Eclampsia: One of the major causes of maternal death

At 23 years she was expecting her first born but Sanyu Nassazi did not live to see her baby and neither did the baby survive. According to Josephine Tushabe, one of her friends, Sanyu complained of a double vision and difficulty in breathing before she died just three hours later.

“According to the postmortem, Sanyu’s demise was due to eclampsia, a life-threatening complication of pregnancy believed to come as a result of high blood pressure and protein in the urine and manifests as seizures.

According to Dr Daniel Zaake, a gynaecologist at Lifesure Fertility and Gynaecology Centre, Kamwokya, it is one of the most documented causes of maternal death in Uganda, causing about 12 per cent of maternal deaths next to bleeding, infections and abortion in that order.

“It is also characterised by the presence of seizures. Unlike the convulsions you may think of as occurring with certain disorders, these seizures are not related to the presence of a brain condition. No one knows what exactly causes this condition and therefore there is no any effective test to predict when it will occur, or treatments to prevent eclampsia from occurring.

The first stage of this condition is known as preeclampsia, which if not addressed early, can rapidly progress into eclampsia, a rather complex condition. In some cases, seizures or coma may be the first recognisable sign that a pregnant woman has this condition. Key warning signs in a pregnant woman may be mild or severe headaches, blurred vision, swelling of feet, right sided abdominal pain among others. The signs and symptoms depend on the severity of the disease.

Elusive cause
“The actual cause is not known but they are associated with substances around the placenta. However, it is more linked to high blood pressure. It does not mean one must have been hypertensive, some women are normal but their blood pressure rises just hours to delivery or even when they are remaining with one or two months to deliver’’ adds Dr Zaake

He continues, “There has never been any clear evidence suggesting an orderly progression of the disease, beginning with mild preeclampsia progressing to eclampsia. The disease process can begin mild and stay mild, or can be initially diagnosed as eclampsia without prior warning. Eclampsia usually occurs in a woman’s first pregnancy but may also occur for the first time in a subsequent pregnancy.”

Studies have also shown that less than one in 100 women with preeclampsia will develop eclampsia and about 20 per cent of all pregnancies are complicated by high blood pressure resulting in equal percentage deaths that occur in pregnant women the world over.

It may also be seen in women with twins, multiple pregnancies, those older than 35 years, who have high blood pressure before pregnancy, diabetes, and other medical problems such as connective tissue disease and kidney disease and eclampsia may also run in families. It is also associated with problems with the placenta, such as too much or too little placenta or how the placenta attaches to the wall of the uterus.

“There is nothing that any woman can do to prevent either preeclampsia or eclampsia from occurring. Therefore, it is not helpful to assign blame, review or rehash events that occurred either just prior to pregnancy or during early pregnancy that may have contributed to the development of the condition. The best thing is routine antenatal visits for checkup,” advises Dr Zaake.

Challenges in management
Experts advise that with Preeclampsia, one has to take a decision either to deliver the baby or wait as you monitor the mother’s blood pressure. But the ultimate cure is to deliver the baby as it might cause vital organ breakdown.

Dr Paul Kiondo of Makerere University College of Health Sciences says, “Eclamptic mothers who are treated and successfully give birth generally have long-term problems like high blood pressure that persist after delivery, and a risk of developing eclampsia or preeclampsia again in the future. With appropriate treatment, the risk of long-term complications is fairly low.

The most devastating complication of maternal eclampsia is fetal death, babies born to eclamptic mothers as well do have a higher risk of death, and this is most likely because they are at risk of being delivered prematurely.”

Complications
About 70 per cent of women with true eclampsia will suffer some type of complication. These include brain or liver damage, excessive bleeding, kidney problems and swelling of the tissues around the lungs.
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