In July 1998, a planning meeting for the demonstration projects was held with Tver Oblast Department of Health
officials, including the Director of Health, the Head of Maternal and Child Health, the Head of Obstetrics/Gynecology, the
Head of Neonatology, selected practicing physicians, quality improvement experts, a representative of CPHRI, and representatives of Tver State Medical Academy. A steering committee was formed later, with many of the same people, to
oversee the work of the project. One goal of the planning meeting was to determine the maternal health problem most
in need of improvement in Tver Oblast. Pregnancy-induced hypertension (PIH) was chosen because it was the single
largest cause of maternal mortality in Tver Oblast, the major cause of complications in pregnancy, and a cause of complications in newborns. In 1997, cases of PIH occurred in 18.1 percent of all pregnancies, and the number of severe forms totaled 4.3 percent of all pregnancies; for the first six months of 1998, these figures were 16.3 percent and 3.2 percent, respectively.i On average worldwide, cases of PIH (preeclampsia) amount to approximately 5 percent of total
pregnancies: less than one third the Tver figures.