War against Preeclampsia cannot be fought from one end only – Expert

The Director of Health Service at Ga West Municipal Assembly, Dr Margaretta Gloria Chandi has said that despite all the interventions, there is still more to be done, especially at the community level where knowledge about preeclampsia remains very low.

Preeclampsia is a complication of pregnancy. With preeclampsia, you might have high blood pressure, high levels of protein in urine that indicate kidney damage (proteinuria), or other signs of organ damage.

Dr Chandi suggested that it should be made part of the orientation that all newly posted doctors/midwives/PAs are made to through in the municipality.

“A combined team from the Municipal Hospital and the MHA will start an aggressive supportive supervision program aimed at improving the knowledge about preeclampsia.

“Madam Chair, it is obvious that the war against Preeclampsia cannot be fought from one end only. It needs the collective efforts of Health providers, patients and their relatives, and support from the community and the Media to be able to win,” she said during the Pre-eclampsia Day celebration.

Below is her full address…

Madam/Mr. Chair, Honorable MCE, Municipal Coordinating Director, Municipal Director of Health Service, All Departmental directors present, My able management team from both the Municipal Health Directorate and the Municipal Hospital, Niimei/Naamei, Our hardworking staff, The Press, Ladies and Gentlemen.

I am very happy and at the same time sad to be called upon to speak about Pre-eclampsia today. Happy that the story of Pre-eclampsia is finally being told and explained for the general public to be aware of this menace. I am at the same time sad that, this menace has contributed significantly to the deaths of so many of our able bodied women as well as uncountable still births or preterm births with its associated challenges. I recall a very sad event in 2010 when my own blood sister, after battling years of infertility, lost her unborn child after 38 weeks of pregnancy. Even though I have seen it all as far as Intra-Uterine Deaths are concerned, this was a very bitter pill to swallow.

Pre-eclampsia( formerly called Toxemia of Pregnancy), is a condition that is characterized by a rise in the blood pressure and affects some pregnant women usually during the second half of pregnancy (from around 20 weeks) or immediately after delivery of theirbaby. Women with pre-eclampsia have high blood pressure, fluid retention (edema) and protein in the urine (proteinuria).

I hope and believe that the key question lingering on the minds of everyone is “what at all is the cause of this deadly condition”? Well, to your disappointment, many experts think preeclampsia and eclampsia happen when a woman’s placenta doesn’t work the way it should, but they don’t know exactly why. There are, however, certain risk factors that contribute to its development:

  • Being a teen or woman over 40
  • Being African American
  • Being pregnant for the first time
  • Having babies less than 2 years apart or more than 10 years apart
  • Pregnancy with a new partner instead of the father of your previous children
  • High blood pressure before getting pregnant
  • A history of preeclampsia
  • A mother or sister who had preeclampsia
  • A history of obesity
  • Carrying more than one baby
  • In-vitro fertilization
  • A history of diabetes, kidney disease, lupus, or rheumatoid arthritis.

Madam/Mr Chair, allow me to clarify that falling into any of these categories does not necessarily mean that the person will automatically develop preeclampsia. It rather increases your chances of getting it.

Ladies and gentlemen, preeclampsia is a worldwide problem. It affects 2 to 8 percent of pregnancies worldwide (2 to 8 in 100). In the United States, it is the cause of 15 percent (about 3 in 20) of premature births. In Africa and Asia 9% of maternal deaths are attributed to pre-eclampsia. From a global perspective, most deaths due to hypertensive disorders of pregnancy occur in developing countries. The World Health Organization (WHO) estimates the incidence of pre-eclampsia in developing countries seven times higher (2.8% of live births) compared to more developed countries (0.4%). In Sub-Saharan Africa alone, pre-eclampsia remains a major public health problem as the reported the prevalence of pre-eclampsia ranges from 1.8 to 16.7% and contributes to high rates of maternal mortality.  

In Ghana, the prevalence of PE is estimated to be between 6.55 and 7.03%. It is one of the top five leading causes of maternal and neonatal deaths. In the Greater Accra Region, PE has for the past 6 years assumed the number one position in terms of cause of maternal death with Ga Municipality not being exempted.

Madam/Mr. Chair, after this long talk about what the problem is and who is at risk of its development, we need to have a look at some of the signs and symptoms that one needs to look out for, whether from a patient’s point of view or that of a health professional.

Along with high blood pressure, preeclampsia signs and symptoms may include:

  • Excess protein in urine (proteinuria) or other signs of kidney problems
  • Decreased levels of platelets in blood (thrombocytopenia)
  • Increased liver enzymes that indicate liver problems
  • Severe headaches
  • Changes in vision, including temporary loss of vision, blurred vision or light sensitivity
  • Shortness of breath, caused by fluid in the lungs
  • Pain in the upper belly, usually under the ribs on the right side
  • Nausea or vomiting

Weight gain and swelling (edema) are typical during healthy pregnancies. However, sudden weight gain or a sudden appearance of edema — particularly in the face and hands — may be a sign of preeclampsia.

Some complications of pre-eclampsia include, but not limited to the following:

Fetal growth restriction

Preterm birth

Placental abruption

HELLP syndrome

Eclampsia

Other organ damage

Cardiovascular disease

Treatment and Prevention

The primary treatment for preeclampsia is either to deliver the baby or manage the condition until the best time to deliver the baby. This decision with the health care provider will depend on the severity of preeclampsia, the gestational age of the baby, and the overall health of the mother and the baby. In very severe cases (where the mother’s health is severely affected), the best is to deliver the baby irrespective of the age of the unborn baby.

For people with risk factors, there are some steps that can be taken prior to and during pregnancy to lower the chance of developing preeclampsia. These steps can include:

  • Losing weight if you have overweight/obesity (prior to pregnancy-related weight gain).
  • Controlling your blood pressure and blood sugar (if you had high blood pressure or diabetes prior to pregnancy).
  • Maintaining a regular exercise routine.
  • Getting enough sleep.
  • Eating healthy foods that are low in salt and avoiding caffeine.

Madam Chair, the good news is that preeclampsia typically goes away within days to weeks following delivery. Sometimes, the blood pressure can remain high for a few weeks after delivery, requiring treatment with medication. Healthcare providers will work with the client after the pregnancy to manage the blood pressure. People with preeclampsia — particularly those who develop the condition early in pregnancy — are at greater risk for high blood pressure (hypertension) and heart disease later in life. Knowing this information, those women can work with their primary care provider to take steps to reduce these risks.

Ladies and gentlemen, having realized how common and dangerous this condition is, the former Regional Director of Health Service, Dr. Linda Vanotoo, in 2015, brought all the obstetricians in the region together to develop a training tool. This, we deployed to all corners of the region in order to help improve the understanding and treatment of preeclampsia. My good self was a key member of the team, and when I was posted into the municipality in 2016, I never rested. I continued with the teaching and supportive supervision across the entire municipality. It is refreshing to note that almost every midwife/doctor in the municipality now understands the condition and are able to offer timely interventions.

Madam Chair, despite all these interventions, there is still more to be done, especially at the community level where knowledge about preeclampsia remains very low. I wish to suggest that it should be made part of the orientation that all newly posted doctors/midwives/PAs are made to through in the municipality. A combined team from the Municipal Hospital and the MHA will start an aggressive supportive supervision program aimed at improving the knowledge about preeclampsia.

Madam Chair, it is obvious that the war against Preeclampsia cannot be fought from one end only. It needs the collective efforts of Health providers, patients and their relatives, and support from the community and the Media to be able to win. Thanks for your attention.

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