Reducing maternal mortality from preeclampsia and eclampsia in low‐resource countries – what should work?

Objective Preeclampsia/eclampsia ( PE /E) remains a major cause of maternal death in low‐income countries. We evaluated interventions to reduce PE /E‐related maternal mortality in sub‐Saharan Africa. Design Mathematical model to assess impact of interventions on PE /E‐related maternal morbidity and mortality. Setting Sub‐Saharan Africa countries. Population Pregnant women in sub‐Saharan Africa in 2012. Methods A systematic literature review populated a decision‐tree mathematical model with interventions to diagnose, prevent, and treat women with PE /E. The impact of increased use of interventions [diagnostics, transfer to a hospital, magnesium sulfate (Mg SO 4 ) use, cesarean section/labor induction] on PE /E‐related maternal mortality was analyzed. Main outcome measures Prevalence of PE /E and PE /E‐associated maternal mortality rates in sub‐Saharan Africa. Results Without interventions, an estimated 20 570 PE /E‐associated deaths would have occurred in sub‐Saharan Africa in 2012. With current low rates of diagnosis, Mg SO 4 use, transfers and cesarean section/induction rates, about 17 520 maternal deaths were associated with PE /E in 2012. Higher use of MgSO 4 would have prevented about 610 deaths. With high diagnostic levels, Mg SO 4 use, transfer and cesarean section/induction, mortality was reduced to 3750 annual deaths, saving about 13 770 maternal lives. If all Mg SO 4 use was removed from the model, 4060 maternal deaths would occur, increasing maternal deaths by only 310. Conclusions In sub‐Saharan Africa, our model suggests that increasing use of PE /E diagnostics, transfer to higher levels of care and increased hospitalization with cesarean section/induction of labor would substantially reduce maternal mortality from PE /E. Increasing use of Mg SO 4 would have a smaller impact on maternal mortality.