University of British Columbia, Department of Medicine, Women's Health Centre, Vancouver, Canada.
Best Pract Res Clin Obstet Gynaecol. 2011 Aug;25(4):537-48. doi: 10.1016/j.bpobgyn.2011.04.002. Epub 2011 May 17.
Pre-eclampsia and eclampsia are leading causes of maternal and perinatal morbidity and mortality worldwide. The exact prevalence, however, is unknown. The majority of pre-eclampsia related deaths in LMIC occur in the community and therefore, interventions must be focused at this level. There are a number of unique challenges facing LMIC but the principles of care for women with pre-eclampsia remain the same as in well resourced settings. Three primary delays lead to an increased incidence of maternal mortality from pre-eclampsia- delays in triage, transport and treatment. There are a number of other challenges facing LMIC and the health care worker shortage is particularly significant. Task shifting is a potential strategy to address this challenge. Community health care workers, specifically lady health care workers, are an integral part of the health care force in many LMIC and can be employed to provide timely care to women with pre-eclampsia. Prevention strategies should be applied to every pregnant woman since we cannot predict who will develop pre-eclampsia given the limitation in resources. Aspirin and calcium are the only two recommended therapies at this time. Measuring blood pressure and proteinuria is challenging in LMIC due to financial cost and lack of training. A detection tool that is affordable and can be easily applied is needed. Magnesium sulfate is the drug of choice for the prevention and treatment of eclampsia but it is underutilized due to barriers on multiple levels.
子痫前期和子痫是全球孕产妇和围产儿发病率和死亡率的主要原因。然而，确切的患病率尚不清楚。大多数中低收入国家与子痫前期相关的死亡发生在社区，因此，干预措施必须集中在这一层次。中低收入国家面临着许多独特的挑战，但对患有子痫前期的妇女的护理原则与资源充足的环境相同。三个主要的延迟导致子痫前期导致的孕产妇死亡率增加——分诊、运输和治疗的延迟。中低收入国家还面临着许多其他挑战，卫生保健工作者短缺尤其严重。任务转移是解决这一挑战的一种潜在策略。社区卫生保健工作者，特别是妇女保健工作者，是许多中低收入国家卫生保健力量的重要组成部分，可以被雇用来为患有子痫前期的妇女提供及时的护理。由于资源有限，我们无法预测谁会患上子痫前期，因此应该对每一位孕妇应用预防策略。目前，只有阿司匹林和钙被推荐作为两种治疗方法。由于费用和缺乏培训，在中低收入国家测量血压和蛋白尿具有挑战性。需要一种价格实惠且易于应用的检测工具。硫酸镁是预防和治疗子痫的首选药物，但由于多个层面的障碍，它的使用不足。
