Pregnant women are advised to go for antenatal care every month, as this helps keep the mother and baby safe throughout the pregnancy. If these check-ups are respected, there are some conditions that can be prevented. One of the conditions, experts say, is preeclampsia — a life threatening ailment if left untreated. Emmanuel Semwaga, a gynaecologist at La Croix Du Sud in Gisementi, Kigali, has come across such cases and he says that dealing with the condition is not easy because of the complications the condition comes with. THE PATHOPHYSIOLOGY OF PREECLAMPSIA Preeclampsia is a disorder of widespread vascular endothelial malfunction and vasospasm that occurs after 20 weeks’ gestation and can present as late as 4-6 weeks postpartum. It is clinically defined by hypertension and proteinuria, with or without pathologic edema. Semwaga explains that it’s normally caused by poorly developed uterine placental spiral arteries. “Normally when the placenta is developed, there are placental branches that routinely connect to the spiral arteries; at times these arteries are narrow, making them send little blood to the placenta,” he says. He adds that this makes the placenta tissue die, leading to production of free radicals, unstable atoms that can damage cells, causing illness. He, however, says that the exact cause of preeclampsia is a result of a placenta that doesn’t function properly, although poor nutrition or excessive body fat are potential contributors. Insufficient blood flow to the uterus could also be associated, as well as genetic factors. WHO IS AT RISK? Iba Mayale, a gynaecologist at Clinic Galien in Gasabo, says not all women are at risk of developing the condition; however, there are some factors, like carrying twins, or a precious encounter with previous preeclampsia. Smoking, or a first pregnancy are also some of the risk factors. Semwaga says although the condition starts around 20 weeks and above of pregnancy, there is also superimposed preeclampsia which develops in someone who has chronic hypertension. Women with chronic hypertension should be on medication. If they conceive, around the 20th week of pregnancy, they will develop signs of preeclampsia. HOW TO KNOW YOU HAVE THE CONDITION Preeclampsia is a serious condition of pregnancy, and can be particularly dangerous because many of the signs are ‘silent’ while some symptoms resemble ‘normal’ effects of pregnancy on your body. Many women suffering from preeclampsia don’t feel sick, and may be surprised or become frustrated when they are admitted to the hospital. High blood pressure is a sign of preeclampsia. The disease is sometimes referred to as a silent killer because most people can’t “feel” their blood pressure going up. As a result, patient awareness of the warning signs is one of the most important tools. John Muganda, a gynaecologist at Harmony Clinic in Kigali, says that there is the swelling of the lower limbs and even the face. Muganda adds that preeclampsia can be categorised in two — mild and severe. For the mild, he says, this is when the blood pressure is not so high. For severe preeclampsia, he says, this can be observed when the blood pressure is more than 160/100 and the protein is around 5gms in 24 hours. Proteinuria, another sign of preeclampsia, is the result of proteins, normally confined to the blood by the filtering role of your kidney, spilling into the urine. He says it can cause damage and affect different organs such as the liver, kidney, lungs and even the heart. Muganda points out that signs of severe preeclampsia may manifest as liquid in the abdomen coming from the liver, causing difficulties in breathing. The renal functioning tests are also compromised due to the affected kidney. Also, he says, the lungs may have water and haemoglobin will be low for people with severe preeclampsia. Dr Theodomir Sebazungu, a gynaecologist at University Teaching Hospital of Kigali (CHUK), says that when a mother develops this condition, her life and that of the baby are at risk. He says that with the condition, the baby can easily die if not attended to in time. He adds that it can cause intrauterine growth restriction, where the baby stops growing or gaining weight, thus becoming small for its gestation age. “Because the placenta is not receiving enough blood, it will not give enough blood to the baby, thus making the baby’s kidneys weak as well, making foetal urination deprived,” he says. Sebazungu explains that this is because 80 per cent of amniotic fluid comes from foetal urine, when the kidneys are not receiving enough blood, the baby will not urinate well. Complications such as amniotic band syndrome (a group of congenital birth defects believed to be caused by entrapment of foetal parts (usually a limb or digits) in fibrous amniotic bands), clubfoot (birth defect where one or both feet are rotated inwards and downwards), pulmonary hypoplasia (incomplete development of the lungs) and sometimes, foetal death. “The baby may also develop cord entanglement where there is compression of the umbilical cord, making the supply of nutrients to the baby poor,” he says. Sebazungu adds that the umbilical cord is supposed to float in the water, and because there is not enough amniotic fluid, the baby will compress the cord, leading to its death. HANDLING THE CONDITION Semwaga says multidisciplinary management involving an obstetrician, anaesthetist, and paediatrician can be carried out, with consideration of maternal risks due to continued pregnancy, and the foetal risks associated with induced preterm delivery. He adds that preventing recurrences is key in the management of preeclampsia. “However, because the condition develops at 20 weeks and above, treatment will depend on its severity. Once it’s confirmed, it can develop very fast, moving from mild to severe in just a short time, leading to complications,” he says. The best way forward, he says, is for every pregnant woman to consult with a gynaecologist/ obstetrician during monthly antenatal visits. During these visits, Semwaga says, the doctor should carry out vital tests, including blood pressure and urine, and if a woman shows signs of preeclampsia, if it’s mild and the baby is still at an early stage, they should boost the development of foetus and plan for delivery. However, if the condition is too severe and the pregnancy at an early stage, he says termination could save the life of the mother. “This is because the only infinitive treatment of preeclampsia is delivery, but the manifestations can be treated,” he observes. Semwaga notes that treatment also involves regularising blood pressure. He says this is because if the blood pressure is not normalised, it will go higher, making the mother develop further complications, like a stroke. PREVENTION There is no sure way to prevent preeclampsia. Some contributing factors to high blood pressure can be controlled and some can’t. Muganda says contributing factors to high blood pressure can be controlled. Also; Use little or no added salt in your meals. Drink 6-8 glasses of water a day. Don’t eat a lot of fried foods and junk food. Get enough rest. Exercise regularly. Elevate your feet several times during the day. Avoid drinking alcohol. Avoid beverages containing caffeine. Your doctor may suggest you take prescribed medicine and additional supplements. Experts share their views Maintaining a regular exercise routine throughout pregnancy can help one stay healthy and prevent some diseases. However; this should be with a doctor’s advice, especially if one has other pregnancy-related conditions. Janvier Rusizina, Practitioner at La Nouvelle Clinic in Remera - In most cases, a woman with preeclampsia will have an underweight baby. The baby may also have conditions such as heart disease and metabolic syndrome, among others. Knowing how to handle them is vital. Immaculate Kiiza, Nurse - Getting enough rest, reducing salt intake, drinking more water, as well as making regular visits to the doctor, are just some of the important ways to avoid preeclampsia. Francis Kazungu, General practitioner - Although unavoidable conditions such as preeclampsia can occur during pregnancy, living a healthy lifestyle is vital. Most importantly, taking prenatal vitamins with folic acid is advisable. Iba Mayale, Gynaecologist - editorial@newtimes.co.rw
