Fetomaternal Outcome of Posterior Reversible Encephalopathy Syndrome (PRES) in Women with Pre-Eclampsia and Eclampsia in a Tertiary Care Hospital in Eastern India – An Observational Study

Abstract

Background: Posterior Reversible Encephalopathy Syndrome (PRES) is a rare yet potentially reversible neurologic disorder seen in severe pre-eclampsia/eclampsia. The late diagnosis may result in permanent neurologic damage and adverse effect on the mother and fetus. Magnetic resonance imaging (MRI) is a very important tool for diagnosing and determining the severity of cerebral involvement.

Objective: To evaluate the fetomaternal outcomes of PRES in women with preeclampsia and eclampsia, and to identify clinical, laboratory and radiological features of poor outcomes.

Methods: An observational study was handled in the tertiary care hospital in the Eastern part of India in hospital setting where 200 pre-eclamptic women with secondary diagnosis of PRES were studied. The demographic data, clinical presentation, laboratory investigations, MR imaging, complications of pregnancy and delivery and neonatal results were recorded. Descriptive statistics, Chi-square test and multivariate logistic regression analysis were used to find independent predictors of adverse fetomaternal outcomes.

Results: The most prevalent neurological manifestation was generalized seizures (81.0%) followed by severe headache (74.0%). MRI showed mainly parieto-occipital involvement (84.0%), and bilateral cerebral involvement (76.0%). Maternal complications consisted of HELLP syndrome (26.0%), admission in the ICU (22.0%) and pulmonary edema (15.0%). Adverse neonatal outcomes were preterm delivery (43.0%), low birth weight (34.0%), admission to NICU (26.0%), and neonatal death (3.0%).  AOR for Diffuse MRI brain lesions, HELLP syndrome Glasgow Coma Scale,  thrombocytopenia and elevated serum creatinine are 5.84, 3.72 , 4.18, 2.94 and 2.56 and p < 0.001 , = 0.001, <0.001, = 0.007 respectively were significant independent predictors of adverse fetomaternal outcomes.

Conclusion: PRES is a potentially devastating neuro-embolic condition in severe cases of pre-eclampsia and eclampsia during pregnancy. The early evaluation with MRI, timely blood pressure control, seizure prophylaxis, and multidisciplinary obstetric management plays major role in the neurological recovery of mother and a good outcome for the neonate. Early detection of high-risk clinical or radiologic parameters enables prompt action and help to minimize fetomaternal morbidity and mortality.