the freedom to discontinue participation at any time during the study period, without coercion. The participants were informed that their care would not be affected irrespective of their participation status, as their management would be per the standard operating procedure of the Department of Obstetrics and Gynecology, JDWNRH. The participants were informed about the study procedure, and the information sheet and consent form were read in the language they understood. Data collection was initiated after written informed consent was obtained.\u003c/p\u003e\u003cp\u003ePrivacy was ensured by not using the names of the participants in the questionnaire. The participants were identified by their citizenship identity card number and contact number to keep track of them during hospital admission, data entry, data analysis and follow-up.\u003c/p\u003e\u003cp\u003eConfidentiality was maintained by keeping the data collection forms securely in a lockable cabinet, and the electronic data file was kept in a password-protected computer accessible only to the principal investigator. The citizenship identity card number and the contact number were confidently maintained and were used only for follow-up purposes. Data sets will be maintained securely for five years after the completion of the study.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThe participants were made aware of their rights to discontinue study participation at any point. Their medical care and management and psychological support were not compromised in this study. The participants were informed that their data would not be used for analysis if they discontinued their participation in this study.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eData collection\u003c/b\u003e:\u003c/p\u003e\u003cp\u003eThe data were collected by the principal investigator and intern medical doctors. The interns were briefed on the objectives of this study and trained on the data collection procedures.\u003c/p\u003e\u003cp\u003eParticipants fulfilling the inclusion criteria who came to deliver at the national referral hospital were identified and invited to participate in the study. Human ethics and consent to participate declarations were taken from the participants in the presence of a witness using the structured designed Pro-forma made for this study, and the data collected were transferred into an Excel sheet.\u003c/p\u003e\u003cp\u003eSome of the socioclinico-demographic details and antenatal records were retrieved via antenatal care cards, maternity wards, birth records, and direct interviews. The data were collected anytime the patients were admitted with preeclampsia, and the final participants were those who delivered at JDWNRH. The period of gestation (POG) was calculated on the basis of the reliable last normal monthly period (LMP), which is consistent with early ultrasound dating within 7 days. If the difference between LMP and ultrasound dating was more than 7 days, the ultrasound date was considered for POG determination. The diagnosis of PE was made on the basis of the fulfilment of the criteria of ACOG practice bulletin number 222, in accordance with international and hospital protocols. The participants\u0026rsquo; treatment and investigations were managed as per the standard operating protocol of the national referral hospital. The timing of delivery was determined by the combined management of the senior oncall consultant and the maternal fetal medicine specialist. The decision regarding the mode of delivery was made by the emergency obstetrician on duty as per standard and hospital protocols. The APGAR score was measured at 5 minutes from the time of birth. The baby was weighed after 90 minutes of Kangaroo Mother Care in the standard weighing machine \u0026lsquo;TANITA\u0026rsquo; by the nurses. Data on the APGAR score and birthweight were collected from the neonatal discharge summary sheet. The mothers and the baby were followed up on day 7 with those still admitted and via telephone conversations with those who were discharged. The data collected were reviewed monthly or whenever needed.\u003c/p\u003e\u003cp\u003e\u003cb\u003eData collection tool\u003c/b\u003e:\u003c/p\u003e\u003cp\u003eA structurally designed pro-forma was used, which consisted of four sections: 1- sociodemographic profile, 2- obstetric/clinical profile, 3- maternal outcome and 4- perinatal outcome.\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eThe first section of the questionnaire focused on sociodemographic data, including age, education status and current occupation.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eThe second section of the questionnaire focused on the following obstetric/clinical profile: ANC booking, total number of ANC visits, gravidity, blood pressure at the time of diagnosis, POG at the time of diagnosis, urine protein status, medical comorbidities, POG at the time of delivery and birth weight of the babies born.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eThe third section on maternal outcomes included the mode of delivery, postpartum hemorrhage, heart failure/cardiomyopathy, oliguria (AKI), abruptio, DIC, cortical blindness, HELLP syndrome and maternal mortality.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eThe fourth section on the perinatal outcome focused on antepartum fetal demise/livebirth/intrapartum stillbirth, preterm birth, low birth weight, APGAR within 5 minutes, meconium-stained amniotic fluid, neonatal respiratory distress syndrome, NICU admission and perinatal status on day 7.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eData confidentiality\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAll data collected from patients were securely stored on a password-protected computer with access only to the principal investigator. Names and citizenship identity cards were used only for correlation and to avoid double entry. Electronic data were kept in a confidential file accessible to the principal investigator. Hard copy data collection forms were secured in a lockable cabinet.\u003c/p\u003e\u003cp\u003eAll the provided and electronic data files will be stored for 5 years, after which they will be discarded. The results and findings were presented to relevant forums without personal identifiers.\u003c/p\u003e\u003cp\u003e\u003cb\u003eStatistical analysis\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe data were reviewed, edited and double entered into a password-protected personal computer in an Excel spreadsheet and analysed via IBM SPSS (version 23). Frequencies and percentages were used for descriptive analysis. Descriptive statistics were computed for all variables according to type, frequency, mean and standard deviation for continuous variables, and the categorical variables were computed via simple frequency tables. The crude odds ratio, adjusted odds ratio and 95% confidence interval (CI) for each variable of interest were calculated. Chi-square tests and Fisher\u0026rsquo;s exact tests were performed for categorical variables to compare outcomes between the groups; a p value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered to indicate statistical significance. Statistical tests were performed to estimate the odds ratios (ORs) of maternal and perinatal outcomes. The overall and specific complications are presented as frequencies and percentages.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of Interests\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003eThe principal investigator, supervisor and cosupervisor had no conflicts of interest, financial or otherwise, for the overall study or study site.\u003c/p\u003e"},{"header":"3.\tRESULTS","content":"\u003cp\u003e\u003cstrong\u003eStudy sample population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDuring the study period between 18\u003csup\u003eth\u003c/sup\u003e May 2024 and 18\u003csup\u003eth\u003c/sup\u003e April 2025, the national referral hospital of Bhutan had 1900 deliveries. Among these, 113 fulfilled the inclusion criteria and consented to participate in this study. The prevalence of PE was 5.9% (113/1900). Among the 113 singleton preeclamptic patients, 32% (36/113) had early-onset preeclampsia, and over 68% (77/113) had late-onset preeclampsia. The details are shown in Figure 1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSociodemographic characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong the 113 preeclamptic patients, 50.4% (57/113) were between the ages of 21 and 30. The median age was 30 years. A total of 66.4% (75/113) had attained higher education or higher, and more than 47% were housewives. Additionally, 44 (40%) of the patients were referred from other hospitals in Bhutan. The sociodemographic details are provided in Table 1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003cstrong\u003e: Sociodemographic characteristics of patients with preeclampsia managed at the national referral hospital of Bhutan (n=113)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"532\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 136px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal, n=113(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEarly onset PE, n=36(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLate onset PE, n=77(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 92px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 56px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e18-20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e3 (2.