Outcomes of pregnancy in women with preeclampsia from the 26-week period of gestation at the National Referral Hospital: A Cross-Sectional Study

Background : Preeclampsia is a multisystem progressive disorder characterized by new-onset hypertension and proteinuria or new-onset hypertension and significant end-organ dysfunction with or without proteinuria in the last half of pregnancy or postpartum. Preeclampsia is the major cause of perinatal and maternal morbidity and mortality. The prevalence of preeclampsia is greater in primigravida and nullipara, and disease progression depends on gestational age. Many studies have been conducted worldwide on various maternal and fetal outcomes associated with preeclampsia. Objective : The primary objective: · To assess the maternal and perinatal outcomes of pregnancies complicated with preeclampsia from the ³ 26-week period of gestation at the National Referral Hospital of Bhutan. The secondary objective: · To study the prevalence of preeclampsia at 26 weeks of gestation at the National Referral Hospital. · To determine the sociodemographic factors associated with preeclampsia. · To assess the maternal complications associated with preeclampsia. · To assess the fetal complications associated with preeclampsia. Methods : This was a cross-sectional study with a purposive sampling method conducted with preeclampsia women who were ³ 26 weeks of gestation at the National Referral Hospital of Bhutan. The data were extracted into a structured questionnaire, entered into an Excel sheet and analysed via IBM SPSS STATISTICS version 23. Ethics approval was obtained from the Institutional Review Board, and administrative approval was obtained from the Ministry of Health and Hospital Administration. The study period was from 18 ^th May 2024 until 18 ^th April 2025. Results : The prevalence of preeclampsia in singleton preeclamptic patients ³ during the 26-week period of gestation was 5.9% (113/1900). Thirty-six (32%) patients had early-onset preeclampsia, and 77 (68%) had late-onset preeclampsia. One hundred percent of the patients with PE had ANC booking. The majority of PE patients were primigravida or nullipara. Cesarean deliveries were significantly more common in early-onset PE patients than in late-onset PE patients (92% vs. 52%, p < 0.001). The number of mothers referred to the NICU was found to have clinical significance. A total of 38.9% (44/113) were found to have maternal morbidity, with no maternal mortality. Over 38% (43/113) of the patients with PE had preterm deliveries (<37 weeks of gestation). A total of 38% (42/110) of the babies required NICU care; among them, 2.7% (3/110) of the babies died. A total of 5.3% (6/113) of perinatal deaths occurred; 2 were antepartum fetal deaths, 1 baby showed signs of life after birth but was declared dead on postoperative day 0 prior to NICU admission, and 3 babies expired in the NICU. Preeclampsia was associated with perinatal mortality in 53 per 1000 liveborn neonates at the national referral hospital. NICU care was required for the majority of the newborns born to mothers with early-onset PE compared with those born to mothers with late-onset PE (87.9% vs 16.9%, p<0.001). Conclusions : The prevalence of preeclampsia was 5.9% in the study population. Preterm labour and acute kidney injury are the two main complications associated with preeclampsia. Cesarean delivery was significantly more common in patients with early-onset preeclampsia than in those with late-onset preeclampsia. Respiratory distress syndrome was detected in 30% of the patients, and the perinatal mortality rate was 5.6%. The number of perinatal deaths was significantly greater in patients with early-onset preeclampsia. Thus, preeclampsia is associated with significant morbidity and mortality, especially in early preeclampsia patients.