Cardiac dysfunction in pre-eclamptic and eclamptic women: A prospective study
Pre-eclampsia (PE) is a clinical syndrome of maternal endothelial dysfunction manifesting with elevated blood pressure and abnormal renal, liver, haematological and neurological function with potential fetal growth impairment. It remains one of the major causes of maternal morbidity and mortality, affecting 5–8% pregnancies worldwide. Cardiovascular manifestations in PE are variable, which may be either secondary to endothelial dysfunction, hypertension, sub-clinical left ventricular dysfunction or other undetermined primary pathological mechanisms.
The study aimed to explore the cardiac status structurally as well as physiologically in pregnant women with PE and eclampsia, in addition to correlate echocardiographic dysfunction with antenatal outcome, as well as cumulative outcome at 6 weeks of post-partum period.
This prospective observational study was conducted in the department of Obstetrics and Gynaecology over 12-months in pregnant women after 20 weeks of gestation presenting with pre-eclampsia/eclampsia, who were followed up-to 6 weeks of post-partum period.
A total of 150 PE patients (83 mild-PE, 48 severe-PE, and 19 eclampsia), with median age of 22.5 years were studied. The lower gestational age of presentation, lower/absent antenatal check-ups and past history of PE/eclampsia were significantly associated with eclampsia. Cardiovascular complications occurred in the form of heart failure, arrhythmia, coronary artery disease, peripartum cardiomyopathy, and unmasking rheumatic heart disease; of which, only heart failure showed significant result. 2-D echocardiographic evaluation showed abnormality in 20 patients (13.33%), with predominant isolated diastolic dysfunction (18 patients), followed by combined systolic and diastolic dysfunction (2 patients). The diastolic parameters showed a significantly higher IVRT, E/A ratio, E, E-deceleration time and E/e/ in eclampsia and severe PE. Systolic dysfunction occurred in one patient of PE with severe features and eclampsia each.
Women with PE with severe signs and eclampsia have a higher risk of developing cardiovascular dysfunction in comparison to those with PE without severe signs. This study concludes that pre-eclampsia and Eclampsia can lead to predominant diastolic dysfunction in pregnancy. Cardiac dysfunction may have a role in the maternal and perinatal outcome in pre-eclampsia and eclampsia. Eclampsia has a worse outcome in comparison to PE, with an increased risk of morbidity and mortality. Factors like early gestational age of presentation, lack of ante-natal visits, nulliparity, uncontrolled hypertension, increased body-mass index, abnormal echocardiogram and cardio-neurological complications can lead to adverse outcome in PE and Eclampsia. The future research should focus on ensuring better pre-conception awareness, antenatal care, life-style modifications for blood pressure and weight management, timely cardiac evaluation in high-risk women for PIH prevention.
Source: Shakya et al. / Indian Journal of Obstetrics and Gynecology Research 2026;13(2):249–257