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e1 (2.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e2 (2.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 56px;\"\u003e\n \u003cp\u003e0.681\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e21-30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e57 (50.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e16 (44.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e41 (53.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026gt;30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e53 (46.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e19 (52.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e34 (44.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eIlliterate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e12 (10.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e2 (5.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e10 (13.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 56px;\"\u003e\n \u003cp\u003e0.587\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e2 (1.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e1 (2.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e1 (1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e24 (21.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e9 (25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e15 (19.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eHigher and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e75 (66.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e24 (66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e51 (66.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOccupation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eHousewives\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e54 (47.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e18 (50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e36 (46.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 56px;\"\u003e\n \u003cp\u003e0.846\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eBusiness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e26 (23.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e9 (25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e17 (22.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eCivil servant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e23 (20.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e7 (19.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e16 (20.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003ePrivate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e10 (8.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e2 (5.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e8 (10.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReferred in\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e68 (60.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e22 (61.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e46 (59.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 56px;\"\u003e\n \u003cp\u003e0.529\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e45 (39.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e14 (38.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e31 (40.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eObstetric characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs shown in Table 2, 100% of the patients with PE had ANC booking. However, only over 81% (92/113) had attended 4\u0026ndash;8 ANC visits. Compared with patients with late-onset preeclampsia, those with early-onset preeclampsia had significantly fewer ANC visits (\u0026lt;4 visits) (36% vs 5%, p\u0026lt;0.001). The majority of PE patients were primigravida or nullipara.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003cstrong\u003e: Obstetric characteristics of patients with preeclampsia at the national referral hospital of Bhutan (n=113)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"544\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal, n=113(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEarly onset, n=36(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLate onset, n=77(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eANC booking\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 141px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 133px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e113 (100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e36 (100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e77 (100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 61px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e0.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e0.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal ANC visits\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026lt;4 visits\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e17 (15.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e13 (36.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e4 (5.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e4 - 8 visits\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e92 (81.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e23 (63.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e69 (89.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026gt;8 visits\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e4 (3.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e4 (5.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGravidity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003ePrimigravida\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e65 (57.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e19 (52.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e46 (59.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 61px;\"\u003e\n \u003cp\u003e0.310\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eMultigravida\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e48 (42.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e17 (47.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e31 (40.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eNullipara\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e70 (63.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e21 (60.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e49 (64.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 61px;\"\u003e\n \u003cp\u003e0.849\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003ePrimipara\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e18 (16.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e6 (17.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e12 (16.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eMultipara\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e25 (20.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e9 (25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e16 (20.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" valign=\"bottom\" style=\"width: 544px;\"\u003e\n \u003cp\u003e\u003cem\u003eANC: antenatal care; POG*: period of gestation at diagnosis\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eBlood pressure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOverall, systolic blood pressure greater than 160 mmHg was recorded in 26.5% (30/113) of the patients, whereas diastolic blood pressure was in the severe range in 21.2% (24/113) of the patients. The diastolic mean pressure was significantly greater in early-onset PE than in late-onset PE. Urine albumin was positive in more than 71% (81/113) of the patients. The details are presented in Table 3.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003cstrong\u003e: Blood pressure levels and presence of urine albumin status in patients with preeclampsia at the national referral hospital of Bhutan (n=113)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"538\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 107px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal, n=113(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEarly onset, n=36(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLate onset, n=77(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e\u003cstrong\u003esBP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 133px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 62px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003eBP\u0026lt;160\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e83 (73.