Morbidity and mortality associated with pre‐eclampsia at two tertiary care hospitals in Sri Lanka

Abstract

The exercise by Dissanayake et al. made an interesting read. Their conclusion that pre-eclampsia in Sinhalese women is associated with increased maternal morbidity and fetal morbidity and mortality is an eye opener to the local health-care providers policy makers and program managers. It also invites further studies on blood pressure variation during pregnancy in Sinhalese women and the postulation of a different cut-off level for diagnosing elevated blood pressure in pregnancy. It may be prudent to educate local obstetricians and other care providers of pregnant women of the detrimental effects of delaying intervention until blood pressure reaches 140/90 mmHg and the likelihood of developing more severe disease by the time the blood pressure reaches the cut-off level which seems to be more suitable for Caucasian women. The study re-evaluates the importance of pre-pregnancy counseling and assessment including blood pressure in fertile women in assessing the rise in blood pressure. As the authors correctly suggest there is an urgent need to invest in specialized maternal care services managing women with pre-eclampsia and neonatal intensive care services in Sri Lanka. In the meantime there are a few drawbacks to the study which need to be considered. The two hospitals utilized to recruit the study samples were teaching hospitals in metropolitan Colombo. These institutions represented only a prescreened and referred group of women from local hospitals and antenatal clinics. So the applicability of the results generated to a larger population is questionable. There may be a type II error accounting for the statistically non-significant result obtained with the booking blood pressures of early onset and late onset groups of pre-eclampsia. This is in contrast to our day-to-day experience in which we often see fluctuating blood pressure values with on-and-off higher readings in early onset preeclamptic patients. The value of uterine artery Doppler in detecting such a subtle change may need to be considered with its reasonable sensitivity specificity rapidity and non-invasiveness in detecting pregnancies destined to develop pre-eclampsia. Though Sri Lanka is not yet ready to supplement all pregnant mothers with a Doppler analysis the future is promising. Moreover it is well-known that blood pressure is poorly measured in clinical practice with digit preference (rounding the final digit of blood pressure to 0). We failed to find a note on this regard in the study. The study does however add some valuable tips to our existing knowledge on gestational hypertension in Sri Lankan women. It opens the door for further studies to generate a novel diagnostic criterion for preeclampsia for Sri Lankan women. (full text)