Pregnant women must routinely go for antenatal care visits in health facilities where their blood pressures can be measured; they must be vigilant to identify any of the danger symptoms and report quickly to the hospital, according to Dr Andrew Oryono, Gynaecologist and Obstetrician at Heritage Medical Park, located in Kagarama, Kicukiro District.
He says HBP is a lethal but often symptomless complication; hence it is nicknamed ‘silent killer.’
Also known as hypertension or better called hypertensive disorders of pregnancy, HBP is among the top five complications that account for nearly 75% of all maternal deaths, according to World Health Organisation (WHO) report 2016.
The complications are severe bleeding (mostly bleeding after childbirth), infections (usually after childbirth), high blood pressure during pregnancy (pre-eclampsia and eclampsia), complications from delivery and unsafe abortion.
Defined as the force of blood pushing against the walls of the arteries as the heart pumps blood, blood pressure is measured by taking the { {{Systolic pressure}} } (blood pressure when the heart beats while pumping blood) and the { {{Diastolic pressure }} } (blood pressure when the heart is at rest between beats. Thus blood pressure is reported as systolic blood pressure over diastolic blood pressure in millimetres of mercury (mmHg).
Dr Oryono says the blood pressure is said to be low when it is less than 90/60mmHg, normal when it is between 90/60mmHg and120/80mmHg while HBP starts at 140/90mmHg and above.
“High blood pressure or Hypertension is when blood flows through blood vessels (arteries) at higher than normal pressures. It is a common disease and often occurs during pregnancy causing maternal and prenatal morbidity and mortality,” he says.
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Dr Oryono says every pregnant woman has a potential to get high blood pressure (Preeclampsia) but there are factors that account for higher risks. These include extreme age as women below 20 and those above 40 years old, first pregnancy, preeclampsia in previous pregnancy, carrying multiple foetuses like twins, triplets or more, family history of high blood pressure or preeclampsia, pre-existing or chronic high blood pressure, kidney disease or blood disorders and diabetes, African or Native American ancestry, obesity before pregnancy and being impregnated by new spouses.
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Pregnant mothers with high blood pressure often have no symptoms and can be referred to as mild preeclampsia but severe preeclampsia (BP ≥160/110mmhg) is characterized by end-organ damage and the symptoms include persistent severe headache, blurred vision, temporary loss of vision in one eye or both, epigastric pain or right upper quadrant abdominal pain, nausea and vomiting after 20 weeks of pregnancy, decreased urine output, shortness of breath or difficulty in breathing on exertion, sudden weight gain, swelling of the face or fingers, altered mental state like developing confusion, anxiety and sometimes coma.
Dr Oryono, however, reminds that these symptoms do not necessarily come from HBP and pregnant women must always get examined to ascertain complications behind the symptoms.
Though the cause of preeclampsia among pregnant women remains unclear, placental delivery reverses the symptoms of preeclampsia, suggesting that the placenta has a controlling role in the condition.
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In addition to possible death, hypertension carries more dangerous effects to mothers and foetuses. Mothers face fatal convulsions; the placenta may prematurely separate from the wall of the uterus and internal bleeding occurs where it had been attached, a condition known as ‘abruptio placentae’; stroke or cardiovascular accident due to burst of blood vessels in the brain and this is the main cause of maternal death, according to Dr Oryono.
It can also cause difficulties in breathing as a result of accumulation of fluids in the lungs (pulmonary oedema), uncontrolled bleeding from various sites of the body, kidney failure, blindness that may occur due to retinal detachment or occipital lobe lesions and ruptured liver.
Foetal complications include foetal growth restriction, preterm delivery resulting into a premature baby, foetal distress, intrauterine foetal death and more.
According to WHO, hypertension is a very common disease, albeit not well-recognised nor well-controlled among people of all categories. The global mortality index ranks hypertension as the leading cause of death (smoking is second), making it the most dominant silent killer disease. Hypertension accounts for 51% of all strokes and 45% of all heart diseases.
WHO statistics show that at least 33 women die of pregnancy related causes every hour in the world and hypertension is among the leading causes. Maternal mortality stood at 216 deaths per 100,000 live births in 2016 while Sustainable Development Goals aim to reach less than 70 per 100,000 live births in 2030.
In Rwanda, the rate was at 290 deaths per 100,000 live births in 2015.
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