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e24 (66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e59 (76.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 62px;\"\u003e\n \u003cp\u003e0.187\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003eBP\u0026ge;160\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e30 (26.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e12 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e18 (23.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003esBP mean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e153.4 \u0026plusmn; 13.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e148.3 \u0026plusmn; 14.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e0.067\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e\u003cstrong\u003edBP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026lt;110 mmHg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e89 (78.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e25 (69.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e64 (83.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 62px;\"\u003e\n \u003cp\u003e0.081\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026ge;110 mmHg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e24 (21.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e11 (30.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e13 (16.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 201px;\"\u003e\n \u003cp\u003e\u003cstrong\u003edBP mean \u0026plusmn; SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e104.8 \u0026plusmn; 15.1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e98.8 \u0026plusmn; 9.4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.011\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 342px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePresence of urine albumin\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 62px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e81 (71.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e30 (83.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e51 (66.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 62px;\"\u003e\n \u003cp\u003e0.046\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e32 (28.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e6 (16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e26 (33.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" valign=\"bottom\" style=\"width: 538px;\"\u003e\n \u003cp\u003e\u003cem\u003eBP: blood pressure; dBP: diastolic blood pressure; sBP: systolic blood pressure; SD: Standard deviation\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBoth the mean systolic and diastolic BP were greater in early-onset PE patients than in late-onset PE patients (Figure 2).\u003c/p\u003e\n\u003cp id=\"_Toc201260559\"\u003e\u003cstrong\u003eComorbidities\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong the 113 patients, 11% (12/113) were either overweight or obese, and we detected frequent urinary tract infections (8%) and anaemia (5.3%). The details are shown in Table 4.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e4\u003c/strong\u003e\u003cstrong\u003e: Medical comorbidities present in the patients with preeclampsia at the national referral hospital of Bhutan (n=113)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"525\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 329px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComorbidities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercent (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 329px;\"\u003e\n \u003cp\u003eGestational diabetes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 329px;\"\u003e\n \u003cp\u003eHeart disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 329px;\"\u003e\n \u003cp\u003eUrinary tract infection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e8.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 329px;\"\u003e\n \u003cp\u003eAnemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e5.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 329px;\"\u003e\n \u003cp\u003eOverweight or obese\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e10.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 329px;\"\u003e\n \u003cp\u003eIntrahepatic cholestasis of pregnancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e2.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 329px;\"\u003e\n \u003cp\u003eDepression\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 329px;\"\u003e\n \u003cp\u003eSystemic Lupus Erythematosus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 329px;\"\u003e\n \u003cp\u003eHepatitis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 329px;\"\u003e\n \u003cp\u003eThyroid disorders\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 329px;\"\u003e\n \u003cp\u003eRheumatoid arthritis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eModes of delivery\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan id=\"_Toc196500314\"\u003eCompared with patients with vaginal deliveries, the majority of patients with PE underwent cesarean deliveries. Cesarean deliveries were significantly more common in early-onset PE patients than in late-onset PE patients (91.7% vs. 51.9%, p \u0026lt; 0.001). Cesarean section was performed on an emergency basis in 78.1% (57/113) of the patients. The details are provided in Table 5.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan id=\"_Toc196500314\"\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e5\u003c/strong\u003e\u003cstrong\u003e: Modes of delivery in patients with preeclampsia at the national referral hospital of Bhutan (n=113)\u003c/strong\u003e\u003c/span\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"525\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 107px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEarly onset\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLate onset\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModes of delivery\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 107px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 88px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003eVaginal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e40 (35.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e3 (8.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e37 (48.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003eCesarean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e73 (64.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e33 (91.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e40 (51.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 295px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCesarean section type\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003eEmergency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e57 (78.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e29 (87.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e28 (70.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 62px;\"\u003e\n \u003cp\u003e0.058\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003eElective\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e16 (21.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e4 (12.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e12 (30.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 295px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTypes of vaginal delivery\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 62px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003eSpontaneous vaginal delivery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e18 (45.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e2 (66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e16 (43.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 62px;\"\u003e\n \u003cp\u003e0.698\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003eInduced vaginal delivery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e19 (47.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e1 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e18 (48.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003eAssisted vaginal delivery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e3 (7.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e3 (8.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp id=\"_Toc201260561\"\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIndications for cesarean delivery\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs shown in multiple response Table 6, caesarean sections were performed for foetal distress in 47.9% (35/73), foetal growth restriction in 30.1% (22/73), severe preeclampsia in 30.1% (22/73) and prior caesarean sections in 13.7% (10/73).