Reducing maternal mortality from preeclampsia and eclampsia in low-resource countries--what should work?

Area of Science:

• Obstetrics and Gynecology
• Public Health
• Global Health

Background:

• Preeclampsia/eclampsia (PE/E) is a critical contributor to maternal mortality, particularly in low-income settings.
• Sub-Saharan Africa faces a high burden of PE/E-related maternal deaths.

Purpose of the Study:

• To evaluate the impact of various interventions on reducing maternal mortality associated with PE/E in sub-Saharan Africa.
• To model the effectiveness of diagnostics, magnesium sulfate (MgSO4) use, and delivery interventions.

Main Methods:

• A decision-tree mathematical model was developed using data from a systematic literature review.
• The model assessed the impact of increased use of diagnostics, hospital transfers, MgSO4, and cesarean section/labor induction on PE/E mortality.
• The study focused on pregnant women in sub-Saharan Africa, using 2012 as a baseline year.

Main Results:

• In 2012, an estimated 17,520 maternal deaths were associated with PE/E in sub-Saharan Africa under current intervention rates.
• Increased use of diagnostics, transfers, and delivery interventions could reduce annual PE/E deaths to 3,750, saving approximately 13,770 lives.
• Higher MgSO4 use alone would prevent an estimated 610 deaths, indicating a smaller impact compared to other interventions.

Conclusions:

• Enhancing PE/E diagnostics, facilitating transfers to higher care levels, and increasing hospitalization for interventions like cesarean section/induction are crucial for reducing maternal mortality.
• While important, the impact of increased magnesium sulfate (MgSO4) use on overall maternal mortality from PE/E appears less significant than other interventions in this region.