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Outcomes are less favorable in women living in developing
Introduction
The International Society for the Study of Hypertension in Pregnancy defines preec- lampsia as hypertension of at least 140/90 mmHg on two separate occasions $4 hours apart accompanied by significant proteinuria of at least 0.3 g in a 24-hour collection of urine (or .30 mg/mmol protein/creatinine ratio), arising de novo after the 20th week of gestation in a previously normotensive woman and resolving completely by the 6th postpartum week.1,2 Preeclampsia complicates 2%–8% of pregnancies and occurs most commonly during the second half of pregnancy.2 While overall rates of preeclampsia remain static, rates of severe preeclampsia appear to have increased over recent decades.3 Preeclampsia is responsible for approximately 15% of all direct maternal deaths in the UK. Furthermore, the condition increases perinatal mortality, largely through iatrogenic prematurity, by five-fold.4–7
Recent reports from the World Health Organization (WHO) estimate that preec- lampsia is directly responsible for 70,000 maternal deaths annually worldwide.8 In addition to the maternal mortality and morbidity, preeclampsia accounts for 500,000 infant deaths annually.4 Preeclampsia is a heterogeneous disorder affecting multiple organ systems. While the severity of clinical presentation is highly variable, outcomes are usually favorable when mild preeclampsia develops after the 36th week. The risk of adverse maternal and perinatal outcome increases significantly when preeclampsia develops early, before 33 weeks’ gestation, or at any gestation in those with preexist- ing medical conditions. Outcomes are less favorable in women living in developing
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