TY - JOUR T1 - It Takes a System: Magnesium Sulfate for Prevention of Eclampsia in a Resource-Limited Community Setting JF - Global Health: Science and Practice JO - GLOB HEALTH SCI PRACT DO - 10.9745/GHSP-D-19-00261 SP - GHSP-D-19-00261 AU - Robert L. Goldenberg AU - Elizabeth M. McClure Y1 - 2019/09/16 UR - http://www.ghspjournal.org/content/early/2019/09/16/GHSP-D-19-00261.abstract N2 - Magnesium sulfate is not a silver bullet to reduce maternal mortality associated with preeclampsia/eclampsia. We believe a well-functioning health care system, especially at the hospital level, with competent well-trained providers, adequate equipment, and medications will likely be necessary.See related article by Williams.One hundred years ago in high-income countries, hypertensive diseases accounted for a large proportion of adverse pregnancy outcomes including maternal mortality, stillbirth, and neonatal mortality. Hypertensive diseases include chronic hypertension, pregnancy-induced hypertension, preeclampsia, and its major complication, eclampsia. Presently, although the incidences of chronic hypertension, pregnancy-induced hypertension, and preeclampsia have not changed substantially, rates of progression of preeclampsia to eclampsia and the maternal mortality associated with preeclampsia and eclampsia have changed.1 The vast majority of hypertension-related maternal mortality is associated with eclampsia, but most hypertension-related stillbirths occur in the presence of preeclampsia.2One hundred years ago in high-income countries, eclampsia occurred in about 70 per 10,000 pregnancies, and the maternal case fatality rate in women with eclampsia was about 20% to 40%.2–5 Today, again in high-income countries, eclampsia occurs in less than 1 in 10,000 pregnancies, and the case fatality rate among women with eclampsia is less than 1%. Thus, the improvements occurred both in the progression of preeclampsia to eclampsia and the case fatality rates of women who developed eclampsia, with both complications reduced by about 99%. Most of the reductions in maternal mortality occurred between 1930 and 1970. During those years, substantial advances occurred in the increased use of antenatal care with more visits late in pregnancy, better screening for hypertension and proteinuria during those visits, increased hospitalization for women with preeclampsia, and in those hospitals, more rapid delivery for women with preeclampsia and eclampsia.2Appreciating that much of the preeclampsia-related mortality is associated with the development of … ER -