28. The massive problem of preeclampsia in indonesia: In need of a redesigned national health care system
Preeclampsia is a global maternal health burden due to its high maternal mortality and morbidity, especially in low income countries like Indonesia. The present national multicenter study was conducted to evaluate the characteristics and outcomes of preeclampsia in Indonesia, that has never been pub...
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| Published in: | Pregnancy hypertension Vol. 13; p. S16 |
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| Main Authors: | , , , , , , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
Elsevier B.V
01-10-2018
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| Online Access: | Get full text |
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| Summary: | Preeclampsia is a global maternal health burden due to its high maternal mortality and morbidity, especially in low income countries like Indonesia. The present national multicenter study was conducted to evaluate the characteristics and outcomes of preeclampsia in Indonesia, that has never been published before.
This is a one year (2016) retrospective multicenter study of all preeclampsia cases in seven tertiary referral centers in Indonesia: Medan, Bandung, Semarang, Solo, Surabaya, Bali, and Manado.
Among the total 1232 preeclampsia (PE) cases registered, late-onset preeclampsia (>34 weeks) was the most common PE phenotype; 54% compared with 48% early-onset PE. Many of the preeclamptic women had known risk factors for preeclampsia, including anemia (26%), obesity (10%), and chronic hypertension (8%). Maternal mortality was quite high (2.2%). Maternal complications were dominated by HELLP syndrome (9.8%) and pulmonary edema (6.5%). About 11.9% of the mother required ICU admission. Most of our patients underwent cesarean Section (52.8%). Perinatal mortality rate was 12%. The most frequent perinatal complication was asphyxia (27%). 11% of these newborn needed NICU admission.
In contrast to most Western countries, the rate of preterm PE and pulmonary edema in Indonesia seems much higher than published. The new format of our national health coverage (BPJS) does often not cover the real cost of hospital treatment. The true hospital costs is in more than 93% of preeclampsia patients exceeding the BPJS funding, and the excess costs must be borne solely by the hospital. As such PE represents also a major financial problem for the already struggling public hospitals in Indonesia.
Preeclampsia stands out as a massive health care problem in Indonesia. Improving quality and consistency of antenatal care and a complete redesign of the national health care insurance system will be the pivotal steps forward to reduce its terrible impact. |
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| ISSN: | 2210-7789 2210-7797 |
| DOI: | 10.1016/j.preghy.2018.08.051 |