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e6\u003c/strong\u003e\u003cstrong\u003e: Indications for cesarean delivery in patients with preeclampsia at the national referral hospital of Bhutan (n=73)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"500\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 241px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIndications for cesarean delivery*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 184px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercent (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 241px;\"\u003e\n \u003cp\u003eFetal distress\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e47.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 241px;\"\u003e\n \u003cp\u003eSevere preeclampsia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e30.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 241px;\"\u003e\n \u003cp\u003eFetal growth restriction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e30.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 241px;\"\u003e\n \u003cp\u003ePrior cesarean section\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e13.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 241px;\"\u003e\n \u003cp\u003eFailed induction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e12.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 241px;\"\u003e\n \u003cp\u003eAcute kidney injury\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e5.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 241px;\"\u003e\n \u003cp\u003eFetal macrosomia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e5.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 241px;\"\u003e\n \u003cp\u003eProlong labor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e2.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 241px;\"\u003e\n \u003cp\u003eOligohydramnios\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e6.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 241px;\"\u003e\n \u003cp\u003eMalpresentation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e4.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 241px;\"\u003e\n \u003cp\u003eAbruptio placenta\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 184px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e*\u003c/strong\u003e\u003cem\u003eSome of the patients had more than one indication for a cesarean section\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaternal outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eApproximately three-quarters of patients with PE develop acute kidney injury, followed by postpartum hemorrhage, abruption, HELLP syndrome and cortical blindness. A total of 38.9% (44/113) of preeclamptic mothers were found to have maternal morbidity, with no maternal mortality. The details are provided in Table 7.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e7\u003c/strong\u003e\u003cstrong\u003e: Maternal outcomes of patients with preeclampsia\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"476\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 154px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMaternal outcomes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal, n=113(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 122px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEarly onset, n=36(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLate onset, n=77(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003ePostpartum hemorrhage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e7 (6.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e2 (5.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e5 (6.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003eAcute kidney injury\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e27 (23.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e16 (44.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e11 (14.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003eAbruptio placenta\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e6 (5.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e5 (13.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e1 (1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003eHELLP syndrome\u003c/p\u003e\n \u003cp\u003eCortical blindness\u003c/p\u003e\n \u003cp\u003eHeart failure\u003c/p\u003e\n \u003cp\u003eDIC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e2 (1.8)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;2 (1.8)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 0\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e1(2.8)\u003c/p\u003e\n \u003cp\u003e2 (5.6)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 0\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e1 (1.3)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;0\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 0\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003eMaternal mortality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 476px;\"\u003e\n \u003cp\u003e\u003cem\u003eHELLP: hemolysis, elevated liver enzymes, low platelet levels; DIC: disseminated intravascular coagulation\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePerinatal outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThirty-eight percent (43/113) of patients had preterm deliveries (\u0026lt;37 weeks of gestation), with 18% (20/113) having low birth weights. Preterm deliveries occurred more frequently in early-onset PE than in late-onset PE (p\u0026lt;0.001); 98% (111/113) of the babies were delivered alive, and 81% (90/113) had a favourable Apgar score (\u0026gt;7 points). Approximately 30% (33/111) of the babies developed RDS, and meconium was present in more than 23% of the babies. Among the 5.3% (6/113) of perinatal deaths, 1.8% (2/113) were antepartum fetal deaths, and over 38% (42/111) of the babies required NICU care; among them, 2.7% (3/110) of the babies expired, and 3 babies never reached the NICU. One baby had expired on postoperative day 0 before NICU admission, and 2 had antenatal fetal deaths. NICU care was required for the majority of the newborns with early-onset PE compared with those with late-onset PE (87.9% vs 16.9%, p\u0026lt;0.001). Additional details are shown in Table 8 and Table 9.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e8\u003c/strong\u003e\u003cstrong\u003e: Perinatal outcomes of patients with preeclampsia\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;at the national referral hospital\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"516\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 124px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePerinatal outcome\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal, N=113(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEarly onset, n=36(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLate onset, n-77(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePOG at delivery (weeks)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026lt;37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e43 (38.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e33 (91.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e10 (13.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e37 and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e70 (61.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e3 (8.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e67 (87.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNewborn outcome\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 129px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 106px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003eAlive*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e111 (98.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e34 (94.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e77 (100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.037\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003eIUFD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e2 (1.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e2 (5.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBirth weight (grams)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026lt;1000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e11 (9.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e11 (30.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e1000 - 1499\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e9 (8.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e8 (25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e1500 - 2499\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e36 (31.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e12 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e24 (31.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u003cu\u003e\u0026gt;\u003c/u\u003e2500\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e57 (50.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e4 (11.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e53 (68.