Many women lose their lives during childbirth especially in developing countries where medical care is still inadequate.
Maternal mortality ratio is highest in the African region, estimated at an average of 800 deaths per 100 000 live births. In Nigeria it is estimated at 1000 per 100 000 live births with wide regional disparities. Common causes of maternal deaths include bleeding, hypertensive diseases in pregnancy, obstructed labour, eclampsia, maternal infections and unsafe abortions. Eclampsia is the most common cause of maternal death especially in Northern Nigeria accounting for about 30% of all maternal deaths while studies carried out in Southern Nigeria found haemorrhage and unsafe abortions as the leading cause of maternal mortality.
Eclampsia is an acute and life threatening complication of pregnancy characterized by the appearance of convulsions in a patient with high blood pressure and protein in the urine. It may occur before, during or shortly after delivery.
Common risk factors of developing eclampsia include first pregnancy, multiple gestations and pre-existing hypertension. When eclampsia occurs after delivery, especially in Northern Nigeria, it may be associated with some harmful traditional practices like “hot bath” and ingestion of Kunun Kanwa [a lake salt rich in sodium].
The hallmark of eclampsia is the occurrence of major epileptiform convulsions. Other features include headache and nausea preceding the convulsions. Patient may present with other features like abdominal pain, vaginal bleeding, liver and kidney failure. Blood pressure is raised and proteins are present in the urine. The mortality varies with the number of fits, the quality of the treatment and the speed with which treatment is made available. Pregnant women with eclampsia are believed to be possessed by evil spirits especially in rural areas where level of educational attainment is still low; and hence those type of ailments are thought to be beyond the realm of modern therapy and the expertise of traditional healers are thought first. This results in considerable delay in seeking modern obstetric care and can lead to severe morbidity and mortality.
The aim of management of eclampsia is prevention of further convulsions, control of the elevated blood pressure and delivery of the woman as soon as possible. These are achieved by sedation and use of drugs like magnesium sulphate and use of antihypertensive drugs. The woman can either be delivered by caesarean section; or with the aid of vacuum extractor or forceps.
Early detection and management of pre-eclampsia are essential part of antenatal care and hence prevention of eclampsia involves regular antenatal visit by all pregnant women. The community should also be educated about obstetric complications like eclampsia and when and where to seek for assistance. All health care facilities should ensure skilled attendance i.e. doctors and midwives at every birth. Doctors attending to pregnant woman should be trained to be proficient in life saving procedures like caesarean section, forceps delivery and vacuum extraction. We should promote antenatal care attendance by pregnant women and female education.
Government, health care workers and well- meaning Nigerians should demonstrate more commitment towards reducing maternal deaths resulting from eclampsia and other pregnancy related complications.
Dr Abdullahi Dahiru is a Kano based medical practitioner.