Pre-eclampsia challenges and care in low and middle-income countries: Understanding diagnosis, management, and health impacts in remote and developing regions

• Published in: Best practice & research. Clinical obstetrics & gynaecology Vol. 96; p. 102525
• Main Authors: Soundararajan, Revathi, Khan, Tamkin, Dadelszen, Peter von
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.09.2024
• Subjects: Developing Countries; Eclampsia; Female; Gynaecology; Humans; Hypertension; India; Maternal death; Maternal Mortality; Pre-eclampsia; Pre-Eclampsia - diagnosis; Pre-Eclampsia - therapy; Pregnancy; India; Hypertension; Gynaecology; Developing countries; Pre-eclampsia; Eclampsia; Maternal death
• ISSN: 1521-6934; 1532-1932; 1532-1932
• DOI: 10.1016/j.bpobgyn.2024.102525

As an example of a low- and middle-income country (LMIC), India ranks pre-eclampsia among the top three causes of maternal mortality, following haemorrhage and infections. It is one of the primary concerns for maternal and perinatal health in LMICs. Many LMICs lack clear consensus and guidelines for the prevention, diagnosis, and management of hypertensive disorders in pregnancy, including pre-eclampsia. The International Society for the Study of Hypertension in Pregnancy 2021 guidelines address LMIC applications, offering customisable solutions. Atypical presentations of pre-eclampsia contribute to diagnostic delays, resulting in additional adverse maternal and perinatal outcomes. Implementing management strategies faces challenges in both urban and rural settings. Adapting global research involving local populations is imperative, with the potential for cost-effective adoption of international guidelines. Prevention, early diagnosis, and education dissemination are essential, involving healthcare providers and advocacy initiatives. Encouraging government investment in pre-eclampsia management as a public health initiative is important. This article explores socio-economic, cultural, and legislative factors influencing the management of pre-eclampsia in LMICs, addressing emerging challenges and potential partnerships for healthcare provision. •Global maternal mortality from hypertensive disorders of pregnancy (HDPs) has decreased, but disparities persist, especially in LMICs.•Strategies focusing on timely and respectful pregnancy care, preventing delayed referrals, and training skilled health workers is the current need.•A comprehensive approach involving primary, secondary, and tertiary prevention strategies is necessary to achieve MDG targets.•Preparedness for the next obstetric transition stage (Stage IV) by 2035 aims to reduce MMR to less than 50 maternal deaths per 100,000 live births.•Education, collaborative research, and healthcare accessibility promotion in LMICs, possibly via public-private partnerships, are needed.