Preeclampsia in pregnant women, leading cause of maternal death

Prossy Nankya, 28-year is grateful to God for giving her a second chance at life after she lost her baby while giving birth. At six months of pregnancy; Nankya started feeling nauseated, her feet started swelling and her general body weight increased.

Nankya’s condition deteriorated and she was rushed to Bukomero health centre IV for medical attention. The health centre could not manage her condition, however, and she was referred to Kawempe National referral hospital. It was however too late by the time she got to the facility, losing her baby in the process.

Agatha Nagadya, 35, a resident of Masanafu, a Kampala suburb shared the same fate with Nankya. She too presented similar symptoms and lost her baby at five months of pregnancy.

These two women represent hundreds of mothers who suffer from a condition known as pre-eclampsia. Pre-eclampsia is a common condition in pregnant women who present with high blood pressure. If not managed, it can lead to slower growth of the fetus, preterm birth, organ damage, and eclampsia, which results in the expectant mother experiencing seizures.

Dr. Lawrance Kazibwe, a consultant gynecologist and the deputy executive director of Kawempe hospital says that pre-eclampsia is the leading cause of maternal death at this hospital.

He said that many mothers die because they don’t go to health facilities for regular checkups to diagnose the condition early enough. Kazibwe added that if not managed early enough, a mother is likely to have their body organs severely damaged.

Risk factors are; a teen or being older than age 40, obesity before pregnancy, when having a first baby or carrying more than one body.

In Uganda, 336 women die from pregnancy and childbirth-related causes per every 100,000 live births. Hypertensive disorder during pregnancy, such as pre-eclampsia and eclampsia is one of the most common causes of maternal deaths after postpartum hemorrhage accounting for 6% of maternal deaths. In 2017/2018 financial year, the pre-eclampsia ward at Kawempe hospital received 520 mothers with severe pre-eclampsia, 132 with eclampsia, 14 Postpartum Eclampsia and 12 maternal deaths.

Unfortunately, according to Dr Kazibwe, despite the huge burden of the condition, the hospital is not well equipped to manage the mothers.

“Each bed has to have a monitoring machine to monitor the pressure levels of a mother but most of them here are non-functional. The health workers are also very few compared to the number of mothers we receive every day.”

According to a 2018 study conducted by the Coalition for health promotion and social development- HEPS Uganda titled; Sexual and Reproductive Health Commodities; Availability, Affordability and Stockouts Report 2018, medicines used to manage the condition register regular stockouts.

Dr Denis Kibira, the Executive Director of HEPs Uganda says that some private health facilities do not stock magnesium sulphate – a drug necessary for controlling pre-eclampsia, because it is expensive. This means that mothers who go private facilities are charged expensively for this drug.