Prevent eclampsia, save mothers
8 June 2013, 18:00 PM
UPDATED
8 June 2013, 22:00 PM
Preeclampsia and eclampsia (PE/E) is one of the leading causes of maternal and perinatal mortality and morbidity. Preeclampsia is characterised by high blood pressure developed during pregnancy, loss of protein in the urine (proteinuria) leading to swelling in the body and associated with some danger signs including headache, blurring of vision, abdominal pain. When preeclampsia occurs with convulsion, it is called eclampsia.
Eclampsia is the second leading cause of maternal death in Bangladesh that contributes to 20% of all maternal deaths due to obstetric complications following post-partum hemorrhage (PPH). A number of studies have shown that case fatality of eclampsia was very high and it is mainly due to delay in referral and consequent long intervals between onsets of convulsions and reaching the hospitals.
Women die in PE/E due to infrequent antenatal care counselling which results in poor detection during of high blood pressure during antenatal care and proteinuria.
Low number of delivery by Skilled Birth Attendant (SBA), reluctance to provide primary care for eclampsia and poor access to emergency obstetric and newborn care also contribute to high mortality.
Unfortunately, in Bangladesh, most preeclampsia cases remain unrecognised until it turns into eclampsia with severe convulsion and complications. Although a major contributor of maternal mortality, PE/E still is not getting the attention it deserves. It is not properly prioritised in public and private health agenda due to lack of awareness at the national level and lack of importance given by the health policymakers as well.
Till now, the management of eclampsia is facility based and there is no community level intervention to provide rapid treatment which is crucial for management. The basic principles of management of eclampsia include control of convulsion, control of hypertension — initiation of steps to effective delivery within 12 hours and general nursing care.
In the effort to detect pre-eclampsia before it becomes life threatening eclampsia, one important approach is to measure blood pressure and proteinuria (checking urine for protein in women) in their home/community by detection kit rather than depending entirely facility testing.
It is also important to ensure loading dose of Magnesium sulfate in convulsive women or severe PE at home before transferring women to facilities. United States Agency for International Development (USAID's) MaMoni intervention which is being implemented by Save the Children in Bangladesh and local NGOs Shimantik and FIVD with technical assistance from OGSB and EngenderHealth and with collaboration of Government is has set a programme on Community Based Prevention of PE/E using the loading dose of injectable Magnesium sulfate in such women at Habiganj District.
The loading dose of Magnesium sulfateat first place followed by urgent referral to facility is crucial to save thousands of mothers from eclampsia.
The writer is Reproductive Health Advisor at Jhpiego in Bangladesh.
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