[Blood pressure complications of pregnancy: through collaborative studies, WHO seeks solutions]. / Les troubles tensionnels de la grossesse: par des etudes collectives, l'OMS cherche des solutions.

PIP: Eclampsia, an obstetrical emergency described in medical texts going back over a century, is characterized by convulsion, loss of consciousness, and high risk of death in the absence of careful medical treatment. Many cases can be prevented if the signs are recognized and treated in time. High blood pressure often giving rise to severe headaches, proteinuria, and edema causing abnormal swelling of the arms, legs, and face are precursors. The possibility of preventing eclampsia led the World Health Organization to undertake a collaborative study of the prevalence, causes, and effects of hypertensive disorders of pregnancy in different parts of the world. The principal investigators of 7 countries who met in Singapore to compare their findings noted strikingly different rates of eclampsia and preeclampsia in the 4 Asian countries represented. Edema was found to be a useful indicator of increased risk where health resources are scarce and the incidence of hypertension and edema are low. A study of maternal mortality in Jamaica around this time found that about 1/3 of deaths from direct obstetrical causes resulted from hypertensive disorders, most often eclampsia. The Jamaican researchers proposed a research project using techniques developed during the collaborative study. Data on more than 10,000 pregnant women allowed detailed study of hypertension, preeclampsia, and eclampsia. Among the women, .72% had had a crisis of eclampsia and 10.4% had hypertension, accompanied by proteinuria in about half the cases. Primigestes, women over 30, and those gaining more than normal amounts of weight during pregnancy were identified as at increased risk. The best indicator of risk was the coexistence of at least 2 out of 3 factors: edema, diastolic pressure of 80 mmHg or over, and proteinuria. The findings caused Jamaica to launch 2 programs, the 1st to screen pregnant women for risk factors for eclampsia and provide special care, and the 2nd to provide small doses of aspirin to half of pregnant women and a placebo to the other half to verify whether small doses of aspirin are an effective means of preventing eclampsia. The World Health Organization is supporting a controlled study of the efficacy of calcium tablets in preventing eclampsia in Peru and is considering a study comparing 2 different regimes for treating eclampsia in Argentina.^ieng