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J Obstet Gynaecol Can. 2013 Mar;35(3):215-223. doi: 10.1016/S1701-2163(15)30993-2.

Pharmacotherapy for preeclampsia in low and middle income countries: an analysis of essential medicines lists.

Author information

1
Faculty of Medicine, University of British Columbia, Vancouver BC.
2
Clinician Investigator Program, Department of Medicine, University of British Columbia, Vancouver BC.
3
Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC; Obstetric Medicine, Children's and Women's Hospital and Health Centre, Vancouver BC.
4
Child and Family Research Institute, University of British Columbia, Vancouver BC; PRE-EMPT Program, Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC.
5
PIERS Program, Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC.
6
PRE-EMPT Program, Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC.
7
CLIP Program, Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC.
8
Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC; Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Children's and Women's Health Centre of BC, University of British Columbia, Vancouver BC.

Abstract

OBJECTIVE:

To determine the prevalence of drugs for comprehensive management of preeclampsia in national essential medicine lists (EMLs) in low and middle income countries (LMICs)

METHODS:

We collected EMLs from the 144 LMICs identified by the World Bank through broad-based Internet searches and in collaboration with the World Health Organization. We identified therapies for hypertension, eclampsia, preeclampsia complications (e.g., pulmonary edema, thrombosis), preterm birth, and labour induction contained in the EMLs.

RESULTS:

In 91 EMLs obtained from 144 LMICs, the most commonly listed parenteral antihypertensive therapies were verapamil (63.7%), hydralazine (61.5%), sodium nitroprusside (48.3%), and propranolol (39.6%). The most prevalent oral antihypertensive therapies were nifedipine (95.6%), methyldopa (93.4%), propranolol (90.1%), and atenolol (87.9%). For eclampsia/preeclampsia, magnesium sulphate was present in 84.6% of EMLs and calcium gluconate in 85.7%. For pulmonary edema, most EMLs (94.5%) listed oral furosemide, for thrombosis 92.3% listed heparin, for acceleration of fetal pulmonary maturity 90.1% listed parenteral dexamethasone, and for labour induction 97.8% listed oxytocin or a prostanoid (usually misoprostol, 40.7%).

CONCLUSION:

EMLs of LMICs provide comprehensive coverage of preeclampsia pharmacotherapy. These EMLs may be used as advocacy tools to ensure the availability of these therapies within each country.

PMID:
23470109
DOI:
10.1016/S1701-2163(15)30993-2
[Indexed for MEDLINE]

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