Current knowledge for the early identification, prevention, and monitoring of eclampsia (literature review)

Introduction

Hypertensive disorders from pregnancy continue to be one of the biggest issues in modern obstetrics. These are some of the leading causes of maternal and perinatal morbidity and mortality across the globe [1]. The most prevalent of these disorders are gestational hypertension, preeclampsia, and eclampsia [2]. Of these, eclampsia is the most severe clinical manifestation and is defined by generalized seizures developing in a pregnant or postpartum woman in the presen­ce of preeclampsia [1].

Preeclampsia complicates ~2–8% of pregnancies worldwide as of current epidemiological data [3]. This condition is one of the leading causes of premature delivery and multiple perinatal complications [3]. Although eclampsia happens less frequently than preeclampsia, it is still a serious obstetric complication. This is because there is a corresponding association with both severe maternal and fetal outcomes [1, 3]. These complications include cerebrovascular diseases, organ dysfunction, and intrauterine fetal death [1].

In the recent past, major attention has been paid in obstetrics towards early identification of women with a higher risk of developing preeclampsia [4]. Early recognition of risk groups to prevent these sequelae is important; earlier identification of risk groups helps in implementing preventive intervention that possibly helps avoiding severe complications as long as early identification of risk groups and even the presence of eclampsia [4].

Preeclampsia is driven by abnormal placentation early in pregnancy and is one of the most important mechanisms [5]. Specifically, aberrant trophoblastic invasion and inadequate remodeling of the uterine spiral arteries cause decreased uteroplacental perfusion and placental ische­mia [5]. Those pathological alterations will then result in systemic endothelial dysfunction, enhanced vascular resistance, and coagulation activation [5].

Thus, the present scientific research mainly focuses on enhancing the techniques to have the early prediction and prevention of hypertensive morbidities of pregnancy [7]. Better screening and preventive measures may reduce the risk for severe complications such as eclampsia [7].

Epidemiology

Hypertensive disorders of pregnancy represent a significant global health problem. According to international epidemiological data, preeclampsia affects approximately 2–8% of all pregnancies worldwide. The incidence varies depending on geographical region, socioeconomic status, and accessibility of prenatal care.

Eclampsia occurs less frequently but remains one of the most severe complications of pregnancy. In deve­loped countries its incidence is estimated at 1–2 cases per 2,000–3,000 pregnancies, whereas in developing regions the frequency may be considerably higher due to limited access to adequate antenatal care and delayed diagnosis.

Hypertensive disorders of pregnancy account for a substantial proportion of maternal deaths worldwide. According to global health estimates, they contribute to approximately 10–15% of maternal mortality. In addition to maternal risks, these conditions are strongly associated with adverse perinatal outcomes including preterm birth, fetal growth restriction, placental abruption, and intrauterine fetal death.

Early identification of women at increased risk and the implementation of preventive strategies remain essential components of modern obstetric care aimed at reducing the burden of hypertensive complications of pregnancy.

Objective

The current objective of this study lay in reviewing contemporary scientific evidence regarding current methods to be employed in early identification and prevention of eclampsia.

Aim of the study:

1. To assess prevailing concepts of preeclampsia pathogenesis [5].

2. To profile the main risk factors for hypertensive complication of pregnancy [6].

3. To review modern methods used for predicting preeclampsia early [4, 7].

4. To assess the efficacy of preventive strategies currently recommended [8].

Materials and methods

The current study was built upon the synthesis and ana­lysis of recent scientific literature. A systematic review of rele­vant scientific publications, clinical guidelines, and systema­tic reviews of hypertensive disorders of pregnancy was conducted.

This included consideration of the discoveries (both clinical and international), trends (clinical), and scientific insights (recent) on the underlying mechanisms of development of disease, the early prediction of disease, and prevention methods for preeclampsia and eclampsia [4, 7].

Risk factors for pregnancy prevention for preeclampsia and eclampsia

A variety of conditions of the clinical and maternal aspects have been shown to be major causes of preeclampsia. The most significant ones include:

• previous history of preeclampsia.
• chronic arterial hypertension.
• chronic kidney disease.
• diabetes mellitus.
• autoimmune disorders.
• multiple pregnancy [6].

These major factors are combined with several conditions which are considered to represent a moderate level of risk. These are maternal obesity, first pregnancy, age >35 years to mother and a positive family history of hypertensive complication during pregnancy [6].

Today’s methods for early prediction

Preeclampsia is identified early using a most common early screening method: combined screening in the first trimester of pregnancy. Such a program considers multiple indicators at the same time and considers:

• assessment of medical risk factors in mothers.
• mean arterial pressure measurements.
• doppler ultrasound evaluation of uterine arteries.
• biochemical markers that indicate placental function [4].

Of the available biochemical biomarkers, placental growth factor (PlGF) has been investigated the most. Low levels of this marker are believed to be related to placental dysfunction, and may be considered an indicator of risk of preeclampsia [7].

Consolidation of screening approaches has been shown to be able to detect a significant percentage of pregnant women at high-risk for early-onset preeclampsia [4].

Role of ultrasound methods

Ultrasound, particularly doppler assessment of uterine arteries, is an important screening for preeclampsia. Increased uterine arteries pulsatility index means limited uteroplacental blood flow. These changes may be a precursor to preeclampsia symptoms of abnormal placentation [4].

New approaches to prevention

Acetylsalicylic acid in the most limited dosing form was the method recommended to avoid high-risk women from developing preeclampsia at the time of study [8].

In randomized clinical trials, use of acetylsalicylic acid at doses between 100 and 150 mg per day, when administered initially in the first trimester of pregnancy, has been shown to reduce preeclampsia rates [9].

As well as pharmacological interventions, non-pharmacological interventions have a significant impact. Some of these can be proper body fat, healthy lifestyle, and sufficient calcium during pregnancy [10].

Conclusions

Maternal and perinatal survival outcomes are also associated with such conditions and eclampsia (as the condition) is one of the most serious consequences of a pregnancy or preeclampsia and happens as a consequence of preeclampsia [1, 3].

Recent studies corroborate that the pathogenesis of this condition relies on abnormal placentation, endothelial dysfunction, and impeded uteroplacental circulation [5]. Therefore, early screening of women who are at increased risks is key for the timely delivery of preventive strategies.

The results of the literature review highlight that the efficient prediction of preeclampsia in pregnancy can be achieved with holistic assessment of maternal clinical factors, as well as determination of mean arterial pressure, Doppler ultrasound assessments of the uterine arteries, and biochemical markers including placental growth factor (PlGF) [4, 7].

With both clinical and maternal tests done in the earliest-trimester it can identify a large number of high risk women that could develop preeclampsia. Other preventive interventions are also important for the prevention of hypertensive complications of pregnancy.

It has also been found that if early pregnancy was initiated without intervention, early administration of low-dose acetylsalicylic acid will significantly reduce the risk of developing preeclampsia among women of high susceptibility [9].

Lifestyle changes, maintaining good body weight and getting all the calcium we need also lead to better pregnancy outcomes [10].

Therefore, combining modern screening methods with evidence-based preventive strategies can dramatically reduce the impact of serious hypertensive complications such as eclampsia, as well as enhance maternal and fetal outcomes.

References

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Надійшла до редакції/Received: 27.03.2026
Прийнято до друку/Accepted: 14.04.2026