Creating Standard Protocol for the Diagnosis and Intervention of Preeclampsia
On November 20-22, 2007, a meeting was held in Vancouver, British Columbia to discuss The Preeclampsia Integrated Estimate of Risk Study (PIERS) which was lead by Dr. Peter von Dadelszen. Besides being the lead investigator for the study, Dr. von Dadelszen is also a member of the Preeclampsia Foundation’s prestigious Medical Advisory Board, President of the North American Society for the Study of Hypertension in Pregnancy (NASSHP), and the President of ERIPED (Equipede Recherché Interdisciplinaire sur la Pre-Eclamspie et ses Determinants), Canada’s preeclampsia research alliance.
The goal of the 41-month PIERS study was to create a rigorous standard care protocol for the diagnosis and intervention of preeclampsia and the purpose of the meeting was to move to the next level of the PIERS study. After prospective gathering of data for seven years, and publishing the findings, the next step was to strategize about what had been learned and figure out how to get hospital administrators to adopt the findings as the standard protocol for care.
Representing the Preeclampsia Foundation in non-scientific roles during the two-day PIERS meeting were Executive Director J. Thomas Viall and Fiona Morrow, Forum Administrator and preeclampsia survivor. Morrow was involved in the PIERS study and presented the human component behind the graphs and charts by sharing her story and answering questions. Viall could tell by the eagerness of the interaction that she really got the audience’s attention and described her speech as “emotive and clear.” He said their entire presentation, “…was very powerful. Many of the scientists and medical professionals had tears in their eyes.” They were “just stricken.” Viall credits von Dadelszen with presenting and keeping the human component “front and center” to keep the researchers focused on the importance of the study. “There are moms losing babies, and husbands losing wives,” said Mr. Viall.
The researchers looked at past practice and records of how 400 women were evaluated for, and diagnosed with preeclampsia, as well as the recommendations that were made for intervention. The researchers compiled a snapshot of how, in these 400 cases, monitoring was done; what diagnostic protocols were used, and what interventions were taken. They matched those data to the outcomes of each of the women and found that five percent of the women had negative outcomes (loss of life, stroke, seizures, organ failure, etc). The next step was to develop a standard protocol for all possible cases of preeclampsia, because one cannot predict the outcomes.
Approximately 300 women participated in this phase of the initiative. When the standard protocol of care, which was very stringent, was used for these women, it produced a significant decrease in negative outcomes; which dropped from five percent to approximately seven-tenths of one percent. Viall pointed out, that unfortunately, there was no shift in neonatal outcomes with the standard care protocol. Viall thought this study might present a major opportunity for the Preeclampsia Foundation, in that the Foundation could seek grants to do similar studies in the U.S., based on the PIERS findings. The goal would be to change diagnostic and intervention protocols in the States, though Viall acknowledged that differences in the Canadian and U.S. health care systems might present certain challenges. At a minimum, he said, “the Preeclampsia Foundation could be a clarion voice for the patient by promoting its view of best practices.” We must continue to be the honest broker with no agenda other than minimizing negative outcomes…that will help to save lives.”
Acknowledging that preeclampsia is an even bigger problem in the developing world, the meeting also focused on the development of condensed recommendations for diagnosis and intervention in less developed countries. ”I had the opportunity to meet and speak to the Coordinator of Maternal and Perinatal Health activities within the Reproductive Health Division of the World Health Organization. He was quite impressed with our work and I do believe we will stay in touch and consider ways in which we can collaborate in the future,” said Viall. While delving into the underdeveloped world is “not necessarily a front line mission-issue for the Preeclampsia Foundation, the Board of Directors has begun to look at ways we might begin developing materials and guidelines to have an impact beyond North America,” said Viall.