Predictive Value of the Signs and Symptoms Preceding Eclampsia: A Systematic Review

Obstet Gynecol. 2019 Oct;134(4):677-684. doi: 10.1097/AOG.0000000000003476.


Objective: To estimate the predictive value of signs and symptoms that occur before onset of eclampsia among pregnant women.

Data sources: Electronic databases, including MEDLINE, EMBASE, Cochrane, and were searched from inception to 2018. Search terms included eclampsia, predict, likelihood ratio, predictive value, and risk.

Methods of study selection: Abstracts and later full texts were selected for review if a diagnosis of eclampsia was made, a comparator arm included (women without a diagnosis of eclampsia), and predictors of imminent eclampsia reported. Of 2,791 retrieved records, 11 were selected. Significant heterogeneity existed between studies, with differing designs, settings, participants, and signs or symptoms. In total, 28 signs or symptoms were reported, with visual disturbances and epigastric pain most common (six studies), followed by headache (five studies), and any edema (four studies).

Tabulation, integration, and results: Data on study characteristics and predictive value of signs or symptoms were extracted, and, where appropriate, bivariate mixed-effect meta-analysis was applied to raw data. None of the pooled estimates were able to accurately predict eclampsia nor rule out eclampsia in their absence, with moderate specificity (83-94%) and poor sensitivity (29-56%).

Conclusion: There is a dearth of high-quality studies investigating the predictive value of imminent signs and symptoms of eclampsia. Owing to the small number of studies, heterogeneity, and inconsistent reporting, it is difficult to provide accurate estimates of the predictive value of prodromal symptoms of eclampsia. Of the most commonly reported symptoms-visual disturbances, epigastric pain, and headache-none were able to accurately predict, nor rule out, imminent eclampsia.

Systematic review registration: PROSPERO, CRD42018095076.

Publication types

  • Research Support, Non-U.S. Gov't
  • Systematic Review

MeSH terms

  • Eclampsia / diagnosis*
  • Female
  • Humans
  • Pre-Eclampsia / diagnosis*
  • Predictive Value of Tests
  • Pregnancy
  • Prenatal Diagnosis / statistics & numerical data*
  • Sensitivity and Specificity
  • Symptom Assessment / statistics & numerical data*