Hypertension leading cause of maternal deaths at Mulago

Thursday May 25 2017
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A midwife attends to an expectant mother. A total of 26 out of the 136 maternal deaths registered last year at Mulago National Referral Hospital were as a result of preeclampsia

KAMPALA: A total of 26 out of the 136 maternal deaths registered last year at Mulago National Referral Hospital were as a result of preeclampsia, the head of the gynaecology and obstetrics department has said.
Dr Annette Nakimuli, the department head said that eight out of the 100 admissions at the obstetrics and gynaecology ward are as a result of onset high blood pressure during pregnancy, a medical conditional called preeclampsia.

“We have since established a four bed preeclampsia ward but they keep flowing to other wards because the numbers surpass the space,” Dr Nakimuli said last week during a media engagement with health workers, organized by African Medical and Research Foundation (AMREF), an international African organisation to mark the first ever World Preeclampsia Day on Monday.
The inaugural World Preeclampsia Day was marked on May, 22 under the theme ‘Be prepared before lightening strikes’ intended to raise awareness of preeclampsia as a life threatening complication of pregnancy.
The condition, Dr Nakimuli said is, however, worsened by myths and misconceptions attached to it such as witchcraft leading to severe effects like damaging the liver, heart and kidney.

“As a result, we are a unit who takes the biggest number to the renal unit [which provides dialysis treatment for patients suffering from kidney failure],” she said, adding that to save the situation, the hospital has started developing guidelines on how to manage preeclampsia.
Dr Jessica Nsungwa, the commissioner in charge of Reproductive Health noted that despite the high prevalence, the condition has remained one of those which are neglected due to lack of awareness and skills among health workers.
“It is a challenge but there are also a few health workers and midwives who have the confidence to diagnose and treat preeclampsia,” Dr Nsungwa said.

As part of the efforts to reduce the number of maternal deaths occurring due to preeclampsia, Dr Nsungwa promised that they have embarked on grass root campaigns to sensitise communities and create awareness.
Country wide, Ministry of Health confirms preeclampsia is among the top five causes of maternal deaths in Uganda.
Although the exact cause of preeclampsia is not known and the exact number of women who develop preeclampsia is also unknown, statistics from the World Health Organisation indicate that, among women who have had preeclampsia, about 20 per cent to 40 per cent of their daughters and 11 per cent to 37 per cent of their sisters also will get the disorder.
WHO 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).

Unhealthy lifestyle choices may lead to high blood pressure during pregnancy. Being overweight or obese, or failing to stay active, are major risk factors for high blood pressure.
Women that are experiencing first pregnancy are also more likely to have high blood pressure. Fortunately, the following pregnancies with the same partner will have a lower chance of this condition.
Women carrying more than one child are more likely to develop hypertension, as their body is under additional stress from the pregnancy. Maternal age is also a factor, with pregnant women over the age of 40 being more at risk.
Symptoms of preeclampsia include

• Protein in a urine sample


• Abnormal swelling in hands and feet.

• Persistent headaches
High blood pressure during pregnancy can also have an effect on the baby’s growth rate. This can result in a low birth weight. According to the American Congress of Obstetricians and Gynecologists, other complications include:
• Placental abruption (a medical emergency during which the placenta detaches from the uterus prematurely)
• Preterm delivery (defined as delivery prior to 38 weeks of pregnancy)
• Caesarean sections

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