Her Body: An Unnecessary Tragedy

The signs of trouble are subtle at first, and many women might miss them, especially if it's their first pregnancy: swelling in the face, hands and feet, severe headaches, flashes of light or other vision problems. But these symptoms could be warning of a potentially fatal condition for pregnant women and their babies. The condition is called preeclampsia, and if untreated it can progress to life-threatening eclampsia, in which a woman suffers seizures or may even go into a coma. In the United States it's relatively rare for cases of preeclampsia to progress to eclampsia. Doctors in this country—where the majority of women get regular prenatal care—would recognize the swelling and headaches as a sign that a woman's blood pressure was rapidly elevating and would begin treatment. Most likely, the woman and her baby would be fine.

But that's not the case in much of the developing world, where eclampsia is a major cause of maternal mortality. At the Women Deliver conference on maternal health in London earlier this month, experts on eclampsia talked about what measures are necessary to give women all over the world the same quality of medical care that American women enjoy. According to EngenderHealth, a nonprofit group that focuses on reproductive health, the risk that a woman in a developing country will die of preeclampsia or eclampsia is 300 times higher than it is for a woman in an industrialized nation. In some countries, such as Mexico, it's the leading cause of maternal death; in many others it's second to hemorrhaging. The World Health Organization (WHO) says that about 63,000 women die every year of eclampsia and severe preeclampsia. Babies are also at risk if the mother dies before the baby is able to survive outside the womb. It's estimated that as many as 300,000 newborns either die or are disabled each year by complications from preeclampsia or eclampsia.

If a woman develops eclampsia close to her due date, doctors generally induce delivery. That usually stops it. But if the baby is still too small to survive, doctors will try to manage the condition. More than a decade ago WHO and the scientific community in general concluded that the most effective and lowest-cost treatment is magnesium sulfate. (That's the medication most commonly used for women in this country.) But the drug, which is administered intravenously, is not available in much of the developing world, for a number of reasons. In some countries it's not licensed for sale; in others it's not on a list of "essential drugs," medications that WHO defines as necessary for basic public health. And even when magnesium sulfate is available, doctors and other health professionals aren't always trained in how to use it, says Dr. Joseph Ruminjo, senior clinical manager for the Safe Motherhood program at EngenderHealth.

Ruminjo, an obstetrician-gynecologist who has worked in sub-Saharan Africa for more than 20 years, recalls one particularly tragic case about four years ago. The patient had already been treated at a regional hospital before she came to a more advanced facility in Nairobi, but by then it was too late. In the regional hospital she was given an older drug, diazepam (an anticonvulsant that is not as effective as magnesium sulfate), because the doctors weren't up on more recent research. She had another convulsion in the emergency room, and by the time Ruminjo saw her she was brain-dead. Her baby died soon after being delivered by cesarean section. "This one sticks in my mind," Ruminjo says, "but unfortunately there are so many more cases."

Even trained doctors may have trouble getting enough magnesium sulfate to treat all the women who need it, says Dr. Ana Langer, president of EngenderHealth. The profit margin for the medication is relatively small, she says, and as a result pharmaceutical companies have no financial incentive to sell it in many countries. Langer says she and other health-care advocates are trying to work with drug companies to find ways to overcome this problem. To find out more about what you can do to help efforts to treat preeclampsia and eclampsia in developing countries, visit EngenderHealth’s Web site. For more general information about these conditions, check out this list of resources from the National Institutes of Health. It's easy to ignore a problem that may seem thousands of miles away, but we all benefit when mothers and babies are healthy—no matter where they live.

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