Department of Obstetrics, Women's and Infant's Specialty Hospital, La Paz, Bolivia.
Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
Pregnancy Hypertens. 2019 Apr;16:139-144. doi: 10.1016/j.preghy.2019.03.008. Epub 2019 Mar 14.
The goals of the United Nation's Millennium Summit for reducing maternal mortality have proven difficult to achieve. In Bolivia, where maternal mortality is twice the South American average, improving the diagnosis, treatment and ultimately prevention of preeclampsia is key for achieving targeted reductions. We held a workshop in La Paz, Bolivia to review recent revisions in the diagnosis and treatment of preeclampsia, barriers for their implementation, and means for overcoming them. While physicians are generally aware of current recommendations, substantial barriers exist for their implementation due to geographic factors increasing disease prevalence and limiting health-care access, cultural and economic factors affecting the care provided, and infrastructure deficits impeding diagnosis and treatment. Means for overcoming such barriers include changes in the culture of health care, use of standardized diagnostic protocols, the adoption of low-cost technologies for improving the diagnosis and referral of preeclamptic cases to specialized treatment centers, training programs to foster multidisciplinary team approaches, and efforts to enhance local research capacity. While challenging, the synergistic nature of current barriers for preeclampsia diagnosis and treatment also affords opportunities for making far-reaching improvements in maternal, infant and lifelong health.
联合国千年峰会旨在降低产妇死亡率，但事实证明，这一目标难以实现。在玻利维亚，产妇死亡率是南美洲平均水平的两倍，改善子痫前期的诊断、治疗，最终实现预防，是实现目标的关键。我们在玻利维亚拉巴斯举办了一次研讨会，旨在回顾子痫前期诊断和治疗的最新修订版，了解实施这些修订版的障碍，以及克服这些障碍的方法。尽管医生普遍了解当前的建议，但由于地理因素增加了疾病的流行率，限制了医疗保健的可及性，文化和经济因素影响了所提供的护理，以及基础设施的不足阻碍了诊断和治疗，因此在实施这些建议方面存在着实质性的障碍。克服这些障碍的方法包括改变医疗保健文化，使用标准化的诊断方案，采用低成本技术改善子痫前期病例的诊断和转诊到专门治疗中心，培训方案以促进多学科团队方法，以及努力增强当地研究能力。尽管具有挑战性，但子痫前期诊断和治疗当前障碍的协同性质也为改善母婴和终身健康提供了广泛的机会。
