Characteristics of Pregnant Patients with Preeclampsia at Ngoerah Hospital Denpasar in the Period of January–December 2023

Objectives: Preeclampsia remains a significant cause of maternal and fetal morbidity and mortality worldwide, particularly in developing countries. This study aimed to examine the characteristics of pregnant women diagnosed with preeclampsia at Ngoerah Hospital, Denpasar, during the period January to December 2023.

Methods: This retrospective descriptive study analyzed secondary data from medical records of preeclampsia patients at the Maternity Center of Ngoerah Hospital. Variables included patient demographics (age, parity, and body mass index), employment status, education level, and relevant health history, such as prior hypertension and preeclampsia in previous pregnancies. Additionally, clinical parameters such as gestational age, blood pressure readings, proteinuria levels, and mode of delivery were analyzed. Data collection was conducted using electronic medical records, followed by statistical analysis with SPSS. Results were summarized using frequency distributions and percentages.

Results: Of 787 deliveries, 141 cases (17.91%) were diagnosed with preeclampsia, showing an increase from previous years. Most patients were aged 20–35 years (73.1%), multiparous (59.6%), and obese (49.6%). Blood pressure reached a maximum of 210/140 mmHg, with severe preeclampsia predominating (92.9% with proteinuria). Late-onset preeclampsia (≥34 weeks) was more common (70.2%) than early-onset (<34 weeks, 29.8%). A history of chronic hypertension and preeclampsia occurred in 12.1% and 12.8% of cases, respectively. Most patients were homemakers (53.9%) with a high school education (70.9%). Cesarean section was the primary delivery method (66%), followed by vaginal delivery (17.8%),  assisted delivery (5.6%), and conservative management (10.6%).

Conclusion: This high incidence of preeclampsia emphasizes the importance of targeted preventive measures and early intervention strategies, especially for high-risk groups identified in this population. Enhanced screening and management protocols at Ngoerah Hospital could significantly reduce the burden of preeclampsia and its complications, contributing to improved maternal and neonatal outcomes.

Introduction

Preeclampsia is a multifactorial hypertensive disorder of pregnancy that continues to pose serious threats to maternal and fetal health, particularly in low- and middle-income countries (LMICs), where healthcare systems may face infrastructural and resource-related challenges [1], [2]. The condition typically arises after 20 weeks of gestation and is characterized by the new onset of hypertension—defined as systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg—accompanied by proteinuria (≥300 mg in a 24-hour urine collection) or evidence of maternal organ dysfunction such as renal insufficiency, hepatic dysfunction, thrombocytopenia, or neurological symptoms [3]. Although the precise etiology of preeclampsia remains incompletely understood, it is widely accepted that abnormal placentation and inadequate trophoblastic invasion play central roles in its pathogenesis. These aberrations can lead to impaired spiral artery remodeling, resulting in placental ischemia, systemic inflammation, and widespread endothelial dysfunction [4]. The resultant maternal vascular and inflammatory responses contribute to the clinical spectrum of the disease, which ranges from mild hypertension to severe complications, including eclampsia, HELLP syndrome, intrauterine growth restriction, and preterm delivery.

Given its multifaceted impact, early identification of at-risk individuals and timely intervention are critical components of effective maternal care. This study focuses on assessing the clinical characteristics of preeclampsia patients at Ngoerah Hospital Denpasar in order to inform future screening and management strategies tailored to regional needs.

Materials and Method

Study Design and Setting

This descriptive retrospective study was conducted at the Maternity Center of Ngoerah Hospital in Denpasar, Bali. The hospital, a tertiary referral center, provides specialized obstetric care and is integral in managing high-risk pregnancies, including those complicated by hypertensive disorders such as preeclampsia.

Population and Sample

The study population consisted of all pregnant women diagnosed with preeclampsia who were admitted to Ngoerah Hospital from January to December 2023. Inclusion criteria included patients with documented diagnoses of preeclampsia based on clinical assessments, including blood pressure measurements, laboratory findings, and clinical presentations following standard diagnostic criteria. Cases with incomplete records or unclear diagnoses were excluded to ensure data reliability. A total of 141 patients met the inclusion criteria and were included in the analysis.

Data Collection

Data were collected retrospectively from patients’ medical records, which included demographic information (age, parity, body mass index [BMI]), gestational age, obstetric histories, employment status, educational background, and relevant health history, such as prior diagnoses of hypertension or preeclampsia. Clinical data on preeclampsia indicators, such as systolic and diastolic blood pressure, proteinuria, and associated complications (e.g., eclampsia, HELLP syndrome), were recorded. Additionally, obstetric outcomes, including mode of delivery, were documented.

