Eclampsia reported as fourth leading cause of maternal death in Malaysia
While pregnancy is a joyous experience for many, pregnant mothers and their unborn babies may be at fatal disadvantage when faced with a condition known as pre-eclampsia or the more severe eclampsia. The condition is characterised by high blood pressure and signs of damage to another organ system, most often the kidneys which leaks protein (proteinuria); this is caused by the abnormal formation of blood vessels in the placenta and the mother’s blood vessels – what causes the abnormalities, however, remains unknown.
In Malaysia, eclampsia accounted for 6% of maternal deaths in 2020, along with ectopic pregnancy, and ranked after obstetric embolism, postpartum haemorrhage, and gestational hypertension with significant proteinuria.
“Eclampsia is the onset of fits or seizures in pregnant women and is a severe complication of preeclampsia. Preeclampsia mostly occurs during the antenatal period, more so in the third trimester. 80% of eclamptic fits occur during the delivery process, or within the first 48 hours following delivery. Statistically speaking, the prevalence of preeclampsia and eclampsia is 4.6% and 0.3% respectively,” explained Kuala Lumpur-based Dr. Nor Elyana Noordin, Consultant Obstetrician and Gynaecologist, Sunway Medical Centre Velocity (SMCV).
With the condition originating from the placenta, preeclampsia may prevent the baby from obtaining sufficient blood supply – as a result, the baby may be smaller in size as it does not grow at a normal rate inside the womb, also known as foetal growth restriction.
Dr. Wong Yen Shi, Consultant Obstetrician and Gynaecologist from SMCV, added that preeclampsia and its complications increase the likelihood of preterm delivery. “The complications that follow preterm deliveries may include cerebral palsy (irreversible movement disorder), learning disabilities, feeding or gut problems, as well as visual or hearing impairment.”
Soon-to-be mothers should watch out for chronic conditions that can increase their risk of developing preeclampsia such as having diabetes, high blood pressure or kidney disease, and/or lupus or antiphospholipid syndrome. Other instances that may increase the chances of preeclampsia include first time pregnancy, a family history of the condition, being over 40 years old, having a 10-year gap from the last pregnancy, expecting multiple babies (twins or triplets), or a Body Mass Index (BMI) of 35 or over.
Dr. Wong mentioned that there is a 15% chance of a woman developing preeclampsia in her second pregnancy if she experienced it in her first. She further explained that the most effective treatment for preeclampsia is delivery of the foetus and placenta, but if it is pre-term, management of the condition includes antihypertensive medications, blood or urine tests and regular follow-ups to monitor both the mother and foetus’ condition.
“It is important to ensure that the blood pressure is under control prior to embarking on a pregnancy journey for ladies with underlying hypertension. Aspirin is used to prevent or delay onset of preeclampsia. Exercising and well-balanced diet is important for general well-being but it does not prevent preeclampsia,” Dr. Wong said.
Although preeclampsia is sometimes asymptomatic, antenatal check-ups should pick up incidences of high blood pressure. Less obvious signs that may present itself during severe preeclampsia are severe headaches, vision problems, pain below the ribs, severe nausea and vomiting, sudden weight gain and swelling (oedema) in the face and hands.
Read: Women with preeclampsia more prone to kidney failure
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