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eApgar score at 5 minutes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026ge;7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 92px;\"\u003e\n \u003cp\u003e90 (81.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e19 (55.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e71 (92.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026lt;7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 92px;\"\u003e\n \u003cp\u003e21 (18.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 129px;\"\u003e\n \u003cp\u003e15 (44.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e6 (7.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAcute RDS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e33 (29.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e24 (70.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e9 (11.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e78 (70.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e10 (29.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e68 (88.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMeconium present\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e26 (23.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e5 (14.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e21 (27.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.088\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e85 (76.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e29 (85.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e56 (72.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNICU admission\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e42 (37.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e29 (85.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e13 (16.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e69 (62.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e5 (14.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e64 (83.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBaby status on day 7 of delivery\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 16px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003eAlive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e107 (96.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e30 (88.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e77 (100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003eDeath*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e4 (3.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 129px;\"\u003e\n \u003cp\u003e4 (11.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 516px;\"\u003e\n \u003cp\u003e\u003cem\u003eIUFD: Intrauterine antepartum fetal death; POG: period of gestation; RDS: respiratory distress syndrome; NICU: neonatal intensive care unit\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e*2 antepartum fetal death, 1 neonatal death prior to NICU admission\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e9\u003c/strong\u003e\u003cstrong\u003e: Details of perinatal fetal death due to preeclampsia.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"584\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eSerial number\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003eReferred/not referred\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003ePOG at delivery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003eBody weight\u003c/p\u003e\n \u003cp\u003e(gm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eRemarks\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003eNot referred\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e27 weeks 4 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e820\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eDeath in D4, impending HELLP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003eReferred\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e33 weeks 3 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e1550\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eIUFD\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003eNot referred\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e29 weeks 2 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e150\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eIUFD\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003eReferred\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e27 weeks 3 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e610\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eDeath in D2 , impending HELLP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003eReferred\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e27 weeks 5 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e720\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eDeath in D4, cortical blindness\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003e06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003eNot referred\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e30 weeks 5 day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 111px;\"\u003e\n \u003cp\u003e895\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eDeath in D0, not shifted to NICU, impending eclampsia with cortical blindness\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003ePeriod of gestation at diagnosis and delivery\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe median gestational age at the time of PE diagnosis and delivery was significantly greater in the late-onset PE group than in the early-onset PE group (Figure 3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFactors associated with poor perinatal outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Apgar score assessed at 5 minutes after delivery was used to determine perinatal outcomes and was considered an independent variable. Newborns with an abnormal Apgar score (\u0026lt;7) were classified as having poor perinatal outcomes, whereas those with a score \u0026ge;7 were classified as having good perinatal outcomes.\u003c/p\u003e\n\u003cp\u003eMultiple dependent variables were analysed via multivariable logistic regression to identify factors associated with poor perinatal outcomes. Patients referred to the national referral hospital from peripheral hospitals were 6.6 times more likely to experience unfavourable perinatal outcomes (aOR 6.6, 95% CI 1.0\u0026ndash;42.13; p=0.047). The number of mothers referred to the NICU was found to have clinical significance (45/113).\u003c/p\u003e\n\u003cp\u003eAmong the factors associated with poor outcomes, early-onset preeclampsia (PE), gravida status, fewer antenatal care (ANC) visits than recommended (\u0026lt;8 visits), the presence of urine albumin, a systolic blood pressure \u0026gt;160 mmHg, a diastolic blood pressure \u0026gt;110 mmHg, and cesarean delivery were associated with an increased likelihood of unfavourable perinatal outcomes. However, the association was not statistically significant (p\u0026gt;0.05). Additional details are provided in Table 10.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e10\u003c/strong\u003e\u003cstrong\u003e: Factors associated with poor perinatal outcomes\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;at the national referral hospital\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"575\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 166px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFactors\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ecOR (95%CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 122px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eaOR (95%CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003eEarly onset PE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.1 (0.04 - 0.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e1.4 (0.15 - 13.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e0.756\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e1.0 (0.91 - 1.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.608\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e1.0 (0.86 - 1.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e0.860\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003eGravida\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e1.2 (0.77 - 1.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.414\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e3.2 (0.22 - 45.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e0.394\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003ePara\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e1.2 (0.74 - 2.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.424\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e0.4 (0.02 -10.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e0.611\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003eANC visits \u003cu\u003e\u0026lt;\u003c/u\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e6.8 (0.86 - 53.