ECLAMPSIA .7. PREGNANCY OUTCOME AFTER ECLAMPSIA AND LONG-TERM PROGNOSIS

OBJECTIVES: Our goal was to report pregnancy outcome and long-term prognosis after eclampsia. STUDY DESIGN: Women whose pregnancies were managed at the E.H. Crump Women's Hospital between August 1977 and April 1989 were studied. A total of 223 women with eclampsia underwent follow-up for an average of 7.2 years. Thirteen had preexisting hypertension and 210 were normotensive (31 were multiparous and 179 were nulliparous). RESULTS: Among these women 23 who were multiparous and 159 who were nulliparous had 366 subsequent pregnancies: 22% of pregnancies were complicated by preeclampsia, 1.9% by eclampsia, and 2.5% by abruptio placentae; 2.7% resulted in perinatal death. Within the nulliparous group, women who had eclampsia before 37 weeks' gestation in the index pregnancy had significantly higher incidences of preeclampsia and poor perinatal outcome in subsequent pregnancies as compared with those who had eclampsia at greater-than-or-equal-to 37 weeks' gestation; the highest incidence of obstetric complications occurred in those having eclampsia at less-than-or-equal-to 30 weeks. Twenty of the 210 normotensive women (9.5%) had chronic hypertension on follow-up; the highest incidence (17.9%) being in those with eclampsia at less-than-or-equal-to 30 weeks and the lowest incidence (4.8%) in those having eclampsia at greater-than-or-equal-to 37 weeks. Women with eclampsia who had preeclampsia in subsequent pregnancies had a higher incidence of chronic hypertension as compared with those who were normotensive in subsequent pregnancies (25% vs 2%, p < 0.0001). Long-term maternal complications included dialysis required in one patient and one case of cardiomyopathy in women with chronic hypertension; there was one maternal death in a woman with chronic hypertension. None of the women had evidence of neurologic deficit or seizures during follow-up. CONCLUSIONS: These findings should be used in counseling women who have had eclampsia and are considering future pregnancies.