HEALTH INTERACTIVE WITH DR. AMINU MAGASHI

The Disease “ Eclampsia ”

healthinteractive@hotmail.com

Penultimate Saturday, at about 10:00 PM, when I was preparing to retire to bed, I heard a knock coming from outside, my mind concluded that such night visitation would be a patient. When I opened my door I encountered two gentle men and a lady who at any moment would commence labor. One of them happened to be a former class mate way back in secondary school who escorted the worried couple to me. I asked the husband about the history of their problem, he mentioned among others that, his wife who was nine months pregnant was having consistent head ache, restlessness and body swelling and it was over five weeks when she visited the hospital for ante natal care. On taking her blood pressure, it was found to be 170 mmHg over 100 mmHg. That was very high considering her age which is below 20 years and her first pregnancy   .

What that lady was suffering from based on her history was Pre- Eclampsia (Pregnancy Induced Hypertension) which if not treated will lead to Eclampsia. Globally about 6 percent of all pregnant women will develop Pre-eclampsia sometime after completing 20 weeks of Pregnancy. Which particular group of people is likely to develop Pre-eclampsia? The condition most often occurs in women having their first baby, but once a woman has had Pre-eclampsia she has a 25 to 50 percent chance of developing it again in a subsequent pregnancy. Other women at risk are those at the extremes of age, such as teenagers and women over 45, as well as women with various underlying medical problems, including high blood pressure, kidney disorders, Autoimmune disorders, and Diabetes Mellitus . Having a multiple pregnancy, as well as a molar pregnancy (an abnormal pregnancy in which the embryonic tissue develops into a grapelike cluster of cells instead of a fetus) also increases the likelihood of Pre-eclampsia.

Symptoms of Pre-eclampsia usually appear in the third trimester of pregnancy. Women with mild forms may have only a slight elevation in blood pressure and on analyzing Urine, there will be presence of protein. A woman is said to have Pre-eclampsia  if in 2 measurements made at least 6 hours apart—her blood pressure is at least 140/90 or if it has risen significantly (by more than 30 mm systolic or 15 mm diastolic) since her first trimester of pregnancy. A woman is said to have Protein in Urine ( Proteinuria )  if, in 2 random urine samples taken 6 hours apart, she has at least 0.3 grams of albumin per liter of urine.

Another symptom of Pre-eclampsia is rapid weight gain which may include fluid retention. Swelling of the face and hands was once thought to signal preeclampsia, but it occurs so often in normal pregnancies that it is no longer considered a cause for concern by itself. The same is true for swollen legs and ankles, which develop in about a third of pregnant women whether or not they have preeclampsia.

In severe preeclampsia, hypertension and proteinuria increase even more, and urine output may decrease. Other symptoms include blind spots, blurred vision, headaches, pulmonary edema (fluid in the lungs), abdominal pain, and exaggerated reflexes.

Pre-Eclmapsia can be assessed if a pregnant woman is found to have either high blood pressure or protein in her urine, and she has pass her 20th week of pregnancy, with that one is bound to suspect mild preeclampsia. Severe preeclampsia is associated with dysfunction of other organs or slow growth of the fetus. If severe preeclampsia develops, various laboratory tests of blood and urine may be done to look for elevated levels of liver transaminases, bilirubin, uric acid, and creatinine, and low levels of platelets—all of which are common in preeclampsia.

The Condition definitive cure is delivery of the baby. Since the disorder usually develops late in pregnancy, this can often be accomplished without compromising the fetus’s chances of survival (that is, after 36 weeks’ gestation). If the fetus is not ready to be born, the decision to deliver can be difficult, but many obstetricians recommend inducing labor because the risks to both mother and child from preeclampsia usually outweigh the risks of premature delivery. Among those risks are acute kidney failure, bleeding disorders, and Eclampsia in the mother, as well as the premature separation of the placenta from the uterine wall and fetal death. . In some instances the mother’s condition can be managed with bed rest and intravenous medication in the hope of giving the fetus a few more weeks to mature. The high blood pressure will be controlled with anti hypertensive drugs.

