Phenotypic profile of eclampsia and severe preeclampsia in intensive care units in kinshasa: A multicenter cross-sectional study

Introduction Eclampsia is a severe pregnancy-related hypertensive disorder, characterized by the onset of seizures in women with pre-existing preeclampsia, typically occurring after 20 weeks of gestation. It remains one of the leading causes of maternal morbidity and mortality worldwide, particularly in low-resource settings. Eclampsia and its precursor, severe preeclampsia, continue to present significant challenges in maternal health care, accounting for a substantial proportion of obstetric complications and maternal deaths, especially in sub-Saharan Africa, where access to specialized care is often limited. Background: Eclampsia, a severe complication of preeclampsia, remains a major cause of maternal morbidity and mortality, particularly in low-resource settings. Understanding the phenotypic profiles of affected women in intensive care units (ICUs) can improve risk stratification and guide targeted management. This study aimed to describe the clinical, biological, and evolutionary characteristics of women with eclampsia admitted to ICUs in Kinshasa. Methods: We conducted a multicenter cross-sectional study across six tertiary and secondary ICUs in Kinshasa from January 2019 to December 2022. All women admitted with eclampsia were included. Data were retrospectively collected from medical records and ICU registers, covering sociodemographic characteristics, clinical presentation, organ dysfunctions, therapeutic interventions, and maternal outcomes. Descriptive statistics summarized patient characteristics, and bivariate analyses identified factors associated with ICU mortality. Results: A total of 212 women were included. The median age was 29 years, and 68.4% were referred from other healthcare facilities. Primiparity was common (41.5%). Neurological complications were frequent, with 42.9% experiencing seizures and 17.5% presenting with a Glasgow Coma Scale ≤ 8. Renal dysfunction (21.7%), HELLP syndrome (12.7%), and pulmonary edema (16.5%) were also observed. Magnesium sulfate and antihypertensive therapy were administered to the majority of patients. Overall maternal mortality was 14.2%, predominantly among women with neurological, renal, or multi-organ involvement. Phenotypic classification revealed four main profiles: neurological, renal/HELLP, cardiovascular/respiratory, and multi-organ involvement, with the last exhibiting the highest risk of death. Conclusion: Eclampsia in Kinshasa primarily presents with neurological, renal, and cardiovascular complications, which strongly influence ICU mortality. Phenotypic classification offers a practical framework for early identification of high-risk patients, optimizing ICU management, and informing health strategies in resource-limited settings.