Health Technologies for Women and Children

Preeclampsia and eclampsia

An overview of devices and innovations that address preeclampsia and eclampsia

Antihypertensive drugs for the management and treatment of hypertensive disorders of pregnancy: Hypertension is the most common medical problem encountered during pregnancy, complicating approximately 10 percent of pregnancies. It is essential to build evidence that differentiates and substantiates the effectiveness and safety of the leading antihypertensive drugs for use in pregnancy and the postpartum period. In addition, to increase access to the most effective drugs and modes of administration, measures must be undertaken such as inclusion in national clinical guidelines and national formularies and increased training on their use.

Biomarkers for Predictive Screening: Over the past decade, research into the discovery and use of biomarkers for predictive screening of preeclampsia has been aggressive; however, many of these technologies are still largely in the developmental stage. Currently, the commercially available kits are more suited to high-resource settings due to cost and technical complexity.

Blood Pressure Measurement Devices: Positive maternal health outcomes for women with preeclampsia/eclampsia depend on timely identification of hypertension using an accurate blood pressure measurement devices (BPMD). The detection of hypertension is often missed because suitable, accurate, and reliable BPMDs are not available, and training in the skills and methods necessary to get a reliable measurement is limited.

Candidate blood‐based biomarkers for preeclampsia testing: Increased access to tests that meet World Health Organization criteria and are affordable will greatly improve the identification of women with preeclampsia and increase their access to treatment packages, ultimately increasing the likelihood of survival for mothers with preeclampsia and their infants.

Deciding on optimal timing for childbirth in pregnancies complicated by preeclampsia: Making a decision for expectant or interventionist childbirth management requires careful consideration of benefits and risks for the woman and her fetus, particularly in settings where accurate means to estimate gestational age are not available and facilities to monitor the woman and fetus or care for premature infants are limited. There is a need for evidence that can be translated into realistic clinical practice guidelines and checklists for use in low-resource settings.

Local/topical hemostatic agents for treatment of postpartum hemorrhage: Local (also known as “topical”) hemostatic agents are applied directly to the affected area of the body and can be used either as a “first aid” measure or as adjunct therapy for management of postpartum hemorrhage. Although the use of local hemostatic agents for various surgical applications has generated a significant body of literature, there are few rigorous randomized trials for their use in postpartum hemorrhage or in low-resource settings.

Magnesium Sulfate Delivery: Devices for the delivery of magnesium sulfate are innovative technologies that make it easier to administer magnesium sulfate, WHO’s recommended treatment for women with severe preeclampsia and eclampsia. This category includes a range of devices that could simplify administration of magnesium sulfate, allowing more low-skilled health care workers to provide this recommended treatment, increasing access in low-resource settings.

Novel therapies for the prevention and treatment of preeclampsia and eclampsia: A number of novel therapies for prevention and treatment of preeclampsia are currently under investigation. If proven to be safe, efficacious, and economical, these therapies may be used to prevent the onset or progression of preeclampsia in women living in low-resource settings.

Preventative Supplements—Calcium and Aspirin: WHO recommends calcium supplementation during pregnancy for all women living in areas where dietary calcium intake is low and low-dose aspirin for women at high risk of developing preeclampsia/eclampsia. A range of supplements exist to address these recommendations.

Proteinuria measurement and urine-based markers for preeclampsia diagnosis: Preeclampsia is characterized by high blood pressure (hypertension) and protein in the urine (proteinuria). Increased access to tests that meet World Health Organization criteria and are affordable would greatly improve the identification of women with preeclampsia and increase their opportunity to access treatment packages, ultimately increasing the likelihood of survival for mothers with preeclampsia and their infants.

Proteinuria Testing: Testing protein in the urine and measuring blood pressure are needed to diagnose preeclampsia. Currently there are several ways to measure protein in urine, but these vary in accuracy, cost, simplicity, and feasibility. Additional testing or adaptation of these technologies is needed.