Data Analysis

Data were entered into SPSS software (Version 23.0; SPSS Inc., Chicago, IL) for analysis. Descriptive statistics, including frequencies, means, and percentages, were calculated to summarize the characteristics of the study population. Categorical variables such as age group, parity, BMI category, gestational age, employment status, educational background, mode of delivery, proteinuria, history of hypertension, and history of preeclampsia were presented in frequency tables. Continuous variables, such as systolic and diastolic blood pressure, were summarized using means and ranges.

Ethical Considerations

Ethical approval for this study was obtained from the Research Ethics Committee of Ngoerah Hospital and conducted in accordance with the Declaration of Helsinki. As the study involved retrospective data collection, patient consent was waived, but data confidentiality and patient anonymity were strictly maintained throughout the research process.

Results

From January to December 2023, a total of 141 pregnant women with preeclampsia were identified at Ngoerah Hospital, Denpasar, making up 17.91% of the 787 deliveries recorded. The majority of patients fell within the 20 to 35 age range (73.1%), while 23.4% were over 35, and a smaller portion (3.5%) were younger than 20 (Table I). Over half of these patients (53.9%) were homemakers, with 41.8% employed in the private sector and 4.3% working as civil servants. Educationally, most had completed high school (70.9%), while smaller groups had primary (7.1%) or middle school education (9.9%), with 3.5% holding a diploma and 8.5% a bachelor’s degree.

Table I. Patient Demographics and Clinical Characteristics

Variable		Frequency (N)	Percentage (%)
Age group	<20 years	5	3.5
	20–35 years	103	73.1
	>35 years	33	23.4
Occupation	Homemaker	76	53.9
	Civil Servant (PNS)	6	4.3
	Private sector	59	41.8
Education level	Primary School	10	7.1
	Middle School	14	9.9
	High School	100	70.9
	Diploma	5	3.5
	Bachelor’s degree	12	8.5
Previous hypertension	No	124	87.9
	Yes	17	12.1
History of pregnancy with preeclampsia	No	123	87.2
	Yes	18	12.8
Parity	Primiparous	57	40.4
	Multiparous	84	59.6
Body Mass Index (BMI)	<18.5 kg/m2 (Underweight)	3	2.2
	18.5–22.9 kg/m² (Normal)	44	31.2
	23-24.9 kg/m² (Overweight)	24	17.0
	>= 25 kg/m2 (Obese)	70	49.6
Gestational age at diagnosis	<34 weeks (Early onset)	42	29.8
	>= 34 weeks (Late onset)	99	70.2
Mode of delivery	Spontaneous vaginal delivery	25	17.8
	Cesarean section	93	66.0
	Vacuum/Forceps	8	5.6
Proteinuria	Positive	131	92.9
	Negative	10	7.1

Regarding medical history, the majority (87.9%) had no prior diagnosis of hypertension, while 12.1% did have a history of the condition. Parity data showed that most patients were multiparous (59.6%), whereas 40.4% were in their first pregnancy. Body mass index (BMI) analysis revealed that 49.6% of patients were classified as obese (BMI ≥ 25 kg/m²), 17.0% as overweight, 31.2% had a normal BMI, and 2.2% were underweight. Finally, most cases (70.2%) were diagnosed after 34 weeks of gestation, with 29.8% identified as early-onset preeclampsia before 34 weeks. These demographic findings underscore obesity and multiparity as significant factors among the preeclampsia cases in this population.

Discussion

This retrospective descriptive study conducted at Ngoerah Hospital Denpasar identified 141 preeclampsia cases out of 787 deliveries in 2023, accounting for 17.91% of all births. This high prevalence is consistent with the global burden of preeclampsia, which remains a leading cause of maternal and perinatal morbidity and mortality, particularly in low- and middle-income countries (LMICs), where delays in diagnosis and resource limitations are common factors contributing to adverse outcomes.