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.069\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e1.7 (0.08 - 34.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e0.742\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003eMedical comorbidities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.7 (0.25 - 1.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.400\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e0.7 (0.11 - 3.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e0.635\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003eUrine albumin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.9 (0.32 - 2.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.868\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e7.9 (0.83 - 75.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e0.073\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003esBP\u0026ge;160\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.9 (0.29 - 2.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.783\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e3.2 (0.24 - 42.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e0.375\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003esBP\u0026ge;110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e0.6 (0.20 - 1.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.371\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e1.7 (0.15 - 20.45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e0.665\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003eCesarean delivery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e3.1 (0.96 - 9.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.058\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e1.9 (0.30 - 12.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e0.476\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003eMeconium-stained amniotic fluid\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e1.4 (0.41 - 4.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.610\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 122px;\"\u003e\n \u003cp\u003e0.9 (0.14 - 6.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e0.925\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 575px;\"\u003e\n \u003cp\u003e\u003cem\u003eANC: antenatal care; aOR: adjusted odds ratio; cOR: crude odds ratio; PE: preeclampsia; RDS: respiratory distress syndrome\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eCorrelation between systolic BP and birth weight\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA correlation was analysed between the systolic BP and birth weight of newborns via Pearson\u0026rsquo;s correlation coefficient. There was a significant negative correlation between systolic BP and the birth weight of babies (r = -0.2, p = 0.020), as shown in Figure 4.\u003c/p\u003e"},{"header":"4.\tDISCUSSION AND CONCLUSIONS","content":"\u003cp\u003eDuring my study period at Jigme Dorji Wangchuck National Referral Hospital, there were a total of 1900 deliveries, of which 1787 pregnant women were excluded. A total of 113 samples were collected from patients who fulfilled the inclusion criteria during the study period. The prevalence of preeclampsia was 5.9% of the total deliveries conducted during the study period. This may be due to good ANC visits in the capital city of Bhutan and the good quality of care provided at the national referral hospital. Our prevalence is comparable to findings from a study in India by Vaibhav Shandilya et al. (6.2%, 31/500)(09) but lower than the prevalence reported in Bangladesh (9.9%, 11/111)(10). This may be because compared with the study group in Bangladesh, the pregnant women in this study were seeking medical help on time and had good medical compliance.\u003c/p\u003e\n\u003cp\u003eIn this study,\u0026nbsp;approximately\u0026nbsp;50.4% of patients were between the ages of 21 and 30 years, while the majority were found to have late-onset preeclampsia (53.2%, 41/113) rather than early-onset preeclampsia (44.4%, 16/113). The median age was 30 years. A study conducted in a tertiary care center by Rajalakshmi Subburam et al. in Chennai, India, reported that the majority of preeclampsia cases in 80% of the population were 21--30 years old, and 60% were primigravida (11). This may be because of the larger sample size of 113 patients in this study than of 65 patients.\u003c/p\u003e\n\u003cp\u003eTwo-thirds (66.4%, 75/113) had attained higher education or higher in this study; however, more than 47% (75/113) were housewives, which is similar to the 52.3% of patients who were housewives reported in the study of Bisman Khan et al. (12). This study revealed that the majority of the pregnant women visiting the national referral hospital were educated housewives (66.4% (75/113)), with our baseline literacy rate being 72.1% according to the national survey for the year 2022 in the Bhutan literacy rate. Businesses such as online-based home businesses were not accepted as part of the occupation by the participants. There is no domestic care support that they choose to remain unemployed. Additionally, approximately 40% (45/113) of the patients had been referred from other hospitals in Bhutan. The number of mothers referred for NICU care shows the clinical significance of perinatal outcomes. This finding shows that the delivery center for high-risk patients is the national referral hospital. The ANC care provided is efficient in detecting preeclampsia, thus providing better quality healthcare.\u003c/p\u003e\n\u003cp\u003eWith all preeclampsia women having 100% ANC booking, only approximately 81% had attended 4–8 ANC visits.\u0026nbsp;This may be due to free health care access to the Bhutanese population.\u0026nbsp;Compared with patients with late-onset PE, significantly more patients with early-onset PE had fewer ANC visits (\u0026lt;4 visits) (36% vs 5%, p\u0026lt;0.001). This may be because pregnant women with preeclampsia are admitted to the ward and monitored for PE symptoms and fetal monitoring via Doppler. This could subsequently result in termination of pregnancy in cases of severe preeclampsia, fetal distress and abnormal Doppler findings. Hence, this explains the lower number of ANC visits during early-onset PE. With 100% ANC booking, zero maternal morbidity and mortality can also be attributed to early intervention before the disease progresses.\u003c/p\u003e\n\u003cp\u003eThe majority of PE patients were primigravida (18%) or nullipara (70%), and there was no difference between early-onset and late-onset PE. Late-onset preeclampsia was more common in primigravida individuals (59.7%, 46/77) than in multigravida individuals (40.3%, 31/77). According to a study by Pooja Wadhwani et al. in India in primigravida, 55.3% of patients had late-onset preeclampsia, whereas 42.7% had early-onset preeclampsia (13). These findings indicate that nullipara, primigravida and young age groups are at risk for developing late-onset preeclampsia.\u003c/p\u003e\n\u003cp\u003eSystolic blood pressure was in the severe range (sBP\u0026nbsp;³\u0026nbsp;160 mmHg) in approximately one quarter of the patients (26.5%, 30/113), whereas diastolic blood pressure (dBP³110 mmHG) was in the severe range in approximately one-fifth of them (21.2%, 24/113). The diastolic mean pressure was significantly greater in early-onset PE than in late-onset PE. This may be affected by the use of antihypertensive medicines during the detection and transition of gestational hypertension to preeclampsia.\u003c/p\u003e\n\u003cp\u003eAmong the 113 patients with PE, more than 11% (12/113) were either overweight or obese, followed by those with urinary tract infection (8%, 9/113) and anaemia (5.3%, 6/113). This finding is similar to the findings of a study by James M Roberts et al., who reported a 3-fold increased risk of developing PE in obese women who became pregnant (14). This may be due to the lack of awareness about the implications of obesity during pregnancy, as they do not seek preconception care. Pregnant women should be aware of the increased risk of PE in obese individuals, as this is a modifiable risk factor that could be prevented. Similarly, a meta-analysis revealed that pregnant women with UTIs have a 1.31 (95% CI: 1.22–1.40) increased risk (RR) of developing PE (15).\u0026nbsp;Urine albumin was positive in more than 71% of the patients.\u0026nbsp;Many cases of asymptomatic bacteriuria are unnoticed during pregnancy, which leads to the development of PE. With respect to UTIs, even asymptomatic bacteriuria must be treated during pregnancy to prevent the risk of PE. In Bhutan, we do not practice screening for asymptomatic bacteriuria.\u003c/p\u003e\n\u003cp\u003eThe prevalence of anaemia during pregnancy in Bhutan according to UNICEF records is 27.3%. Hence, 5.3% of anaemia cases are associated with PE. The presence of anaemia during pregnancy is a risk factor for PE, which may be due to poor compliance with iron supplements by patients and may be due to side effects associated with nausea and/or the use of iron supplements with dairy products. This requires further studies.