Reducing maternal and fetal mortality related to eclampsia in intensive care through the management of traditional risk factors: prospects in Kinshasa.

Eclampsia remains one of the leading causes of maternal and perinatal mortality, particularly in low- and middle- income countries. Despite the availability of effective treatments, deaths persist, especially among patients ad- mitted to intensive care. This review summarizes current knowledge on the pathophysiology of preeclampsia and eclampsia, highlighting the cascade of events involving defective placentation, angiogenic imbalance, and sys- temic endothelial dysfunction, which cause multiorgan and neurological complications. It also analyzes the tra- ditional risk factors associated with increased mortality : insufficient or absent prenatal care, late recognition of signs of severity, uncontrolled comorbidities, and struc- tural limitations of health systems. Resource-limited set- tings, with a focus on Kinshasa (Democratic Republic of Congo), illustrate the impact of overburdened health ser- vices, limited access to essential medicines and intensive care units, and delays in referral on maternal-fetal prog- nosis. The article proposes concrete ways to improve care and reduce mortality, including strengthening prenatal monitoring, standardizing clinical protocols for blood pressure control and magnesium sulfate administration, providing continuing education for health professionals, and developing effective referral pathways between pe- ripheral facilities and centers with obstetric resuscitation capabilities. These pragmatic interventions, adapted to the local context, can transform the management of ec- lampsia and contribute to a sustainable reduction in ma- ternal and fetal mortality.