Maternal age emerged as a notable risk factor in this study. Most patients were aged between 20 and 35 years; however, 23.4% were over the age of 35. Advanced maternal age has been associated with a 1.5–2-fold increase in preeclampsia risk due to physiological changes in vascular function and the higher prevalence of chronic diseases such as hypertension and diabetes [3], [4]. Barton and Sibai emphasized the importance of age-based risk assessments in prenatal care to anticipate hypertensive complications [5]. Socioeconomic status, including education and occupation, also appeared to influence preeclampsia risk. In this study, 70.9% of patients had only completed high school, while smaller proportions had lower or higher educational attainment. Low education levels are associated with reduced access to healthcare services and limited knowledge of antenatal warning signs, increasing vulnerability to complications like preeclampsia [6], [7]. Furthermore, over half of the patients (53.9%) were homemakers.

Previous studies have suggested that homemakers, especially in rural settings, may face structural and economic barriers to receiving adequate antenatal care [8]. Regarding medical history, 12.1% of patients had chronic hypertension, and 12.8% reported a previous pregnancy complicated by preeclampsia. These conditions are known to significantly increase the likelihood of recurrence due to persistent vascular damage and maladaptation to pregnancy [9], [10]. Barton and Sibai reported recurrence rates as high as 25%, especially when prior preeclampsia was early-onset or severe in nature [5].

Parity data showed that 59.6% of the affected women were multiparous. Although nulliparity is traditionally recognized as a risk factor, multiparity may also contribute to preeclampsia risk, particularly when associated with long interpregnancy intervals, advanced maternal age, or preexisting conditions [11]. The protective effect of multiparity may therefore be context-dependent and influenced by the presence of comorbidities [12]. Obesity emerged as one of the most dominant risk factors in this cohort, with 49.6% of women classified as obese (BMI ≥25 kg/m²). Obesity is a well-established contributor to the pathophysiology of preeclampsia through mechanisms such as systemic inflammation, insulin resistance, and endothelial dysfunction [13], [14]. Roberts and Gammill demonstrated that obesity triples the risk of developing preeclampsia, underscoring the importance of weight management in preconception care [15].

In terms of clinical presentation, 70.2% of cases were diagnosed at or beyond 34 weeks of gestation, categorized as late-onset preeclampsia. Meanwhile, 29.8% were early-onset, which is often associated with poorer outcomes due to impaired placental development and function [16]. Redman and Sargent differentiated early- and late-onset preeclampsia based on placental versus maternal pathophysiology, with early-onset forms typically reflecting more severe placental pathology [17]. Proteinuria was a defining feature in 92.9% of cases. Severe proteinuria (>2 g/24 hours) is correlated with significantly worse maternal and neonatal outcomes, including intrauterine growth restriction, preterm delivery, and HELLP syndrome [18], [19]. The average systolic and diastolic blood pressures among patients were 160 mmHg and 110 mmHg, respectively, with extreme values reaching up to 210/140 mmHg, indicating severe disease in many cases.

Delivery methods reflected the clinical severity and urgency associated with preeclampsia management. Cesarean section was the most common delivery method (66%), which aligns with current clinical guidelines advocating for expedited delivery in cases of severe or unstable maternal or fetal conditions [20]. The elevated cesarean section rate is also reflective of tertiary hospital practices, where more complex and high-risk pregnancies are managed [21]. Despite the absence of inferential statistical analysis, the descriptive nature of this study provides valuable insight into the clinical and demographic characteristics of preeclampsia at a tertiary care center. It underscores the importance of early screening and intervention among at-risk populations. These findings could serve as a foundation for future analytical research and as a guide for improving antenatal risk assessment strategies in similar settings.

Conclusion

This study reveals a high incidence of preeclampsia at Ngoerah Hospital, Denpasar, particularly among multiparous and obese patients. These findings underscore the significant burden of preeclampsia on maternal health in tertiary healthcare settings that manage high-risk pregnancies. Key risk factors identified in this population included obesity and severe hypertension, which were closely associated with adverse outcomes such as high rates of cesarean delivery and the need for specialized maternal and neonatal care.

The data suggest that early identification and targeted interventions are crucial for managing preeclampsia, especially for high-risk groups. Incorporating both traditional diagnostic markers, such as proteinuria, and emerging biomarkers could enhance early detection and enable healthcare providers to initiate timely, individualized care. Further studies with larger, multicenter populations are recommended to provide more generalizable insights and to support the development of more effective screening and intervention strategies for preeclampsia in similar healthcare settings.

By addressing the identified risk factors and enhancing screening protocols, Ngoerah Hospital and similar institutions can improve maternal and neonatal outcomes, contributing to the broader goal of reducing the impact of preeclampsia in high-risk regions.