#EMMAseries: Q & A on PRE-ECLAMPSIA / ECLAMPSIA – By Dr Gbolahan Oladele Obajimi

By Dr Gbolahan Oladele Obajimi. MBBS(Ib), MHS(Pop &RH), FWACS. Lecturer, University of Ibadan. Consultant Obstetrician & Gynaecologist. University College Hospital, Ibadan.

Q: what is Pre-eclampsia?

A: Pre-eclampsia is a hypertensive condition unique to pregnancy.

Q: how often does it occur in pregnant women?

A: Its occurrence has been estimated to be about 5% of all pregnancies. It is more common in blacks, twin gestation, diabetics, hypertensive and young women in their first pregnancy.

Q: How does this condition affect Nigeria and Africa as a whole?

A: It is an important contributor to maternal deaths in Africa.

Q: How is it diagnosed?

A: Pre-eclampsia is diagnosed when a pregnant woman has high blood pressure and increased protein in her urine.

Q: What causes Pre-eclampsia?

A: Various theories have been proposed as causative factors. These include problems with blood clotting at the placenta, vascular endothelial damage(damage to the inner surface of the blood vessels), genetic factors and dietary deficiency especially calcium. It is largely classified as mild or severe pre-eclampsia.

Q: We often hear Pre-eclampsia and Eclampsia in the same context. Is there a difference between the two?

A: Yes, they are different. Eclampsia on the other hand is the occurrence of seizures in patients with pre-eclampsia in who other causes of convulsion such as epilepsy, low glucose and metabolic derangement have been excluded.

Q: What are the symptoms of Eclampsia?

A: Early signs and symptoms of imminent eclampsia include increased urinary protein, headaches, visual impairment and epigastric pain.

Q: How are Pre-eclampsia/ eclampsia managed?

A: Management of Pre-eclampsia/ eclampsia entails delivery of the baby. However, the decision to deliver the baby must be balanced against the risk of prematurity for those babies yet to get to maturity. Conservative care is often employed for the mild cases which involve the use of medications (antihypertensives), steroids for fetal lung maturity, magnesium sulphate to prevent convulsion and comprehensive feto-maternal monitoring. For severe cases, stabilization and delivery by the fastest possible route, usually a caesarean section is done.

Q: Are there complications that could arise if these conditions are not properly managed?

A: Complications include a clinical entity called HELLP syndrome which is an acronym for haemolysis (blood destruction), elevated liver enzymes (liver damage) and low platelet count (resulting in uncontrolled bleeding from multiple sites). Ultimately it can lead to maternal or fetal demise.

Q: How can the mortality rate of mothers and babies caused by Pre-eclampsia/Eclampsia be reduced?

A: Early recognition and prompt management is the key to reducing the catastrophe posed by this condition. Equipping skilled care attendants with the requisite knowledge and facilities coupled with public enlightenment is the key to mitigating the disastrous consequences of ignorance.

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