Pre-eclampsia: A silent killer of pregnant women

Pre-eclampsia is a silent pregnancy related condition, but one which has continued to cause expectant women untold pain the world over.

The pregnancy disorder begins at the fifth month, and is rated as the second highest cause of death of expectant women globally.

It is characterised by high blood pressure and presence of proteins in urine. Sadly, there is no universal criterion established for its diagnosis in early pregnancy. High blood pressure affects the placenta’s ability to deliver oxygen and nutrition to the unborn baby thus affecting the mother’s function of the kidney.

Warning signs

It is estimated to occur between two and ten per cent of pregnancies globally, but in developing countries it is about seven times higher. If left untreated, it progresses to seizures. It is mysterious and unpredictable. This may affect its timely diagnosis for effective treatment. Reproductive health expert Simon Kigondu says timely and effective care should be given to pregnant women who have symptoms that point towards pre-eclampsia.

The consultant gynaecologist and obstetrician advises that some of the warning signs like excess swelling of the face and legs known as oedema, constant headaches, severe stomach pains and bleeding should be reported immediately when noticed. While swelling can be a normal occurrence in pregnancy, Dr Kigondu opines that a health expert should examine to rule it out. “Oedema is the accumulation of excess fluid. It should not be taken for granted because it could be communicating what is happening inside your body,” Dr Kigondu noted.

He is calling on pregnant women who commonly complain of stomach pains to avoid over-the-counter medicines. Throbbing headaches are another warning sign because they could be an indicator of high blood pressure.

Blurred vision can also be a symptom of more serious problems of the central nervous system or bleeding in the brain known as cerebral oedema.

“In some cases, pregnant women collapse and die and further investigation establish it was due to abruption placentae, the premature separation of the placenta from the uterus, that causes bleeding,” Dr Kigondu said.

In its severe form, the ailment can cause damage to the liver, HELLP syndrome, where there is destruction of red blood cells, elevated liver enzymes and low platelet count. The diagnosis of pre-eclampsia is complicated.

“There is not a single reliable and cost-effective screening test for pre-eclampsia which can be recommended in most developing countries,” read excerpts of a research paper by Kayode and Olusimbo published in the journal of pregnancy. The pair recommends routine screening based on measurement of blood pressure and protein in urine among all pregnant women as per World Health Organisation.

Women who have had high blood pressure, kidney disease or diabetes before conceiving are more likely to develop pre-eclampsia. The presence in a previous pregnancy also increases chances of developing the disorder in the subsequent ones.

The risk of developing pre-eclampsia is highest during first pregnancy or when expecting twins. However, these risk factors do not fully explain its development because it has also been found in women without the listed factors. “In some women, the disease can worsen during the first 48 hours after delivery.

This should be closely monitored by checking their of blood pressure and responding to complaints like persistent severe headaches, stomach pains, vomiting, vision and breathing problems,” Dr Kigondu observed. The disorder can be managed by a balancing act that aims at a final result of a healthy baby and mother.

“The treatment is to deliver the baby,” said Dr Kigondu while adding that for this to happen, the mother’s condition should be stable for a safe delivery.

A recent scientific research has shown that baby aspirin can be given before the fifth month of pregnancy for the prevention of pre-eclampsia and its related complications.

Appropriate treatment

The World Health Organisation has also shown that women with severe high blood pressure during pregnancy should receive the appropriate treatment with antihypertensive drugs. Those at high risk should be given magnesium sulfate, commonly known as Epsom salt.

On the same note, restrictions in dietary salt intake, Vitamin D supplementation, individual or combined vitamin C and vitamin E is not recommended during pregnancy to prevent the development of pre-eclampsia and its complications.

The writer is health and medicine editor at The Conversation Africa