emergency-sign-hospital-11649792It is quite unlike the opposite, when you have a platform to speak about pertinent issues affecting man, or woman alike, you take charge and relate your situation. Maternal Mortality continues to remain a leading public health issues because of the special role of women in the society. So when Dr Obinna decided to write this article, since his mother was a victim, it reminds us of the role we all must play… Pre-eclampsia is an obstetric emergency.

Read the article as he sent it to Medical World Nigeria…

Successful pregnancy and eventual delivery of the baby is always the wish of any woman and her family. However, most pregnancies are being endangered by some preventable health conditions which can be detected and sorted out early to avoid any morbidity or mortality that might ensue. According to World Health Organisation, some of the major causes of maternal mortality ( death) includes:

– Obstetrics hemorrhage ( excessive bleeding during and after pregnancy/delivery),  Pre-eclampsia/ Eclampsia, Unsafe Abortion, Obstructed labour and its sequalae e.t.c.

Pre-eclampsia/ Eclampsia are among the common causes of maternal morbidity and death. Pre-eclampsia can be defined as a multi systemic disorder characterised by the presence of hypertension and significant proteinuria in a pregnant woman usually after 20 weeks of pregnancy in a previously normotensive and non proteinuric woman, resolving within 6 weeks of delivery. Eclampsia on its own is Pre-eclampsia + seizure.

Recently, Pre- eclampsia has been a common findings in pregnant women (seen in about 4% of pregnancies) and a major cause of referrals from primary and secondary health facilities to tertiary health facilities. Hardly will you visit obstetric wards of any teaching hospital without seeing women with this problem. In most cases, these woman are ignorant of what is happening to them and how to prevent complications. Hence most presenting late after they have fitted ( had seizure). The unlucky ones having a serious morbidity or eve dieing from it.

There is no doubt that the level of maternal mortality in this part of the world is still very high ( 565/100,000 live births) despite the efforts of our gallant medical personnel working tirelessly to ensure that our women are safe during and after child birth. The major challenge is that of ignorance among our women, hence the need to equip them with necessary information that will help them have successful pregnancy and safe delivery.

Maternal mortality(death) is defined as the death of any woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration or site of the pregnancy from any cause related to or aggravated by the pregnancy itself or its management(World health organisation). Here, one the causes of note is pre-eclampsia.

Pre-eclampsiais one of the leading causes of maternal and even child deaths world wide but more especially in this part of the world. Nearly one tenth of all maternal deaths in Africa are associated with hypertensive diseases in pregnancy.

Some of the risk factors of present eclampsia in pregnancy include: Chronic hypertension, Previous history of pre-eclampsia, Family history of pre- eclamsia, Diabetes mellitus, Abnormal placentation, Obesity, Immunologic factors, Multiple gestation ( Twin pregnancies) and Environmental factors e.g smoking, low calcium supplementation e.t.c has also been implicated.

However, there is no definite known cause of Pre-eclampsia hence the need for proper monitoring of pregnancies by trained health workers, for early identification and management.

Some signs and symptoms include: oedema I.e pitting leg oedema. However, its no longer being used as its often seen in about 50-60% of woman with normal pregnancy. From the definition of pre-eclampsia the two major problems are “HYPERTENSION” and ” PROTEINURIA” ( protein in urine). Hypertension here is defined as blood pressure greater than 140mmhg systolic and 90mmhg diastolic measured 2 separate times and 4 hours apart. While proteinuria is defined as the presence of 300mg or more of protein in a 24 hour urine collection or a protein measurement of 2++ or greater in random urine specimen.

Pre-eclampsia being a multi systemic disorder I.e can affect so many systems in the body if not properly managed can lead to Eclampsia, red blood cell hemolysis, low platelet count, impair liver functions, affect the kidneys, pulmonary oedema and when there is headache + visual disturbances + epigastric pain = Imminent Eclampsia. The end point of pre-eclampsia is maternal or perinatal death.

There is need for us to avoid maternal deaths due to  pre-eclampsia because its preventable and treatable. The only way out to avoid being a victim is by remaining SAFE:

S- Social equity and empowerment for women for women, public health education for women.

A- Regular antenatal care by ALL pregnant women.This will ensure early detection and management and even prevention in high risk women. Women are advised to register for antenatal care immediately they discover that they are pregnant, to help reduce cases of pre-eclampsia and also death during pregnancy from any cause.

F- Family planning especially in high risk patient, to ensure blood pressure control before pregnancy.

E- Emergency obstetric care when eventually there is any victim to prevent maternal death.

Let’s join hands together to save our women from preventable deaths during pregnancy, they need our support. Few years ago it was my mother, today it could be another person’s sister and tomorrow who knows could be your wife.

Excerpts Originally Appeared On Medical World Nigeria



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