PREECLAMPSIA – Leading cause of maternal mortality

Pre-eclampsia is a broad term used to define all forms of hypertensive complications in pregnancies. It’s marked by high blood pressure in women whose blood pressure had been normal. Pre-eclamptic women will have a high level of protein in their urine and often also have swelling in the feet, legs, and hands which usually begins after 20 weeks of pregnancy. It affects about 2%-8% of all pregnancies with grave maternal and foetal impact.

Ghana continues to have persistently high levels of preventable causes of maternal deaths. Statistics revealed by the First lady Rebecca Akufo Addo has shown that in some regions in Ghana, notably Greater Accra and central, pre-eclampsia is the leading cause of maternal deaths.

Due to these increasing rates, it is essential for the awareness of this disorder in order to save lives through effective pre-eclampsia education.

Thus, this literature review focuses on causes and effects of pre-eclampsia.

Pregnancy features a number of physiological changes to help foetal adaptation and its pathological state results in pregnancy complications. Unlike other hypertensive disorders of pregnancies, preeclampsia is a multisystem disease affecting kidney and liver function and the cardiovascular system. These characteristics make the mother and foetus prone to risks such as premature labour with its associated congenital disorders for the foetus Also, compared with pregnancy in normal women, women who are hypertensive during pregnancy or having preeclampsia are at higher risks profile of cardiovascular events and disease, and other diseases in later years. Pre-eclampsia, if not managed, progresses to a life-threatening condition, Eclampsia, with the onset of seizures.

Throughout gestation in normal pregnancy, there are a number of physiological changes that aids the mother’s system adapt to the body’s metabolic needs. Virtually, every organ system is affected in pregnancy.

A normal pregnancy induces a coagulable condition due to a combination of hormonal and physical factors, as well as hematologic changes.

At week 5 of pregnancy, there is a fall in pressure which is as a result of changes in peripheral resistance and flow in multiple vascular beds.

During pregnancy particularly the third trimester, blood flow to the breast and the kidney increases this later will in turn increase urination. Also heart rate will increases by 10-20 beats over the course of pregnancy which is within normal.

Hypertension in pregnancy occurs at about 14% of all maternal death. Hypertension is defined as the force of the blood pumped by the heart against the blood resistance in the arteries. This occurs when blood pressure is greater than 140/90 mmHg for more than one occasion of measurement.

By the NHBPEP (national high blood pressure education program) working group, hypertension in pregnancy can be classified under four categories:

1. Chronic hypertension of any cause.
2. Gestational hypertension.
3. Preeclampsia superimposed on chronic hypertension.
4. Preeclampsia-eclampsia.

Eclampsia is a further complication when preeclampsia goes unnoticed and untreated with convulsions or seizures setting in.

Women are predisposed to preeclampsia when they exhibit one of the following:

• Nulliparous, that is, a woman carrying the first child.
• Pregnant women under twenty years of age or over 35 years of age.
• Women with low serum magnesium and calcium are associated with preeclampsia and pregnancy induced hypertension.
• African-American women are more predispose than Caucasian women.
• Multiple pregnancies also have higher risk factors than singleton mothers.
• Pre-existing hypertensive condition.
• It is also likely to develop in women who have family history of preeclampsia.

The cause of preeclampsia is still not fully understood but increasing evidence focuses on abnormal placental development, blood vessel disruption, immune system or genetic factors. Preeclampsia can also be influenced by the health and pre-existing conditions of the mother.

The increased risk applies to the mother as well to the foetus.

Pregnant women with hypertension can be divided into two groups: normotensive women who develop the pre-eclampsia, and women with chronic hypertension who become pregnant and are at a higher risk of developing superimposed pre-eclampsia.

As already stated, pre-eclampsia can develop to eclampsia with further central nervous system. PRES is a syndrome characterized by headache confusion and seizures and visual loss inhibiting growth of new blood vessels.

Also, these women are at a higher risk of cardiovascular implications, liver and kidney failure.

Pre-eclampsia is the chief cause of iatrogenic premature delivery. Lastly, there are higher rate of intrauterine foetal demise if not delivered preterm.

In conclusion, Pre-eclampsia remains a significant obstetric disorder capable of leading to significant events of maternal and foetal complications with child-birth related causes each day. Also Infants born to mothers who have pre-eclampsia are at risk for both immediate and long-term health consequences following a number of complex pathophysiologic changes that seem to be a consequence of abnormal placental development. The education on pre-eclampsia remains a very critical healthcare issue as it becomes a leading cause of maternal death in some rural community in Ghana.

Acknowledgment:

DR. KINGSLEY PREKO

DR. T. DERRICK

KOFI OBENG AND FREDA VERIEGH

WRITTEN BY: GLADYS OKOJI

PHYSICIAN ASSISTANT STUDENT

LEVEL 200

UNIVERSITY OF CAPE COAST