Pre-eclampsia, the little talked about complication of pregnancy – 01/30/2024 – Balance and Health

In 2012, Koiwah Koi-Larbi was in the 25th week of her first pregnancy and very happy. She and her family were excited about the swelling of her legs, feet and hands. In Ghana, getting too big during pregnancy is a sign that a boy is on the way, she told DW.

But Koi-Larbi noticed other symptoms besides the swelling. She was having a headache and something called epigastric pain, in the upper right part of her stomach. She had heartburn and was seeing “all kinds of spots” on herself. When she reported her symptoms to the nurse, she was told that “it was just like that.”

One of the challenges of the diagnosis Koi-Larbi would later receive — pre-eclampsia — is the fact that many of the symptoms can be difficult to recognize by pregnant women themselves and by healthcare professionals, like her nurse, who are not trained to identify them. them.

Pre-eclampsia is one of the leading causes of maternal mortality worldwide. It is characterized by high blood pressure during pregnancy, something women are generally unable to feel.

“You can have [pressão alta] and not noticing,” said Joyce Browne, professor of global health and epidemiology at UMC Utrecht in the Netherlands. If you can notice, you may notice symptoms like Koi-Larbi’s or “a general feeling of not feeling well,” she said.

The incidence of pre-eclampsia varies from country to country. The World Health Organization (WHO) estimates that rates are about seven times higher in developing countries than in developed ones. Globally, it causes around 12% of maternal deaths per year.

Stages of preeclampsia: seizure, coma, death

Later that month, Koi-Larbi began having seizures and was rushed to the hospital at 2 am. They told her she had eclampsia — the result of untreated pre-eclampsia, which can lead to coma and even death if not treated in time.

The only thing that could save Koi-Larbi and her baby at that moment was an emergency cesarean section.

On the way to the hospital, her then-husband had spoken to her mother on the phone. Her mother was not surprised by her daughter’s condition. “Ah, that’s my illness,” she said. Koi-Larbi said this was the first time she knew her mother had had pre-eclampsia.

Browne advises all women going through pregnancy to ask their mothers if they had high blood pressure during their pregnancies. “It’s a major risk factor,” she said. “If you know your mother had it, that’s a reason for you to be more careful.”

Koi-Larbi met her baby three days after birth. He was tiny and too small to be breastfed – 48 hours later, the baby developed a complication and died. “We were devastated,” she said.

Second and third pregnancies

Koi-Larbi was determined to have a child. In fact, her dream was to have five. She became pregnant again a year later, in 2013. Five months into her pregnancy, she traveled to the United States to be cared for there for the remainder of her pregnancy. Again, she had late-onset preeclampsia but was able to give birth to a girl at 37 weeks.

Motivated by the positive birth experience, she became pregnant for the third time in 2017. She had the same symptoms that she had had in her other pregnancies, but they were less intense. This time, she said, she was just exhausted.

At 26 weeks, she went to the hospital to have her blood pressure checked. She wasn’t experiencing any intense symptoms, but she knew from her previous pregnancies that these tests were crucial. Her blood pressure was 150 over 100 – high enough for the doctor to recommend admitting her to the hospital.

On Koi-Larbi’s fourth day in the hospital, a midwife checked the baby’s heartbeat and couldn’t feel anything. A doctor confirmed that she had lost the baby. The medical team performed surgery to remove the dead fetus from Koi-Larbi’s body, saving her own life.

“At that point, yes, I was traumatized. I was asking questions. I was thinking, twice, this is a lot for me,” Koi-Larbi said.

During her recovery, she began looking online for answers. She found pre-eclampsia support groups, but only in the US, UK and Australia. She communicated with them and created her own help group, which she called “Action on Preeclampsia Ghana”.

Koi-Larbi’s goal was to provide information about the disease and raise awareness among women and healthcare professionals. She wanted to partner with researchers to find ways to improve the situation in Ghana. And provide a focal point where women who have had pre-eclampsia could access counseling.

“In our context, it’s not easy to talk or talk about your mental health, and unless you have a supportive husband and family during this traumatizing time, you’re going to have to deal with these kinds of things alone,” Koi said. -Larbi.

In 2019, with Action on Preeclampsia Ghana already in operation, Koi-Larbi, armed with years of knowledge, became pregnant for the fourth time. “There was a lot of hope for this one,” she said. But this time, she developed HELLP syndrome, the most serious form of pre-eclampsia, and had to give birth to avoid losing her own life. The 1 kg baby died three days after birth.

The three delays linked to maternal mortality

Maternal health is an indicator of how well a health system works and how much we prioritize women’s health, Browne said.

“Most women are healthy when they begin pregnancy. But there can be complications that require fast, good-quality care. And if you don’t have access to that fast, good-quality care, [isso pode significar] adverse outcomes, and adverse outcomes can literally be lethal.”

Experts like Browne look at maternal mortality through something called the “three lags” model.

The first delay occurs on the part of the woman herself – she does not think her pain is serious enough to warrant medical attention and ignores it.

The second delay is logistical – the barriers a woman may face when trying to reach a health center. These barriers are worse in remote villages, where women may live hours away from a health clinic.

The third delay is the quality of care when the woman arrives at the hospital.

Titus Beyou, a doctor from Ghana who has researched preeclampsia, said that after women arrive at the hospital, the quality of communication between them and the doctor can determine this third delay.

It’s not uncommon for a pregnant woman to be told she needs to terminate the pregnancy and give birth immediately without receiving an explanation why or understanding what the doctor is saying, Beyou said. This can lead the patient to reject treatment for their condition simply because they don’t understand what is happening.

Koi-Larbi said it was a miscommunication like this that led to the death of her first baby. “Ignorance killed my baby,” said Koi-Larbi. “I hadn’t been informed.”

It is a bitter irony that even when women have access to the health care they need, some may even reject treatment because of their religious convictions. And that can lead to another form of misunderstanding, Beyou said.

“They’ll ask, ‘Why do you want to give me a premature baby?'” They won’t accept the treatment — the crucial, life-saving premature birth — until they consult the pastor, he said.

Hospitals in Ghana have evaluated the possibility of solving this problem by hiring chaplains to work on-call at their facilities, Beyou said. But the country has many different religions and several denominations of each of them, which makes the solution not comprehensive.

But perhaps this is the important point: each woman and her pregnancy are individual and unique. Just as Koi-Larbi discovered, each of her pregnancies was different. Experts say that pregnancy care is not limited to childbirth or an emergency. Care must start from the beginning.