\u003c/p\u003e\n\u003cp\u003eCompared with patients with vaginal deliveries, the majority of patients with PE underwent cesarean deliveries. Cesarean deliveries were significantly more common in early-onset PE patients than in late-onset PE patients (91.7% vs. 51.9%, p \u0026lt; 0.001). Additionally, most cesarean procedures were performed on an emergency basis (78.1%, 57/113). Smita Dubey et al., Kritpol Pasolpuckdee et al. and Gautam SK et al. reported 15.4%, 51.2% and 54% cesarean rates of preeclampsia, respectively (16,17,18).\u0026nbsp;In the majority of cases, cesarean sections in preeclampsia (PE) patients were performed for fetal distress, followed by fetal growth restriction, severe preeclampsia and prior cesarean sections. This explains the zero data on intrapartum stillbirth. Early intervention is made in the timing and mode of delivery as a result of early recognition of suspicion of fetal distress in CTG. However, there was a perinatal rate of 53 per 1000 livebirths in this study. Similarly, Minal A. Kalambe et al reported that the majority of cesarean sections were affected by fetal distress (19.15%) in patients with preeclampsia (19). The use of cardiotocography, Doppler for foetal monitoring and the quality of intrapartum monitoring may have contributed to the increased rate of emergency caesarean delivery.\u003c/p\u003e\n\u003cp\u003eApproximately three-quarters of patients with PE develop acute kidney injury followed by postpartum hemorrhage, abruption, HELLP and cortical blindness. A total of 38.9% (44/113) of preeclamptic mothers were found to have maternal morbidity, with no maternal mortality. However, in the study by Subrat Panda et al., 7.4% of the patients experienced abruption, 5.7% of the patients experienced postpartum hemorrhage, and 0.7% of the patients experienced ARF (20). This may be due to close monitoring of the blood parameters in the ward. Hence, early detection of PE-related complications, such as acute kidney injury, is needed. The rate of abruption may be lower in my study because of early intervention in the timing of delivery, and with respect to PPH, it may either be unrecognized or be due to active management of the third stage of labor. This explains the lack of maternal mortality due to preeclampsia. Compared with the Thangappah Radha Bai Prabhu study(21), which reported 0.17% (16/9199) cortical blindness, cortical blindness was found in 1.8% of the participants in this study. It is a transient loss of vision that can be treated with termination of pregnancy.\u003c/p\u003e\n\u003cp\u003eIn this study, approximately 38% (43/113) of the patients with PE had preterm deliveries, with approximately 18% (20/113) having low birth weights. Preterm deliveries were significantly more common in early-onset PE than in late-onset PE (p\u0026lt;0.001); however, over 98% (111/113) of the babies were delivered alive, with 81% (90/113) having a favourable Apgar score (\u0026gt;7 points).\u003c/p\u003e\n\u003cp\u003eMany perinatal outcomes were recorded, and 30% of the babies developed RDS, more than 23% had meconium, and over 38% (42/111) of the babies required NICU care; among them, 2.7% (3/110) of the babies had expired and were under NICU care. Among the 5.3% (6/113) perinatal deaths, 2 were antepartum fetal deaths, 1 baby died prior to NICU admission, and 3 died in the NICU. NICU care was required for the majority of the newborns with early-onset PE compared with those with late-onset PE (87.9% vs 16.9%, p\u0026lt;0.001). This explains early intervention during the close monitoring of the PE symptoms of the mother and the Doppler profile of the foetus that has led to preterm deliveries with low birth weight and 98% survival of the baby.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStrengths\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;of the study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs this is a tertiary care hospital, the majority of severe preeclampsia cases are referred to here. There was 100% follow-up performed on perinatal day 7. This study provides baseline data on the maternal and perinatal outcomes of preeclampsia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations of the study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study sample was calculated for a year with no previous published records on the incidence of PE in the national referral hospital. The study sample size could not be accomplished due to several factors, such as, as mentioned earlier, the duration of the study period for sample collection being eleven months in total. The total number of deliveries decreased over the year. The study sample size was small. This study was hospital-based at Thimphu National Hospital, and the results are not representative of the entire Bhutanese population.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion of the study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe prevalence of preeclampsia was 5.9% in the study population. Preterm labour and acute kidney injury are the two main complications associated with preeclampsia. Cesarean delivery was significantly more common in patients with early-onset preeclampsia than in those with late-onset preeclampsia. Respiratory distress syndrome was detected in 30% of the patients, and the perinatal mortality rate was 5.6%. The number of perinatal deaths was significantly greater in patients with early-onset preeclampsia. Thus, preeclampsia is associated with significant morbidity and mortality, especially in early preeclampsia patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cbr\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGeneral recommendations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOn the basis of the findings of the study, I would like to recommend the following:\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eInitiation of aspirin in primigravida and nulliparous individuals irrespective of risk factors.\u003c/li\u003e\n \u003cli\u003eStrengthening of NICU care at the national referral hospital.\u003c/li\u003e\n \u003cli\u003eInitiation of treatment for asymptomatic bacteriuria during pregnancy.\u003c/li\u003e\n \u003cli\u003eStrengthening of preconception care.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the Institute Research Board, Thimphu, Bhutan. Consent to participate was obtained from the patients.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from the patients for use in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials are available from the corresponding author on reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author(s) declare(s) no conflicts of interest with respect to the research, authorship, and/or publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author received no financial support for the publication of this article.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003econtributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1\u003csup\u003est\u003c/sup\u003e author SD: Conceptualized and wrote the manuscript, interpreted the data, and was involved in data collection and interpretation.\u003c/p\u003e\n\u003cp\u003e2\u003csup\u003end\u003c/sup\u003e author TW: Conceptualized the manuscript and interpreted the data.\u003c/p\u003e\n\u003cp\u003e3\u003csup\u003erd\u003c/sup\u003e author YD: Analysed and interpreted the data.\u003c/p\u003e\n\u003cp\u003e4\u003csup\u003eth\u003c/sup\u003e author SCR: Conceptualized the manuscript and interpreted the data.\u003c/p\u003e\n\u003cp\u003eAll the authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDeepest gratitude to the Department of Obstetrics and gynecology, Jigme Dorji Wangchuck National Referral Hospital, Faculty of Postgraduate Medicine,\u0026nbsp;Interim Institutional Review Board (I-IRB), Dr. Sanagy Tshering, Associate Professor, Obstetrics and Gynecology, Dr. Thinley Dorji, Medical Specialist, interns who helped in the process of thesis completion.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eEspinoza J, Vidaeff A, Pettker CM, Simhan H. ACOG practice bulletin Clinical Management Guidelines for Obstetrician-Gynecologists. 2020;135, No.6:2\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMa\u0026rsquo;ayeh M, Costantine MM. Prevention of preeclampsia. Semin Fetal Neonatal Med. 2020;25(5).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMagee LA, Nicolaides KH, Von Dadelszen P, Preeclampsia. N Engl J Med. 2022;386(19):1817\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJim B, Karumanchi SA, Preeclampsia. Pathogenesis, Prevention, and Long-Term Complications. Semin Nephrol. 2017;37(4):386\u0026ndash;97.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eW\u0026oacute;jtowicz A, Zembala-Szczerba M, Babczyk D, Kołodziejczyk-Pietruszka M, Lewaczyńska O, Huras H. Early- and Late-Onset Preeclampsia: A Comprehensive Cohort Study of Laboratory and Clinical Findings according to the New ISHHP Criteria. Int J Hypertens. 