Let’s prepare for the unexpected guest who always arrives at odd hours: Pre-eclampsia

Anu Joseph*

Consultant Obstetrician and Gynaecologist, Kauvery Hospital Electronic City, Bengaluru, India

*Correspondence: doctoranujoseph@yahoo.com

Pre-eclampsia is one of the most dreaded complications in pregnancy and puerperium for the obstetrician and the patient alike. It is the hypertensive disorder of pregnancy with elevated blood pressure. It is often accompanied by signs and symptoms suggestive of multi-organ dysfunction, usually liver and kidneys.

The disease itself is a spectrum, with all shades of grey. If well screened for, and placed on prophylactic measures, the pregnancy continues smoothly with little or no complications. On the other hand, without proper identification and without timely medical interventions, it can cause loss of the mother and the child. It remains ranked amongst the top three causes of maternal mortality worldwide and in India, along with obstetric haemorrhage and sepsis.

From the time of Hippocrates and beyond, there has been various postulates about the disease. However, even today, with all the technological advances in the field of medicine, we are left with multiple postulates of the cause, multiple pathways, and no single root cause or pathway to describe what goes wrong. However, the symptoms and the disease progress are well defined. There is increase in blood pressure above 140/90mmHg, there is placental insufficiency, fetal growth restriction, and there is evidence of multisystem affliction on investigations. All of these in varying severity from patient to patient, and from pregnancy to pregnancy.

With this background, we, a group of like-minded High-Risk Pregnancy and Fetal Medicine practitioners from various parts of the world who joined under the common umbrella of the Society of Maternal Fetal Medicine (India), looked into the feasibility of Pre-eclampsia detection, screening and treatment to reach all the corners of India and if possible, the world. Thus, was born PEN(I)- Pre-eclampsia Education of the Nation (India). This project aims to upgrade the knowledge and skillsets of healthcare workers with the latest guidelines and evidence-based practices related to pre-eclampsia through certification which could empower them to manage the disease more appropriately, contributing to reduction in adverse outcomes.

As the phase 1 of this project, an online certification course was launched on the auspicious occasion of the World Pre-eclampsia Day, May 22, 2021. It is one of the most collaborative, comprehensive, educational, certification module course on Hypertensive Disorders in Pregnancy with special emphasis to Preeclampsia. As one of the concept builder and faculty for the programme, I can vouch for the usefulness of the program to every practitioner from various specialities who may be faced with the responsibility of caring for women with pre-eclampsia. It has something for everyone: General practitioner, Obstetrician, Pediatrician, Internal Medicine or its sub-specialities, Intensivists, Anaesthetists, Nurses, etc.

The course is accredited by SMFM(I) and ISSHP (International Society for the Study of Hypertension in Pregnancy). It shall have both the Indian and global perspectives on the disease, discussed by renowned Indian and International faculty. At the end of a comprehensive set of six modules discussing various pertinent points, there would be an Objective Based Test (OBT)and Case-Based Comprehension Test (CBCT) assessment followed by certification. Details of the course are available on http://smfmi.comhttp://smfmi.com/docs/finalpen.pdf

We hope the word spreads, and the management of pre-eclampsia gains more momentum!

Let’s save mothers and their unborn from the unwelcome, often unrecognised visitor called pre-eclampsia in pregnancy.


Dr. Anu Joseph

Consultant Obstetrician and Gynaecologist