Hypertensive disorders push maternal mortality rate



MASERU – Hypertensive disorders of pregnancy (HDP) stand as significant contributors to maternal health complications and mortality rates, posing potential risks to infant development during pregnancy in the country. Hypertension during pregnancy encompasses five distinct classifications: chronic hypertension in pregnancy, preeclampsia, preeclampsia superimposed on chronic hypertension, and eclampsia.

Chronic hypertension denotes elevated blood pressure that existed prior to pregnancy or was diagnosed before the 20th week of gestation. Women with chronic hypertension may also experience the onset of preeclampsia. Gestational hypertension emerges at or after the 20th week of gestation, often accompanied by indicators such as proteinuria or other cardiac and renal issues. Typically, this condition resolves postpartum, though there remains a risk of progression to chronic hypertension in the future.

According to the South Australian Perinatal Practice Guideline, preeclampsia is described as “a multi-system disorder characterised by hypertension and involvement of one or more other organ systems and/or the fetus.” Proteinuria is the most commonly recognised additional feature following hypertension (though not mandatory for clinical diagnosis).”

Superimposed preeclampsia on chronic hypertension typically manifests in women already afflicted with chronic hypertension, posing diagnostic challenges due to their closely intertwined characteristics. Eclampsia, as depicted in a synopsis in the Lesotho Medical Journal by Radiance Ogundipe, entails seizures arising as a complication of preeclampsia. A study reveals that “hypertensive disorders are prevalent complications of pregnancy, affecting 2–8% of pregnancies globally and accounting for approximately 9% of maternal deaths in Africa.”

The same synopsis in the Lesotho Medical Journal authored by Radiance Ogundipe underscores, “Hypertensive disorders of pregnancy carry significant maternal morbidity and mortality risks, alongside adverse pregnancy outcomes. Despite this, the precise burden of these conditions remains undocumented in Lesotho.”

Nelly Fobo, a retired midwife nurse and current president of the Independent Midwives Association, Lesotho, shares her wealth of experience, stating that throughout her career, she has cared for numerous pregnant women grappling with hypertensive disorders. “Pregnancy-induced hypertension emerges as a primary cause of maternal mortality during pregnancy and childbirth in Lesotho,” Fobo says.

She adds: “It is imperative for every pregnant woman to undergo blood pressure monitoring during their initial antenatal visit to initiate early detection and monitoring of any hypertensive disorders they may develop. “If a woman has a history of hypertension or has previously been diagnosed with the condition, it is crucial for her to receive care and monitoring under the supervision of a physician.”

“Any elevation in a woman’s blood pressure noted during antenatal care warrants immediate attention or referral to a physician for further management,” Fobo also says. The seasoned midwife highlights the bidirectional nature of the battle against hypertension in pregnancy.

While some women diligently adhere to prescribed guidelines, others face challenges due to factors such as poverty, which may lead them to consume whatever food is available, thus hindering adherence to a recommended diet. “Futhermore, some women still rely on traditional remedies (pitsa), despite their contraindication for pregnant women with hypertension,” adds Fobo.

She underscores the importance of women with hypertensive disorders of pregnancy receiving support from their families. Additionally, adherence to prescribed treatment and management is paramount. Investing in family planning methods is also advised to allow the body adequate rest between pregnancies.

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