Preeclampsia in low and middle income countries-health services lessons learned from the PRE-EMPT (PRE-Eclampsia-Eclampsia Monitoring, Prevention and Treatment) project.
The hypertensive disorders of pregnancy, in particular preeclampsia, matter because adverse events occur in women with preeclampsia and, to a lesser extent, in women with the other hypertensive disorders. These adverse events are maternal, perinatal, and neonatal and can alter the life trajectory of each individual, should that life not be ended by complications. In this review we discuss a number of priorities and dilemmas that we perceive to be facing health services in low and middle income countries as they try to prioritize interventions to reduce the health burden related to preeclampsia. These priorities and dilemmas relate to calcium for preeclampsia prevention, risk stratification, antihypertensive and magnesium sulphate therapy, and mobile health. Significant progress has been and is being made to reduce the impact of preeclampsia in low and middle income countries, but it remains a priority focus as we attempt to achieve Millennium Development Goal 5.
Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC; Child and Family Research Institute Reproduction and Healthy Pregnancy Cluster, Vancouver BC.
Peter
P
von Dadelszen
Child and Family Research Institute Reproduction and Healthy Pregnancy Cluster, Vancouver BC; Department of Medicine, University of British Columbia, Vancouver BC.
Tabassum
T
Firoz
Maternal Health, Family Health Department, Bill & Melinda Gates Foundation, Seattle WA.
France
F
Donnay
Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC; Child and Family Research Institute Reproduction and Healthy Pregnancy Cluster, Vancouver BC.
Rebecca
R
Gordon
Department of Obstetrics and Gynaecology, Walter Sisulu University, East London, South Africa.
G
G
Justus Hofmeyr
Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC.
Shifana
S
Lalani
Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC; Child and Family Research Institute Reproduction and Healthy Pregnancy Cluster, Vancouver BC.
Beth A
BA
Payne
Magee-Women's Research Institute, University of Pittsburgh, Pittsburgh PA.
James M
JM
Roberts
Maternal Health, Family Health Department, Bill & Melinda Gates Foundation, Seattle WA.
Katherine C
KC
Teela
Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC; Child and Family Research Institute Reproduction and Healthy Pregnancy Cluster, Vancouver BC.
Marianne
M
Vidler
Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC; Child and Family Research Institute Reproduction and Healthy Pregnancy Cluster, Vancouver BC.
Diane
D
Sawchuck
Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC; Child and Family Research Institute Reproduction and Healthy Pregnancy Cluster, Vancouver BC; Department of Medicine, University of British Columbia, Vancouver BC.
Laura A
LA
Magee
D002118:Calcium / Q000008:administration & dosage / Q000009:adverse effects; D003906:Developing Countries; D004461:Eclampsia / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy; D005260:Female; D006801:Humans; D007182:Income; D008427:Maternal Health Services; D011225:Pre-Eclampsia / Q000453:epidemiology / Q000517:prevention & control* / Q000628:therapy*; D011247:Pregnancy; D011507:Proteinuria / Q000628:therapy
D002118:Calcium