2019;2019(1):1\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBilanoVL, Ota E, Ganchimeg T, Mori R, Souza JP. Risk Factors of Pre-Eclampsia/Eclampsia and Its Adverse Outcomes in Low- and Middle-Income Countries: A WHO Secondary Analysis.Young RC. editor PLos One. 2014;9(3):e91198.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBurton GJ, Redman CW, Roberts JM, Moffett A. Preeclampsia: pathophysiology and clinical implications. BMJ. 2019;366(366):12381.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChang KJ, Seow KM, Chen KH, Preeclampsia. Recent Advances in predicting, preventing, and managing the maternal and fetal life-threatening condition. Int J Environ Res Public Health. 2023;20(4):2994.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVaibhav Shandilya, Sinha N, Rani S, Preeclampsia. Prevalence, Risk Factors, and Impact on Mother and Fetus. Int J Cardiovasc Dis Women. 2023;8(3):193\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMou AD, Barman Z, Hasan M, Miah R, Hafsa JM, Das Trisha A et al. Prevalence of preeclampsia and the associated risk factors among pregnant women in Bangladesh. Sci Rep 2021;11(1).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRajalakshmi Subburam, Sharma N, Nimrah A. Insights into feto maternal outcomes in preeclampsia: A tertiary care center descriptive study. IJOGR. 2024;11(4):652\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKhan B, Yar RA, Khakwani A, khan, Karim S, Ali HA. Preeclampsia incidence and its maternal and neonatal outcomes with associated risk factors. Cureus. 2022;14(11).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWadhwani P, Saha PK, Kalra JK, Gainder S, Sundaram V. A study to compare maternal and perinatal outcome in early vs. late onset preeclampsia. Obstet Gynecol Sci. 2020;63(3):270\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRoberts JM, Bodnar LM, Patrick TE, Powers RW. The Role of Obesity in Preeclampsia. Pregnancy Hypertension: Int J Women\u0026rsquo;s Cardiovas Health. 2011;1(1):6\u0026ndash;16.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYan L, Jin Y, Hang H, Yan B. The association between urinary tract infection during pregnancy and preeclampsia: A meta-analysis. Medicine. 2018;97(36):e12192.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDubey S, Sarkar R, Aditya V, Singh R, Dubey VK, Chauhan M. The outcome of preterm births in pregnant women with hypertensive disorders: an observational study. Int J Reprod Contracept Obstet Gynecol. 2023;12(10):3128\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePasokpuckdee K, Dittakarn Boriboonhirunsarn. Incidence of Preeclampsia and Cesarean Section Rate According to the Robson Classification. Cureus. 2023.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGautam SK, Paudel K. Management and Outcome of Preeclampsia/Eclampsia among patient admitted in maternity ward in tertiary hospital. JIOM Nepal. 2013;35(2):30\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKalambe MA, Soni NN, Ali S, Bankar NJ. An Observational Study of Maternal and Perinatal Outcome in Preeclampsia Cases in a Tertiary Care Center. Cureus. 2024;16(4):e59352.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePanda S, Das R, Sharma N, Das A, Deb P, Singh K. Maternal and Perinatal Outcomes in Hypertensive Disorders of Pregnancy and Factors Influencing It: A Prospective Hospital-Based Study in Northeast India. Cureus. 2021.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRadha Bai Prabhu T. Serious Visual (Ocular) Complications in Preeclampsia and Eclampsia. J Obstet Gynaecol India. 2017;67(5):343\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Preeclampsia, maternal morbidity and mortality, neonatal morbidity and mortality","lastPublishedDoi":"10.21203/rs.3.rs-7013535/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7013535/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Preeclampsia is a multisystem progressive disorder characterized by new-onset hypertension and proteinuria or new-onset hypertension and significant end-organ dysfunction with or without proteinuria in the last half of pregnancy or postpartum. Preeclampsia is the major cause of perinatal and maternal morbidity and mortality. The prevalence of preeclampsia is greater in primigravida and nullipara, and disease progression depends on gestational age. Many studies have been conducted worldwide on various maternal and fetal outcomes associated with preeclampsia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003eThe primary objective:\u003c/p\u003e\n\u003cp\u003e·\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; To assess the maternal and perinatal outcomes of pregnancies complicated with preeclampsia from the ³ 26-week period of gestation at the National Referral Hospital of Bhutan.\u003c/p\u003e\n\u003cp\u003eThe secondary objective:\u003c/p\u003e\n\u003cp\u003e·\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; To study the prevalence of preeclampsia at 26 weeks of gestation at the National Referral Hospital.\u003c/p\u003e\n\u003cp\u003e·\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; To determine the sociodemographic factors associated with preeclampsia.\u003c/p\u003e\n\u003cp\u003e·\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; To assess the maternal complications associated with preeclampsia.\u003c/p\u003e\n\u003cp\u003e·\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; To assess the fetal complications associated with preeclampsia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: This was a cross-sectional study with a purposive sampling method conducted with preeclampsia women who were ³ 26 weeks of gestation at the National Referral Hospital of Bhutan. The data were extracted into a structured questionnaire, entered into an Excel sheet and analysed via IBM SPSS STATISTICS version 23. Ethics approval was obtained from the Institutional Review Board, and administrative approval was obtained from the Ministry of Health and Hospital Administration. The study period was from 18\u003csup\u003eth\u003c/sup\u003e May 2024 until 18\u003csup\u003eth\u003c/sup\u003e April 2025.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: The prevalence of preeclampsia in singleton preeclamptic patients ³ during the 26-week period of gestation was 5.9% (113/1900). Thirty-six (32%) patients had early-onset preeclampsia, and 77 (68%) had late-onset preeclampsia. One hundred percent of the patients with PE had ANC booking. The majority of PE patients were primigravida or nullipara. Cesarean deliveries were significantly more common in early-onset PE patients than in late-onset PE patients (92% vs. 52%, p \u0026lt; 0.001). The number of mothers referred to the NICU was found to have clinical significance. A total of 38.9% (44/113) were found to have maternal morbidity, with no maternal mortality. Over 38% (43/113) of the patients with PE had preterm deliveries (\u0026lt;37 weeks of gestation). A total of 38% (42/110) of the babies required NICU care; among them, 2.7% (3/110) of the babies died. A total of 5.3% (6/113) of perinatal deaths occurred; 2 were antepartum fetal deaths, 1 baby showed signs of life after birth but was declared dead on postoperative day 0 prior to NICU admission, and 3 babies expired in the NICU. Preeclampsia was associated with perinatal mortality in 53 per 1000 liveborn neonates at the national referral hospital. NICU care was required for the majority of the newborns born to mothers with early-onset PE compared with those born to mothers with late-onset PE (87.9% vs 16.9%, p\u0026lt;0.001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e: The prevalence of preeclampsia was 5.9% in the study population. Preterm labour and acute kidney injury are the two main complications associated with preeclampsia. Cesarean delivery was significantly more common in patients with early-onset preeclampsia than in those with late-onset preeclampsia. Respiratory distress syndrome was detected in 30% of the patients, and the perinatal mortality rate was 5.6%. The number of perinatal deaths was significantly greater in patients with early-onset preeclampsia. Thus, preeclampsia is associated with significant morbidity and mortality, especially in early preeclampsia patients.\u003c/p\u003e","manuscriptTitle":"Outcomes of pregnancy in women with preeclampsia from the 26-week period of gestation at the National Referral Hospital: A Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-07 12:49:19","doi":"10.21203/rs.3.rs-7013535/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4a5aa1ab-76ff-4d11-bcba-6ffafdc0bf82","owner":[],"postedDate":"August 7th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-09T21:08:21+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-07 12:49:19","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7013535","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7013535","identity":"rs-7013535","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}