Pre-eclampsia and eclampsia: global challenges in low resource settings complete with proposed interventions in rural Haiti

Preeclampsia is a complex multi-pathway disease process diagnosed by hypertension with two readings of systolic blood pressure ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg, separated by a 4-6 hour period, and proteinuria with a urine dipstick of ≥ 1+ or ≥ 300 mg per 24 hours, after 20 weeks’ gestation in a previously normotensive patient. Ninety-nine percent of pregnancy related deaths occur in middle and low-income countries (LMIC). Of these deaths, the World Health Organization (WHO) ranks pre-eclampsia and eclampsia as the second leading direct cause of maternal morbidity and mortality, behind only postpartum hemorrhage. A woman born in a developing country has a seven times greater risk of developing pre-eclampsia and a three times greater risk of progressing to eclampsia. This paper seeks to review what we know about the basics of detection and management to encourage thoughtful applications in improving the global burden of pre-eclampsia and eclampsia in low resources settings.