Thirty five-year-old Fola had complained of mild discomfort in her two eyes. This was followed three days later by progressive difficulty recognising things she used to see far away. Soon, she was unable to see clearly the letters and numbers on her cell phone so she decided to seek help.
“Are you diabetic?” I asked her. “No,” she answered. She added that she had had a test at the onset of her pregnancy and it was normal. She wasn’t hypertensive either. “How far is your pregnancy?” I asked again. “It is in its seventh month,” she replied. She went on to tell me all had been well until now. The first two pregnancies went very well and she had normal single birth deliveries.
As she reeled out her symptoms, my mind went to a number of possible causes of her problem. I had actually commenced my examination as she walked into the consulting room. She didn’t look like someone with severe visual difficulties of recent onset but the distance was rather short for this observation.
Her demeanour too betrayed no anxiety usually associated with sudden visual loss. This must be a gradual, mildly progressive condition, I surmised. I asked a few more questions hoping to get some more clues from her. I drew a blank. Now I had no more option, I had to depend on the accuracy of my examination.
While examining the external part of her eyes, I took a quick look at her tummy. Something unusual struck me. Her tummy was not as protuberant as I would expect for a seven-month-old pregnancy.
“Are you sure of your dates because — She didn’t allow me to finish the sentence before she interjected,
“Doctor I know what you are thinking, I don’t usually have a big tummy. I have been attending antenatal clinic regularly and my obstetrician told me at the last visit that all was well with me and my pregnancy.”
Having found no clue on the surface of her eyes, I proceeded to peep through the window in her eyes (pupils) into the inner recesses of her eyes. I was stunned by what I saw!
“Are you sure everything about this pregnancy has been normal all along,” I asked again in disbelief.
“Yes,” she answered, now visibly disturbed. “Why do you ask doctor? Can pregnancy make my vision worse?” she asked in return. “I can see some changes inside your eyes but I can’t place them yet. I have to put some drops in your eyes to dilate your pupils so I can see better,” I answered.
Several minutes later, I was more than convinced of the problem. “Sister!” I called to one of my senior nurses, “please check Fola’s blood pressure for me.” Sister came back looking very distraught. “What is it?” I asked anxious to hear the result.
She walked up to me and whispered her findings into my ears to ensure that those in the room didn’t hear. “240/160! I can’t believe! I said. “Get me the instrument I‘ll do it myself,” I told her. She was right! Fola’s BP had skyrocketed. I looked at her feet, they were mildly swollen. I gently pressed my thumb over her ankle. There was a lasting indentation or dimple. We call this pitting oedema – an ominous sign.
“You have PET?” I announced to Fola. “What is PET?” she asked. “PET means Pre-Eclamptic Toxaemia. Pre-eclampsia is a complication of pregnancy in which high blood pressure (hypertension) occurs and can lead to a more serious complication called eclampsia. Preeclampsia is also known as toxaemia of pregnancy and pregnancy-induced hypertension. You must see your obstetrician straightaway,” I told her.
After a little more explanation as to the dire consequences if urgent steps were not taken to control her blood pressure, I gave her a letter to take to her obstetrician.
On reflection, I thought Fola was lucky to be alive. There are often no symptoms in early preeclampsia. Symptoms of advanced preeclampsia include headaches, blurred vision and bloating. The cause of preeclampsia is unknown, but it is more common in pregnancies that involve twins, triplets or other multiple births.
It also happens more often in first pregnancies and in women with a personal or family history of diabetes or hypertension. I was glad to hear that Fola had an induced labour and a bouncing baby boy, a few days after her visit. Fola and her baby had been saved by her eye symptoms!