TREATMENT AND MANAGEMENT OF PRE-ECLAMPSIA AND ECLAMPSIA IN PAKISTAN: A SYSTEMATIC REVIEW OF THE LITERATURE

Abstract

Background: Hypertensive disorders of pregnancy are among the main drivers of illness and death for mothers and newborns. Pre-eclampsia and eclampsia (PE/E) can largely be prevented when care is timely, yet Pakistan, one of six countries responsible for more than half of all maternal deaths worldwide, still carries a heavy burden.

Objective: To synthesise published evidence on the risk factors, consequences, detection, prevention and treatment of PE/E in Pakistan, with special attention to magnesium sulphate (MgSO4).

Methods: Seven databases (PubMed, Google Scholar, Medline/POPLINE, ScienceDirect, Cochrane, WHOLIS and EBSCO Host) were searched for peer-reviewed English-language papers from 2010 to 2025. Two reviewers independently screened titles, abstracts and full texts. Retained papers were grouped as descriptive, risk-factor, health-outcome or intervention studies.

Results: Of 11,766 records identified, 226 papers were kept: 147 descriptive, 20 on risk factors, 33 on other health outcomes and 26 on interventions. Reported risk factors included a first pregnancy, very young or older maternal age, twin pregnancy, diabetes, chronic hypertension, obesity, stress and poverty. Reported consequences included stillbirth, restricted fetal growth, placental abruption, acute kidney injury, HELLP syndrome and maternal death. MgSO4 is officially the first-choice drug and is part of national policy, but it is used far less than it should be because of supply failures, complicated dose preparation, inadequate training and reluctance among providers.

Conclusions: Pakistan’s main shortfall lies in putting policy into practice. Priorities are a dependable MgSO4 supply (preferably prefilled doses), provider training, national clinical guidelines, stronger antenatal care and community-based research.