Posterior Reversible Encephalopathy Syndrome in Eclampsia: A Prospective Study of Risk Factors and Outcomes

Introduction Posterior reversible encephalopathy syndrome is an important neurological complication associated with eclampsia that contributes significantly to maternal and perinatal morbidity in high-risk pregnancies. This study aimed to determine the prevalence of posterior reversible encephalopathy syndrome in women with eclampsia and to evaluate the associated risk factors, radiological findings, and maternal and perinatal outcomes. Materials and methods This prospective observational study was conducted at a tertiary care teaching hospital in Hyderabad, India, between January 2022 and December 2024. In total, 140 women with eclampsia were enrolled in this study. The diagnosis of posterior reversible encephalopathy syndrome was confirmed using magnetic resonance imaging performed within 48-72 hours of admission. Clinical, laboratory, and imaging data were recorded. Statistical analysis was performed using SPSS Statistics (version 26.0; IBM Inc., Armonk, New York, United States). Continuous variables were compared using the independent samples t-test or Mann-Whitney U test, and categorical variables were compared using the chi-square test or Fisher's exact test. Logistic regression analysis was used to identify the independent predictors. Results Posterior reversible encephalopathy syndrome was observed in 62 (44.3%) women. The syndrome was associated with higher systolic blood pressure (178.4 ± 18.6 vs. 162.3 ± 16.2 mmHg; p < 0.001), higher frequency of three or more convulsions (p < 0.001), delayed treatment (p = 0.002), thrombocytopenia, and elevated serum creatinine (p < 0.001). The independent predictors included systolic blood pressure of 170 mmHg or more (adjusted odds ratio 3.21; p = 0.003), three or more convulsions (adjusted odds ratio 3.68; p < 0.001), delayed treatment (adjusted odds ratio 2.54; p = 0.017), platelet count less than 100 × 10³ per microliter (adjusted odds ratio 2.24; p = 0.044), and serum creatinine of 1.2 mg/dL or more (adjusted odds ratio 2.86; p = 0.008). Maternal complications, including intensive care unit admission (p < 0.001) and acute kidney injury (p < 0.001), were higher in the posterior reversible encephalopathy syndrome group. Neonatal outcomes were also worse, with higher rates of low birth weight (p = 0.001) and preterm birth (p < 0.001). Conclusion Posterior reversible encephalopathy syndrome is a frequent complication of eclampsia and is associated with a severe clinical presentation and adverse maternal and neonatal outcomes. Early identification and timely management of high-risk patients are essential for improving prognosis.