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Pre-eclampsia kills 28 moms in 5 years

BY PETRE WILLIAMS-RAYNOR Career & Education editor williamsp@jamaicaobserver.com
Sunday, July 22, 2012

IN the last five years, complications in pregnancy have claimed the lives of 186 women in Jamaica, 28 or 15 per cent of them because of pre-eclampsia (PE) — a disorder that sometimes causes the deaths of both mother and child.

This is according to Ministry of Health statistics, which also reveal that in the last seven months of this year alone, PE has claimed the lives of four of the 13 pregnant mothers who have died.

The precise number of babies whose lives have been lost as a result is not known.

At the University Hospital of the West Indies (UHWI) — a quasi-Government facility and pre-eclampsia referral centre — 150 pre-term babies were delivered last year alone, according to consultant obstetrician and gynaecologist Dr Leslie Samuels.

"I am not certain of the precise number attributable to pre-eclampsia. Based on experience, though, I would guess at about 25 to 30 per cent, so maybe about 35 to 40 infants annually," he told the Sunday Observer.

He could not say how many of those infants died as a result. However, Samuels noted that there are a number of factors that would determine whether a preemie delivered as a result of pre-elampsia — or due to any other complication — survives.

"The causes of death in pre-term infants depends on how much the babies weigh at birth, how far in the pregnancy they got before being delivered, as well as if there were any other significant problems at the time of birth, and/or which developed after birth," he said.

PE is one of the pregnancy-induced hypertensive disorders, which are the leading cause of maternal deaths in women worldwide and, according to Samuels, affects about seven per cent of pregnancies in Jamaica.

"Women with hypertension before pregnancy or who are found to have it in the first half of pregnancy, are called chronic hypertensives. Women who develop it in the second half of pregnancy or even immediately following delivery may have either pregnancy-induced hypertension (PIH) or pre-eclampsia — if the hypertension is also associated with passing protein in the urine," explained Samuels, who is also an associate lecturer in the Department of Obstetrics and Gynaecology at the University of the West Indies, Mona.

"We see about 130 cases of PIH annually, along with about 85 cases of pre-eclampsia. So over five years, we would have seen approximately 425 pre-eclampsia cases," he said of what obtains at UHWI.

The realities of PIH and pre-eclampsia have prompted a plea for women to take antenatal care seriously since it could mean the difference between life and death for them and/or their children.

"It is important for women with a history of pre-eclampsia in previous pregnancies or hypertension to have regular and early antenatal care in a high-risk clinic, should they become pregnant again," said Dr Karen Lewis-Bell, director of Family Health Services at the Ministry of Health.

It is important for them to also be aware of eclampsia, which can follow pre-eclampsia, causing seizures.

"Compliance with clinic visits and medications and knowing the danger signs of eclampsia like severe headaches, seeing flashing lights, vomiting late in pregnancy and pain in the top part of the stomach are important for women to ensure that they receive proper and timely management," Lewis-Bell added.

There is no known cause of pre-eclampsia, which ranges from mild to severe and can occur from as early as 20 weeks into a woman's pregnancy. There are, however, some known risk factors, notably, being 35 years old or older, being of African descent, having gestational diabetes, having a history of hypertension as well as a first-time pregnancy and having multiple gestations (twins or triplets).

"We know the risk factors for pre-eclampsia... but we are currently unable to accurately and consistently predict or prevent it from occurring. The next best approach, therefore, is vigilance in monitoring our pregnant patients, particularly those identified as being high risk for the disease, and close monitoring and aggressive therapy when the cases do occur," noted Samuels.

Meanwhile, the management of the cases of mothers with pre-eclampsia, certainly at the UHWI, is decided on the basis of a number of variables.

"This depends on the time of presentation in the pregnancy, the severity of the illness, other maternal and/or fetal problems, and other contextual factors. Cases at term are delivered, as this is the cure for the illness," Samuels said.

"Cases diagnosed after 34 weeks — when the baby's lungs mature — may be managed with medication until term (after 37 weeks), if the case is mild. Severe cases are managed on an individual basis, attempting to strike a balance between the benefit of delivery, in the interest of the mother, and the benefit of the fetus/infant, trying to avoid extreme prematurity. Where this is not possible, that is, to find a compromise, the mother's best interests are given priority," he added.

As with most health challenges, UHWI, as elsewhere, could be aided in their efforts by additional resources.

"I personally think we (UHWI) are doing a good job in monitoring and management of pre-eclamptic patients, as our maternal and neonatal outcomes are, by and large, quite good. We have a high-risk antenatal clinic for these and other high risk cases, and we have had a high dependency unit formally incorporated into our labour ward since 2010," he told the Sunday Observer.

"We were also the first hospital in the country to have an obstetrician assigned specifically to the labour ward and post-natal wards on a long-term basis, to ensure better continuity of care, particularly for sick patients. Additional personnel resources would probably make the most difference in terms of additional nursing/midwife staff, and additional physical resources, for example, incubators and ventilators, particularly for the Neonatal Intensive Care Unit," Samuels added.

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