Dr
Joan Okemo, Consultant Obstetrician Gynaecologist at Aga Khan University
Hospital Nairobi.
Pregnancy is a delicate moment for
mothers. They are most susceptible
to serious complications, some which are fatal. One of the major problems that
usually develop or manifest during pregnancy is preeclampsia, a condition
associated with high blood pressure.
According to the World Health Organization, it affects between 5.6 per cent and 6.5 per cent of pregnancies in Kenya. It is the
third leading cause of maternal deaths, accounting for 20 per cent of maternal
mortality in Kenya.
Dr Joan Okemo, consultant obstetrician gynaecologist at Aga
Khan University Hospital Nairobi, says preeclampsia happens during pregnancy when the top value of blood pressure readings is above 140, and the lower
value above 90 (140/90), mostly after the week 20 of
pregnancy.
However, there must be a combination of blood pressure together with protein in urine for a diagnosis of preeclampsia to be made.
“We have
two definitions of preeclampsia where there’s either high blood pressure together with
what we call protein in urine, or high blood pressure together with end-organ
damage evidence,” Dr Okemo says.
She points out specific signs that patients should look out for in case they
suspect they have the condition.
She says: “Unfortunately, sometimes pressure may rise and someone doesn’t know. By the
time you start having symptoms and signs, it already means it’s in a severe
form. We have to generally classify it into two things, either preeclampsia
with severe features or preeclampsia without severe features.”
“The one
without severe features means only the pressure is high, but you don’t have any
symptoms or signs that would make you think that you have high blood pressure.
So, it’s something that you’ll probably be in a clinic, you’ve come for a
routine check-up, they do a blood pressure and they see that your blood
pressure is high.”
Some of the most common symptoms in severe preeclampsia include severe headache that does not go away even
with taking painkillers, blurry vision and sometimes gaps in your vision,
severe heartburn or pain in your upper abdomen and swelling in your lower limps.
Sometimes
it can present with severe heartburn or pain in your upper abdomen. Sometimes
it’s swelling up too much, even in your upper limbs. Swelling in the lower limbs is considered normal, but
if it’s too sudden and too much, it may also be a sign of high blood pressure.
If preeclampsia becomes severe, it can also mean the mother
needs to deliver the baby early.
“If the preeclampsia develops and it’s the severe form, you
may need to deliver the mum. Unfortunately, sometimes it may happen before the
baby’s birth time leading to prematurity, preterm delivery, which would lead to
admission in ICU for the newborns, or even the HDU. The babies are not where
they are supposed to be because their growth was strained as well,” Dr Okemo
adds.
For mothers, preeclampsia can also be dangerous. “It could be so bad that you can’t save a
life, especially with little adults, which sometimes creates a need to do a
cesarean section if you have to save the mother or the baby urgently, and that
becomes the quickest way to do that,” she says.
According to Dr Okemo, diagnosing preeclampsia is not
complicated. All the women need to do is to visit a clinic on regular checkup
then their BP is checked before a urine test is done to check the availability
of blood and proteins in urine.
Treatment depends on how
bad the preeclampsia is. If it is just a simple high blood pressure without the
severe features, then mostly all you want to do is to manage the pressure.
“Giving antihypertensive medication and to also do some
tests to check where we are at in terms of severity, even in the effects to the
baby. Doing something as simple as an ultrasound to check the growth of the
baby and whether the baby is affected or not is very important,” she explains.