If necessary measures are not put in place during pregnancy, like regular ante natal care and check up, Pre-Eclmapsia will lead to Eclampsia, it is a serious complication  that presents with convulsion, state of unconsciousness and coma. Among the complications of Eclampsia are: stroke, bleeding disorders, liver failure, and kidney failure, as well as blindness and placenta abruptio (the premature separation of the placenta from the uterine wall). The risks to the fetus include premature birth, which may lead to respiratory distress and other potentially life-threatening conditions.

Seizures (convulsions) during pregnancy, labor, or delivery or after delivery are the chief symptoms of Eclampsia. Although some women may have only 1 or 2 seizures, others may have many if the condition goes untreated. These seizures can be severe enough to cause unconsciousness or coma, or, in severe cases, death.

In about half of the women with Eclampsia, symptoms develop before delivery. Usually labor follows shortly thereafter and is often quite rapid. About a quarter of women with Eclampsia do not start having seizures until labor or delivery begins, however. Sometimes convulsions start again the day after delivery. Another quarter of women with Eclampsia do not develop any symptoms until after delivery is over. These usually occur during the first 24 hours after childbirth.

If a woman commences convulsions, she need to promptly be hospitalized and generally given anti conversant agents to control the convulsions. She may also receive antihypertensive medications to lower her blood pressure. If she has not yet had the baby, labor will usually be delayed (if possible) until symptoms are under control. Ultimately, however, the treatment for Eclampsia is delivery of the baby.

After delivery the woman will be monitored closely to make sure symptoms do not recur. Because most seizures occur within 24 hours of delivery, she may be given anti convulsants for at least this long to prevent seizures. Meanwhile, fluid intake and output will be closely monitored.

Eclampsia can often be prevented with early detection and treatment of Preeclampsia. This in turn involves good prenatal care, including increasingly frequent checkups during the third trimester of pregnancy, as well as frequent checks of weight gain, blood pressure, and urine. If symptoms of Preeclampsia develop, labor may have to be induced as soon as possible to prevent Eclampsia, although some women may be able to get by for a few weeks with bed rest and frequent, careful monitoring.

Looking at the plight of women in Nigeria , when one analyzes a recent research conducted by Society of Gynecologist  and Obstetricians   of Nigeria  ( SOGON ) in 6 states of Nigeria ( Lagos , Enugu , Cross River , Plateau , Borno and Kano ) , the Maternal Mortality Ratios of some of the states is above 3000 death /100, 1000 live birth . At the rate women are dying during pregnancy, we are approaching a scenario of having one death out of every ten live birth. Nigeria is accounting for 10 % of the global estimate of maternal mortality ratio, even though our population only accounts for 2 % of the world population. And the irony of this aware some  figures is the fact that,  majority of the causes of maternal death are preventable using simple and basic means. In line with such discovery, Nigeria has become the most unsafe place for a woman to be pregnant and go in to labor.

Among the complications of Pregnancy that are lives threatening, in some states particularly in Northern Nigeria, Eclmapsia is contributing to about 50 % of all causes of  maternal death. This is so because majority of women deliver at home and even those that attempt to deliver in Primary Health Centers, such places are devoid of facilities to curtail the menace of Eclampsia .  Many women are rush to secondary health centers where facilities are in place, but however, they are rushed already convulsing and in coma and at times has lost the baby and gasping. One can hardly resuscitate those women before they gave the ghost. Delay in decision to seek for medical attention which is attributed to cultural norms, poverty and ignorance and delay in transportation, due to distance from where people live and a good health centers are also worsening the condition of Eclampsia.

Strategies out of this doldrums is to ensure that all pregnant women have access to good antenatal care in a good and equipped center and to also ensure sustain awareness creation and educating the public through mass media about Eclampsia and other life threatening conditions during Pregnancy .

Dr Magashi is the Executive Director of Community Health and Research Initiative , Kano , Nigeria and can be reached at healthinteractive@hotmail.com