Pre-eclampsia risk remains years later —Experts

Her pregnancy with her first child, a boy, hasn’t been going smoothly. Seven months in, Mrs Helen Ogundipe, a school teacher, who had been running around to conduct the end of the term examination had noticed that her feet and ankles were swollen and she could barely see.

With her friend’s counsel that she takes time off to rest, cut down on salt intake and have her legs raised to reduce the swelling, she assumed all will be well, until she started to feel faint and was rushed to a nearby hospital where she was diagnosed to have severe pre-eclampsia, a condition that causes dangerously high blood pressure in women, often in the later stages of pregnancy.

Unfortunately not many women were this fortunate. Professor Olalekan Adetoro, Principal Investigator, Community Level Intervention for Pre-eclampsia (CLIP), recounted the case of a 20-year-old Mrs Alimatu Oguns (not real name) that died from eclampsia, the full-blown form of preeclampsia.

Mrs Alimatu Ogun’s case started with headache and her mother-in-law took her to a faith-healer to be prayed for, being her first pregnancy.

By the time she started to feel dizzy and could barely see well, the traditional birth attendant she was receiving care from asked her mother-in-law to take her to a nearby district hospital, where her blood pressure was discovered to have escalated to about 200/140mmHg.

Due to several incidences of convulsions, she was transferred to the town’s district hospital where efforts to revive her failed after she became unconscious. Despite the frantic efforts of medical personnel, she died with her unborn baby.

Sadly, pre-eclampsia is a leading cause of pregnancy-related deaths, a feasibility study on the disease in Ogun State, for instance, showed that the disease thrives more in rural areas where there are no medical facilities to look after pregnant women.

“At the community level, three major factors that had contributed to deaths of pregnant mothers are due to preeclampsia where limited access to prompt medical care, adverse cultural practices that make pregnant women patronise faith healers and traditional healers and insufficient health care providers and facilities,” Professor Adetoro, a consultant obstetrics and gynaecologist said.

Professor Bukola Fawole, a consultant Obstetrics and Gynaecologist, University Teaching Hospital (UCH), Ibadan, Oyo State, declared that pre-eclampsia affects women from all races, and about one out of every 10 pregnancies.

“Pre-eclampsia usually occurs after the fifth month of pregnancy till the end of pregnancy. It can also occur in labour or after delivery, till up to the sixth week after delivery,” he added.

He declared that though it is common during labour or shortly before labour, it usually manifests first in pregnancy with very high blood pressure and excessive protein in the urine of a pregnant woman.

Its risk factors, he added, include first pregnancy, pregnancy with a new partner, being pregnant with more than one baby, being younger than 20 or older than 40 years, as well as diabetes and chronic high blood pressure before pregnancy.

“If a mother has a similar experience, then the daughter may be predisposed to it, that is, the chances are higher that the daughter too may experience it,” added Professor Fawole.

Unfortunately, common symptoms pointing to severe preeclampsia such as mild headache, dizziness, discomfort and being unable to breathe well are signs that many women just assume to be due to pregnancy stress or exposure to excessive heat from the sun and therefore, they do not see the need to see a medical doctor.

Paradoxically, the exact cause of preeclampsia is not known, “We think, it is due to abnormal placental formation, but research has revealed that it can be easily prevented if the problem is identified early and treated immediately,” said Professor Fawole.

When pre-eclampsia escalates into eclampsia, which consists of seizures, he declared that it can permanently damage all  the organs in a woman’s body and cause coma, brain damage, heart disease, stroke and death.

In addition, some studies suggest that women with pre-eclampsia are more likely, than women with normal blood pressure during pregnancy, to have high blood pressure after giving birth.

Also, it may lead to poor growth of the baby. Pre-eclampsia can prevent the placenta from getting enough blood. If the placenta doesn’t get enough blood, the baby gets less oxygen and food. This can result in low birth weight, premature birth and even death.

“Severe pre-eclampsia is diagnosed by a blood pressure above 160/100mmHg and excessive protein in urine in a pregnancy that is above 20 weeks and the face and other parts of the body such as the knee need not be swollen,” he added.

However, he declared, “the only effective treatment is when the placenta is delivered after the woman has had the baby. But in a small proportion of cases, the blood pressure may persist particularly if the woman has the tendency to develop hypertension later.”

Meanwhile, Dr Kayode Obembe, consultant Obstetrics and Gynaecologist, Christus Hospital, Ibadan, disclosed  that pre-eclampsia occur more during the rainy season, adding that increasing humidity and a lower temperature is associated with increased incidence of eclampsia.

He declared: “During dry season, there is a lot of evaporation and water escapes from the body but during the rainy season, there is very little evaporation so, the water continues to increase in the cardiovascular system thereby leading to higher incidence of hypertension.”

In reducing complications of pre-eclampsia, Dr Obembe said a woman that stands a higher risk of preeclampsia should ensure she registers early for antenatal care with a specialist, who will continue to monitor her blood pressure and urine for protein regularly.

“This is the best precaution. If it is going high, there are drugs they will give that will lower the blood pressure. And once it is treated very early, the baby will not be compromised or the woman go on to the stage of convulsion, which is eclampsia,” he added.

Also, he said such women are advised to reduce salt intake and ensure they eat balanced diet to ensure they have enough nutrients and vitamins to prevent anaemia. According to him, there is significant relationship between pre-eclampsia and anaemia.

How is pre-eclampsia managed? Its management is by controlling the high blood pressure using a blood pressure lowering medicine and preventing the woman from convulsing using injections of Magnesium sulphate.

In addition, delivery by caesarean delivery may be necessary if there are clinical or obstetric conditions that require a speedy delivery.