Clinical signs and symptoms preceding eclampsia: A systematic review of associated warning features
DOI:
https://doi.org/10.35335/midwifery.v14i4.2481Keywords:
Eclampsia, Preeclampsia, Prodromal Symptoms, Systematic ReviewAbstract
Eclampsia is a life-threatening complication of pregnancy that may occur without previously recognized hypertension, and early recognition of women at imminent risk remains difficult. An earlier systematic review found that no single symptom accurately predicted eclampsia, but newer studies have since been published. This systematic review aimed to synthesize evidence on clinical signs and symptoms preceding eclampsia while distinguishing symptom frequency, association, and predictive accuracy. Following PRISMA 2020, PubMed and SagePub were searched on July 6, 2026 for original studies published in English between 2013 and 2026, with eligibility defined using the PICOS framework. Two reviewers independently screened records and extracted data, and risk of bias was assessed with the Joanna Briggs Institute checklists. Seven observational studies from Ethiopia, Ghana, Italy, the United States, South Africa, and Pakistan were included; five were at moderate and two at high risk of bias. Among women with eclampsia, headache (75–88%), visual disturbances (47–65%), and epigastric or right upper quadrant pain (18–46%) were the most frequent manifestations. In the only comparative study of symptoms, these were associated with eclampsia compared with preeclampsia (odds ratio [OR] = 2.56, 5.73, and 2.25, respectively), whereas limb jerking, altered mental state, impaired speech, and confusion showed stronger associations (OR = 20.5–42.0). Younger maternal age, multiple pregnancy, and assisted reproductive technology were also associated with eclampsia. No study reported sensitivity, specificity, or discrimination, and the certainty of evidence for associations was low to very low. These symptoms are warning signs associated with eclampsia rather than validated stand-alone predictors and should prompt assessment of blood pressure, laboratory findings, and maternal risk factors.
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