World Preeclampsia Day: What expectant mothers should know

Tomorrow will mark the second year since May 22, was declared World Preeclampsia Day. The day is to raise awareness about the on-set hypertension also known as preeclampsia known by very few women of child bearing age and expectant mothers.
Statistics from Mulago National Referral Hospital’s gynaecology and obstetrics department indicate that at least 26 out of the 136 maternal deaths registered annually result from preeclampsia.

On July 7, 2017, several hospitals failed to manage the case of a five month pregnant mother who was rushed there and had to refer the case to Kawempe General Hospital where doctors failed to save her life. It was apparently too late. Grace Hailat Kaudha, the former Iganga District Woman MP, passed on the next day Saturday July 8, 2017 as a result of preeclampsia. She was serving her first term in Parliament.
The 31-year-old legislator had reportedly not attended any antenatal care apparently due to her busy schedule which involved both attending to her constituents and attending plenary sessions. This, the mourners supposed, could have made it very hard for the doctors to monitor and also manage her condition.

Experts
Gynecologists as well as other general doctors however, strongly caution women to always make time for antenatal visits regardless of their work schedule. According to Dr Vincent Karuhanga, a general practitioner at Friends Polyclinic in Kampala, preeclampsia occurs when vessels of the placenta are abnormal and do not give the child enough blood and oxygen.
As a result, he says, the condition weakens the immune system and causes high blood pressure of the mother. “It causes complications in mothers. The child may be born dead or too small while the mother may suffer high blood pressure for the rest of her life and heart issues,” Dr Karuhanga says. At worst, he says preeclampsia damages other major organs of the body such as the kidney, brain and liver which makes it irreversible causing death in most cases.

Signs and symptoms
Dr Karuhanga advises expectant mothers to watch out for the signs and symptoms of preeclampsia by attending antenatal care often as recommended by the doctors.

“Some of the first signs to watch is when a mother comes in with swollen legs, hands and fingers, shortness of breath, sudden weight gain, a very fast heart rate and flashing lights in the eyes,” he adds. The condition, Dr Karuhanga says, progresses to eclampsia when a woman starts getting convulsions, warning people against visiting traditional doctors because chances are both the mother and the baby will die due to delayed medication.

“For example, a woman should be able to tell that something is not right when their wedding ring stops fitting. This might indicate she has a lot of water in her body. So, even with the absence of other signs of the condition, the mother should rush to hospital for a checkup,” he says. He advises expectant mothers to take note of their ring fitness since they may not get any other signs, asking those who do not wear rings to at least secure one as a measure of monitoring their weight.

Management
A preeclampsia ward was also created at Mulago National Referral Hospital’s gynaecology and obstetrics department which has since been shifted to Kawempe General Hospital to give way for the ongoing construction of the referral hospital.
Dr Annette Nakimuli, the department head, says at least eight out of the 100 admissions at the obstetrics and gynaecology ward are as a result of onset high blood pressure during pregnancy.

Dr Jafhar Nyombi, a gynecologist at Naguru General Hospital in Kampala, adds that women ought to know that the condition makes a pregnancy high risk and fatal and hence the need to be vigilant. “Other signs usually develop in the severe form of disease…but usually look out for headache, blurred vision, pain in the epigastrium (upper side of the abdomen, swollen feet , and high blood pressure ,” he states.
Dr Nyombi further cautions mothers against self-medication which causes delays in seeking treatment.

Challenges
The Sexual and Reproductive Health Commodities: Measuring Prices, Availability and Affordability Data collection Report - Uganda 2017 points out, among others, the rampant stock-out of Magnesium Sulphate, a drug prescribed for pregnant mothers with pre-eclampsia, as one of the leading causes of maternal deaths.
“Magnesium Sulphate, used in the treatment of pre-term labour and pre-eclampsia had low availability across all sectors; no sector had it available at more than 30 per cent of facilities,” the report, reads in part.

The exact cause of preeclampsia is not known and the exact number of women who develop preeclampsia in Uganda is also unknown. The World Health Organisation estimates the incidence of preeclampsia to be seven times higher in developing countries (2.8 per cent of live births) than in developed countries (0.4 per cent).
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