A few years back while working in one of the National Referral Hospitals, a colleague conceived for her first time. We all advised her to start her Antenatal Care as soon as possible, to which she agreed. We were all happy for her as friends especially when she told us that she was carrying twins. When her pregnancy reached 20 weeks onwards, our petit colleague started putting on a lot of weight.
At first, we took it lightly, since we knew she was carrying twins, and we would even make some jokes on how good looking she was with the pregnancy. However, at around 28weeks of gestation, we realized that the rate at which our colleague was gaining weight was abnormal.
I remember asking her if she had any concerns like frontal headaches, dizziness, blurred vision, to which she told me she had nothing like that. Since she was already seeing a specific obstetrician, I advised her to quickly go for checkup. Good enough, she went for ANC even when it was before the expected next visit.
Her blood pressure was taken, and she was found with very high blood pressure of 180/130mmHg on two different occasions. Blood and urine samples were also taken off from her, and she was found to have a lot of proteins in urine and her blood results also indicated that her liver was failing. Infact, she was told she had severe preeclampsia. Her obstetrician further told her that in-order to save her life, she requires an emergency caesarean section as soon as possible, even when the twin pregnancy was at 28weeks.
As colleagues, we helped in the preparations of the procedure, which was successfully done. Unfortunately, one of the twins passed away immediately after birth, while the 2nd twin passed away on day 3 after delivery. The death of her twins psychologically affected her, and she was depressed for some time, to which we tried our level best to comfort her, and ensure she heals. On the other hand, our colleagues’ life was saved. Her body started returning to normal, including the proper functioning of the liver which had started to fail.
May is the preeclampsia awareness month globally and annually; and 22nd May 2022 was World pre-eclampsia day under the theme: “Act early! Screen early! In Uganda, the Ministry of Health Department of Reproductive and Infant Health in collaboration with associations like National Midwives Association (NMAU), Association of Obstetricians and Gynaecologists of Uganda (AOGU), National Safe Motherhood Expert Committee (NASMEC), implementing partners, health institutions among others organized various events across the country including community outreaches creating awareness on high blood pressure during pregnancy, screening pregnant women for high blood pressure among other services. In Uganda, the final celebrations of World Preeclampsia Day were held in Mbale district.
The Hypertensive Disorders in Pregnancy (HDPs) include chronic hypertension, gestational hypertension, preeclampsia and eclampsia, and chronic hypertension with superimposed preeclampsia which complicate 8-10% of pregnancies worldwide. These are a leading cause of maternal and infant death worldwide. In Uganda, maternal mortality ratio is estimated at 368 deaths per 100,000 live births, and approximately 15 pregnant women die every day due to direct causes like hemorrhage and hypertensive disorders. Yet, these Maternal deaths related to the HDPs are preventable.
Preeclampsia is a common cause of caregiver-initiated preterm delivery and accounts for approximately 20% of all intensive care unit admissions of newborn babies. For the mother, complications of the HDPs can cause complications with long-lasting sequelae, such as stroke, and the HDPs are strongly associated with a heightened risk of future risk of cardiovascular disease. Too many lives are taken or seriously affected by these disorders and the NCDs that result from them, underscoring the importance of detection and prevention, symptom recognition, and timely and effective response by trained healthcare workers. This is especially true in countries where access to care is limited like Uganda.
I therefore call upon the Government of Uganda through the Ministry of Health (MoH) to recognize the importance of early detecting and diagnosing risk factors and preventing and treating the hypertension disorders in pregnancy and related non communicable diseases. I, recommend the Ministry of Education with MoH to prioritize education, training, and access to medical resources for healthcare providers, address prevention through a better understanding of the causes and through access to appropriate, safe, and effective treatments. Lastly, I, recommend health workers to prioritize patient and community education and treatment for these hypertensive disorders. The opportunity to reduce the prevalence of these disorders and their impact on women, infants, families, and communities worldwide is within our grasp as health workers, the community and country at large.
Lilian Nuwabaine Luyima is Midwife & Women’s’ Health Specialist working with Aga Khan University as the CPD Coordinator & the Heroes in Health Award Winner-Midwife of the year 2021