How to Manage Pregnancy Induced High Blood Pressure

Hypertensive disorders in pregnancy are leading causes of maternal mortality worldwide. But access to antenatal care and quality care during childbirth could avert unnecessary deaths.


Atinuke Oluwalana’s pregnancy for her first baby was a smooth and easy ride. As the pregnancy approched 12 weeks, she began her ante-natal clinic and fortunately, she was hale and hearty throughout until the eight month, when Oluwalana started experiencing persistent headache and fever.
This development prompted her husband, Mr. Cooker Oluwalana to rush her to the Lagos University Teaching hospital (LUTH) where she attended her ante-natal. On taking Mrs. Oluwalana’s blood pressure reading, the nurse was alarmed – it was 220/180. Without a second thought, the nurse alerted the doctor on duty that Oluwalana’s case was an emergency.
After the doctor’s examination, she was promptly admitted in the hospital for further observation. By the second day, the doctor leading the health team taking care of her informed her husband that since the blood pressure was not reducing the possibility of a caesarean operation as a quick intervention.
The doctor added that the increasing blood pressure could pose danger to both mother and the unborn baby. By the time the blood pressure was checked at 11pm on that fateful day and it was confirmed that despite having been placed on blood pressure control medication, it continued to rise, the health team decided that a caesarean surgery as earlier hinted should be the next move to save both mother and baby.
Within minutes, the information was passed to the couple and with their support Mrs Oluwalana was moved into the theatre for the surgery. The medical team conducting the surgery moved in and by 1.30 am, a baby boy had been delivered, all to the joy of the family and the medical team that saved the day.
In another scenario which occurred in a private hospital in Abuja two years ago, a pregnant woman, Mrs Ogechi Mba who was seven and half month pregnant experienced excessive high blood pressure but because she had not been attending ante-natal, her condition was not detected. However, following the severe fever that ensured, she was rushed to the Abuja hospital.
Although, medical team on ground moved in and carried out a quick surgery on the woman, while the baby was delivered safe, the mother could not make it. Her death however shocked her husband, friends and relations.
Most people that heard about that the death of Mrs. Mba did not believe that high blood pressure could result to such a death. Despite their unbelief however, it was real that Mrs. Mba was not as lucky as the Mrs. Oluwalana.
According to medical experts, gestational hypertension or pregnancy- induced hypertension is the development of new hypertension in a pregnant woman after 20 weeks gestation. Hypertension is defined as having a blood pressure greater than 140/90 mm Hg. It is worthy to mention that it may sound unbelievable that many pregnant women have lost their lives as a result of hypertension during pregnancy.
According to the World Health Organisation (WHO), about 830 women die from pregnancy- or childbirth-related complications around the world every day. “By the end of 2015, roughly 303,000 women will have died during pregnancy and childbirth. Ninetynine per cent of all these maternal deaths occur in developing countries including Nigeria.”
In Nigeria, maternal mortality rate in the country is 576 per 100,000 live births (lb). It is estimated that the number of maternal deaths in Nigeria is 40,000 annually and the life-time risk of dying from pregnancy or child-bearing related causes is one in 13. What this means is that out of every 13 pregnancies one of the pregnant woman faces the risk of losing her life from pregnancy-related causes.
The International Journal of Gynecology & Obstetrics has identified hypertensive diseases as one of the leading cause of maternal death. A WHO response to addressing maternal death due to not only high blood pressure, but also severe bleeding, infections, complications from delivery, unsafe abortion, among others is hinged mostly on prevention.
According to the world body, health-care solutions to prevent or manage complications are well known: “all women need access to antenatal care in pregnancy, skilled care during childbirth, and care and support in the weeks after childbirth”.
So far, many women fail to access care from skilled attendants. For instance it is estimated that the percentage of births taken by skilled health personnel in Nigeria is 38.1 per cent. What this translates to is that over 50 per cent of deliveries in the country are taken by unskilled birth attendants.
If this is not reversed to pave way for the intervention of more skilled birth attendants to take deliveries, targets set to reduce maternal deaths in the Sustainable Development Goals (SDGs) by 2030 may not be achievable, according to Mrs Titilope Gbemisola Akosa of the Centre for 21st Century Issues, a nongovernmental organisation.
In spite of wide publicity by the three tiers of governments, agencies, civil society groups and non-government organisations in Nigeria calling on pregnant women to seek ante-natal care, many do not bother to attend ante-natal clinics based on the experience that some women deliver naturally without any complications.
Even many deliver at home with the assistance of traditional birth attendants. Confirming this trend, a Family Physician, Dr. Adeyeye Arigbabuwo admitted that although, some women would deliver their babies naturally without any complications some deliveries would also lead to complications.
He therefore advised pregnant women to attend ante-natal clinics as recommended by the WHO as this measure could forestall conditions that would pose risk to them. He said during pregnancy blood pressure of pregnant women is checked at every antenatal appointment. This is because a rise in blood pressure can be the first sign of pre-eclampsia, often called ‘pregnancy induced hypertension’ (PIH) or ‘pre-eclamptic toxaemia’ (PET).
For instance, if Mrs. Mba whose case is highlighted in this report, had been attending antenatal, there could have been a medical intervention that could have saved her life. The WHO stated that maternal health and newborn health are closely linked. Approximately 2.7 million newborn babies die globally every year, and an additional 2.6 million are stillborn. “It is particularly important that all births are attended by skilled health professionals, as timely management and treatment can make the difference between life and death.

Culled: newtelegraphonline.com