Over half a million women die each year from pregnancy related causes, 99% in low
and middle income countries. In many low income countries, complications of pregnancy
and childbirth are the leading cause of death amongst women of reproductive years.
The Millennium Development Goals have placed maternal health at the core of the struggle
against poverty and inequality, as a matter of human rights. Ten percent of women
have high blood pressure during pregnancy, and preeclampsia complicates 2% to 8% of
pregnancies. Preeclampsia can lead to problems in the liver, kidneys, brain and the
clotting system. Risks for the baby include poor growth and prematurity. Although
outcome is often good, preeclampsia can be devastating and life threatening. Overall,
10% to 15% of direct maternal deaths are associated with preeclampsia and eclampsia.
Where maternal mortality is high, most of deaths are attributable to eclampsia, rather
than preeclampsia. Perinatal mortality is high following preeclampsia, and even higher
following eclampsia. In low and middle income countries many public hospitals have
limited access to neonatal intensive care, and so the mortality and morbidity is likely
to be considerably higher than in settings where such facilities are available. The
only interventions shown to prevent preeclampsia are antiplatelet agents, primarily
low dose aspirin, and calcium supplementation. Treatment is largely symptomatic. Antihypertensive
drugs are mandatory for very high blood pressure. Plasma volume expansion, corticosteroids
and antioxidant agents have been suggested for severe preeclampsia, but trials to
date have not shown benefit. Optimal timing for delivery of women with severe preeclampsia
before 32 to 34 weeks' gestation remains a dilemma. Magnesium sulfate can prevent
and control eclamptic seizures. For preeclampsia, it more than halves the risk of
eclampsia (number needed to treat 100, 95% confidence interval 50 to 100) and probably
reduces the risk of maternal death. A quarter of women have side effects, primarily
flushing. With clinical monitoring serious adverse effects are rare. Magnesium sulfate
is the anticonvulsant of choice for treating eclampsia; more effective than diazepam,
phenytoin, or lytic cocktail. Although it is a low cost effective treatment, magnesium
sulfate is not available in all low and middle income countries; scaling up its use
for eclampsia and severe preeclampsia will contribute to achieving the Millennium
Development Goals.