What is pre-eclampsia, a seldom discussed pregnancy complication?

 

Despite being a leading cause of maternal death, many women first learn about it after being diagnosed. What you need to know.

Koiwah Koi-Larbi was thrilled at her first pregnancy’s 25th week in 2012. She and her family enjoyed her leg, foot, and hand swelling. She told DW that in Ghana, being overly large during pregnancy means a male is coming.

Besides edema, Koi-Larbi detected additional symptoms. The upper right area of her stomach hurt and she had headaches. Heartburn and “all kinds of spots” plagued her. After reporting her symptoms, the nurse said “it was just like that.”

Koi-Larbi’s condition, pre-eclampsia, is difficult to diagnose since pregnant women and healthcare workers like her nurse are not educated to detect many of the signs. them.

Pre-eclampsia is a top maternal killer globally. Pregnancy-related elevated blood pressure is usually not felt.

“You can have [high blood pressure] and not realize it,” said UMC Utrecht global health and epidemiology professor Joyce Browne. You may observe Koi-Larbi-like symptoms or “a general feeling of not feeling well,” she added.

Pre-eclampsia rates vary by nation. The WHO believes that underdeveloped nations have seven times greater rates than industrialized ones. It causes 12% of maternal fatalities worldwide.

Preseclampsia: seizure, coma, death

Later that month, Koi-Larbi had convulsions and was hospitalized at 2 am. Untreated pre-eclampsia may cause unconsciousness and death, thus they diagnosed her with eclampsia.

An emergency cesarean surgery was the only way to rescue Koi-Larbi and her baby.

Her then-husband called her mother on the way to the hospital. Her mother expected her daughter’s condition. “That’s my illness,” she added. Koi-Larbi learned her mother had pre-eclampsia for the first time.

Browne recommends all pregnant women question their moms whether they have high blood pressure. “It’s a major risk factor,” she added. “If you know your mother had it, that’s a reason for you to be more careful.”

Three days after delivery, Koi-Larbi met her kid. The infant died 48 hours later from a problem after being too little to breastfeed. “We were devastated,” she added.

 

Second and third pregnancies

Koi-Larbi wanted kids. In fact, she wanted five. She became pregnant again in 2013. After five months, she came to the US for her last pregnancy care. Again, she developed late-onset preeclampsia but delivered a daughter at 37 weeks.

The happy delivery experience inspired her third pregnancy in 2017. Symptoms were similar to her previous pregnancies, although less severe. She stated she was fatigued this time.

She had blood pressure monitored at 26 weeks in the hospital. She didn’t have severe symptoms, but she knew from past pregnancies that these tests were important. Her blood pressure was 150 over 100, thus the doctor advised hospitalization.

“In our context, it’s not easy to talk or talk about your mental health, and unless you have a supportive husband and family during this traumatizing time, you’re going to have to deal with these kinds of things alone,” added Koi. -Larbi.

With years of experience, Koi-Larbi got pregnant for the fourth time in 2019 with Action on Preeclampsia Ghana. “There was real hope for this one,” she remarked. However, she developed HELLP syndrome, the most severe type of pre-eclampsia, and had to give birth to survive. The 1-kg infant died three days after delivery.

 

Three delays related to maternal death

Browne said maternal health shows how effectively a health system operates and how much we value women’s health.

“Most pregnant women are healthy. However, problems may need prompt, high-quality treatment. Without timely, high-quality treatment, unfavorable effects may be fatal.”

Browne and others use the “three lags” technique to study maternal mortality.

The lady first ignores her agony, believing it is not bad enough for medical assistance.

Logistics—barriers a woman may confront while reaching a health center—are the second delay. Women in isolated areas may be hours from a health center, making these hurdles worse.

Hospital treatment upon arrival is the third delay.

Ghanaian preeclampsia researcher Titus Beyou explained that once women arrive at the hospital, their contact with the doctor might influence this third delay.

Beyou said pregnant women are often encouraged to terminate the pregnancy and give birth quickly without being explained why or what the doctor is saying. The patient may refuse therapy because she doesn’t grasp what’s occurring.

Koi-Larbi stated this misinterpretation killed her first kid. “Ignorance killed my baby,” Koi-Larbi said. “I hadn’t been informed.”

Ironically, some women refuse health care due to religious beliefs, even when they need it. And it might cause another misunderstanding, Beyou noted.

“They’ll ask, ‘Why do you want to give me a premature baby?'” Before seeing the pastor, they won’t accept the life-saving preterm birth therapy, he stated.

Beyou said Ghanaian hospitals have considered employing on-call chaplains to solve this issue. However, the country contains several faiths and their denominations, making the answer incomplete.

But maybe this is most important: each woman and her pregnancy is unique. As Koi-Larbi found, each pregnancy was distinct. Experts believe pregnancy care goes beyond delivery and emergencies. Be careful from the outset.

A midwife couldn’t feel Koi-Larbi’s heartbeat on her fourth hospital day. Doctors verified her pregnancy loss. The deceased fetus was surgically removed from Koi-Larbi, sparing her life.

I was traumatized then. Asking inquiries. I considered twice, this is too much “Koi-Larbi remarked.

While recovering, she searched online for solutions. Her only pre-eclampsia support groups were in the US, UK, and Australia. Her Action on Preeclampsia Ghana assistance group was formed after communicating with them.

Koi-Larbi wanted to educate women and healthcare professionals about the condition. She wants to work with scholars to better Ghana. Offer pre-eclampsia counseling in a central location.

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