weeks did not reveal anything wrong
and blood pressure behaved right
through the 2nd trimester.
At about 32 weeks Miriam’s
pressure starts to rise. I put her on
antihypertensives (drugs to lower
her blood pressure) and give her
steroids considering the first delivery
was preterm and not sure how
far we will reach with the current
pregnancy. Baby had been growing
well and scans showed no problem
with growth or fetal circulation.
Despite the antihypertensives her
pressure continued to rise, but
family adamant they didn’t want
a pre-term delivery. As Miriam
showed no signs of damage to vital
organs we continued pregnancy up
to 38 weeks and delivered via C/S a
1.6 kg baby boy who is admitted in
the New born unit due to small size
for gestational age cause by intra
uterine growth restriction.
tissues from blood, lungs, kidneys,
pancreas, eyes, the nervous system
are affected. On the baby’s side
it’s mostly complications from
prematurity (being born too soon)
and most unfortunately in quite a
number of cases the baby can die
while still in the mother’s womb.
The goal in a patient with
preeclampsia is to prevent
complications, convulsions and
maintain the blood pressure below
a certain threshold and deliver a
viable baby, i.e a baby that has high
chances of going home. The cost
of new born care in very preterm
babies is very prohibitive.
Eyes
Arteriolar spasm Retinal
Hemmorrhage
Papillaedema Transient
Scotomata
Mother recovers well post
operatively discharged home on the
5th post-operative day, but pressures
remain elevated and she continues
drugs for about 4 weeks when blood
pressure stabilized.
Respiratory System
What was interesting about the
case was the late onset of her
symptoms and the profound effect
that it had on the baby. The baby
just stopped growing from 32 weeks
of gestation. This indicates that the
issues had started much earlier just
symptoms came much later. Baby
stays in hospital for two weeks but
discharged home stable after gaining
good weight and suckling from his
mother’s breast.
Hematopoietic System
Miriam is just an example of what
can happen to mothers due to
preeclampsia. Unfortunately not all
women are as lucky as she is.
What complications can one expect
from preeclampsia?
Preeclampsia is disease that starts
in the placenta and spreads to
affect all tissues and organs. Only
bone is not affected. All organs and
Pulmonary Edema
ARDS
Liver
Subcapsular Hemorrhage
Hepatic Rupture
HELLP Syndrome
DIC
What should be noted is that no
amount of medication will prevent
onset or progression of the disease
process. So the idea is to time
delivery when feasible to balance
between prematurity (baby’s
interest) and the maternal condition
(Mummy’s interest).
The only definite cure is to deliver
the mother, as once the placenta is
out the maternal condition usually
improves. All obstetricians are clear
that their first responsibility is the
mother, but cognisant that the baby
is why the woman was pregnant in
the first place. All efforts are made
to save both mother and baby where
possible.
Eclampsia as indicated previously
is the worst case scenario and this
involves the development of seizures
in a patient with preeclampsia. We
usually give Magnesium Sulphate
(MgS04) both for prevention and
treatment of eclampsia. Personally I
think it is a wonder drug as patients
fare much better now than in the era
prior to use of MgS04.
Can preeclampsia be prevented? Not
really but as mentioned earlier use of
calcium in people with low dietary
intake of calcium, and use of low
dose aspirin in high risk women has
shown promising results in terms of
delaying onset of disease.
Preeclampsia:
Amulti-system Disorder
CNS
Seizures
Intracranial Hermorrhage
CVA
Encephalopathy
Pancreas
Ischemic Pancreatitis
Kidneys
Acute Renal Failure
Uteroplacental Circulation
IUGR
Abruption
Fetal Compro mise
Fetal Demise
Early detection and use of calcium
and junior aspirin can only be
instituted if women come for
pre-conception counselling and
treatment and antenatal care. So if
you are planning to conceive please
visit your gynaecologist and if you
are already in the way attend your
antenatal care clinics.
I hope this piece has given you some
useful insights and until next issue,
bye for now.
Dr. Maureen Owiti is a Gynaecologist
based in Nairobi. You can commune
with her on this or related matters via
mail at: [email protected].