Government explains cause of high maternal deaths

Friday May 22 2020

Medical care. Mothers under postnatal care at

Medical care. Mothers under postnatal care at Kawempe Referral Hospital on August 23, 2016. PHOTO BY ERIC DOMINIC BUKENYA.  

By TONNY ABET

With a ratio of up to 16 mothers dying on a daily basis while giving birth, maternal and associated infant mortality rates in Uganda remain unacceptably high with preeclampsia being one of the major causes.
Described as an onset of high blood pressure during pregnancy, the exact reason for the prevalence of preeclampsia in Uganda is unknown due to the fact that detailed clinical records of all births are lacking.

The World Health Organisation (WHO), however, estimates that six in every 100 maternal deaths in Uganda are a result of the condition. The country commemorates preeclampsia day every year on May 22 to raise awareness about its severity.
Also responsible for cases of miscarriage and low birth weight, the condition usually begins after the fifth month of pregnancy in women whose blood pressure had been normal, according to experts.
Very low awareness among pregnant women and limited skills of health workers to manage the condition persist as the top bottle-necks towards the fight against preeclampsia.

Ms Prossie Maseruka, a 38-year-old who is eight months pregnant with twins was diagnosed with preeclampsia.
Although the doctor at Kawala Hospital in Kampala where she visits for antenatal care told her about this condition, she thinks it is a normal occurrence among expectant mothers.
Ms Maseruka who lives in Ganda, one of the slums in Wakiso, said all she does is massage her legs when they get swollen.
She believes that the rising blood pressure is not that deadly and will normalise after giving birth.

“It is what happens to most women when they are pregnant,” she said.
Besides the notable swelling of legs, medical experts say, the condition starts manifesting with weight gain because of a large increase in bodily fluid. Patients are also faced with belly pain, severe headaches, dizziness and vomiting.
Dr Sam Ononge, a specialist in gynecology and lecturer at Makerere University College of Health Sciences, says preeclampsia is a silent killer that starts manifesting in late stages.
“One of the challenges is that a woman may not know that they have preeclampsia because it is not manifested. When you start getting the symptoms like severe headache, the situation is already serious,” he said.
He said the condition normally starts manifesting in the fifth month of pregnancy and above.

Dr Richard Idro, the president of Uganda Medical Association (UMA) says preeclampsia usually affects the first or second pregnancy.
“It manifests with rising blood pressure and starts damaging the kidney and so protein starts leaking into the urine,” he said.
He, however, highlights those who are carrying twins or more in their pregnancy as being at higher risk of developing the condition.
Dr Ononge said preeclampsia is basically managed in hospital where the blood pressure is controlled.

“The definite management is the delivery of the baby. Once the baby is delivered, in majority of people, the pressure comes down,” he added.
According to Dr Idro, however, some patients are often subjected to emergency caesarian section to save them and the baby.
“If the blood pressure is high, we actually perform an emergency caesarian section and we deliver the premature baby otherwise it will kill the baby,” he said.

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How it affects mother and baby
Issue. According to Dr Richard Idro, preeclampsia raises the blood pressure and it starts damaging the kidney and so protein starts leaking into the urine. “If the blood pressure rises too high it starts affecting the blood vessels in the brain and the mother can die,” Dr Idro said. The condition can also cause death of the unborn and miscarriage, according to the medical doctor. “The high blood pressure also affects blood flow to the baby in the womb and in worse case scenario, the baby dies. If the blood is not going to the baby, you get intra-uterine fetal death,” he said. Intra-uterine foetal death is the unborn baby dies in the womb,” he said.

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