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Understanding pre-eclampsia: The hidden killer in pregnancy

Dr Emmanuel Byaruhanga (R) launches the fight against pre-eclampsia in Uganda

Dr Emmanuel Byaruhanga (R) launches the fight against pre-eclampsia in Uganda

About 200 mothers and their newborn babies die annually due to pre-eclampsia from all health facilities within the country, yet these deaths are preventable, said Dr Richard Mugahi, the commissioner of Reproductive and Child Health.

“Last year alone (2023), we lost over 1,300 mothers from all health facilities in the country, and 15 per cent of these mothers (200 mothers) died due to pre-eclampsia,” he said.

According to the study, pre-eclampsia is a pregnancy complication that causes dangerously high blood pressure levels. In rare cases, it can lead to a liver and blood-clotting disorder called HELLP [Hemo- lysis, Elevated Liver enzymes and Low Platelets] syndrome, which can be fatal to both mother and baby.

The causes of pre-eclampsia and how to treat it are still not fully understood. However, the simplest and most effective treatment for pre-eclampsia is delivering the baby as soon as possible. Dr Mugahi also noted that while a significant number of mothers recover from pre-eclampsia, they often do so with permanent disabilities.

“Pre-eclampsia affects the kidney, liver, lungs, and brain, and many mothers who survive end up with strokes and lead lifeless lives,” he explained.

He highlighted the alarming impact of pre-eclampsia on maternal and newborn mortality in Uganda. He stated that over 1.6 million babies are delivered annually in all health facilities across the country, and out of these, 1,300 babies die along with their mothers due to pre-eclampsia.

“Most of these mothers and their babies would have survived if they had visited hospitals early during their pregnancies to monitor their blood pressure and start the pre-eclampsia treatment immediately.

“However, most of these mothers reach hospitals when it’s too late to save them, after their blood pressure has already increased significantly. Pre-eclampsia mainly occurs when a mother develops high blood pressure during pregnancy, which then damages most of her body organs, including the liver, kidneys, brain, and lungs, causing death,” he explained.

“This pressure also affects the baby inside the womb, often leading to premature birth and death,” added Mugahi.

According to a recent study conducted in three referral hospitals in Uganda, severe pre-eclampsia/eclampsia comprised eight per cent of cases of severe maternal morbidity. In another study conducted at Mulago hospital, it was found that severe pre-eclampsia/eclampsia accounted for 12 per cent of maternal deaths among women with severe maternal morbidity.

The permanent secretary of the ministry of Health, Diana Atwine, emphasized the importance of timely medical intervention for pre-eclampsia, noting that some women spend time in witchcraft and churches praying, claiming that they have been bewitched. By the time they reach hospitals, it is often too late to save them from pre-eclampsia.

“Recently, they brought a woman to Kawempe hospital who collapsed, convulsed, and had fits in the church, but people continued praying to cast demons out of her without knowing that she had pre-eclampsia. By the time they brought her to the hospital, it was too late, and she died,” Atwine recounted.

She highlighted the public’s lack of awareness about the dangers of pre-eclampsia and announced the launch of a campaign to reduce the maternal mortality rate and encourage mothers to seek early antenatal care.

“We are informing the public about the burden of pre-eclampsia, sensitizing them that any pregnant woman can get it, but it can be treated and managed in hospitals if you go there early. The baby can also be saved and grow, and pre-eclampsia is not witchcraft,” she said.

Atwine announced the distribution of over 200 ambulances to lower-level health centers to ensure that pre-eclampsia first-aid treatment is always available across the country.

“The medicine and all treatments for pre-eclampsia are free of charge and available in all health facilities within the country. Our facilities can respond to emergencies at any time, and if they can’t handle a case, they will refer you to bigger hospitals,” she said.

Atwine also advised men to support their pregnant partners to help reduce stress, which can lead to high blood pressure and result in pre-eclampsia.

We want husbands to provide for their pregnant partners by buying them medicine, food, clothes, attending antenatal care together, and helping with housework,” she said.

Dr Emmanuel Byaruhanga, director of Kawempe hospital, highlighted the severity of pre-eclampsia, identifying it as the leading cause of death for mothers and their babies in major health facilities. He noted that it is the second leading cause of maternal mortality in the country and globally, following postpartum haemorrhage.

“At Kawempe national referral hospital, we admit over 150 mothers each month with pre-eclampsia, and out of these, 10 mothers are in a severe condition, experiencing fits,” he stated.

Dr. Byaruhanga emphasized that many mothers die of pre-eclampsia because they arrive at hospitals too late. Often, these women are unaware they have high blood pressure during pregnancy until they experience convulsions.

“The only way to save a mother in a severe or fit condition of pre-eclampsia is to deliver the baby, even if it is pre-mature. We advise pregnant mothers to visit antenatal care as early as possible to avoid pre-eclampsia,” he said.

Professor Annet Nakimuli, a gynaecologist at Mulago hospital and chairperson of the Pre-eclampsia National Committee, stressed the importance of research and awareness to reduce maternal and newborn deaths due to pre-eclampsia.

“In order to reduce the deaths of mothers and their newborn babies due to pre-eclampsia, we conducted research on how to manage it in hospitals, as it was little known in the community and often confused with witchcraft,” she explained.

She outlined the symptoms of pre-eclampsia, which include swelling of the body, especially the legs, headaches, high blood pressure, protein in urine, fits, and organ injuries affecting the brain, liver, kidneys, and lungs.

She advised women to undergo routine blood pressure checkups, even if they feel fine, as blood pressure can rise abruptly, leading to pre-eclampsia and sudden death.

“The drugs to manage pre-eclampsia are available at referral hospitals. If you suspect any discomfort during pregnancy, go to a big hospital immediately,” she urged.

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