The Lagos State Government, in collaboration with a Consortium of Partners, which included the Johns Hopkins Program on International Education in Gynecology and Obstetrics (JHPIEGO), recently trained clinical staff at the General Hospital, Ijede, on the use of opportunistic diagnosis for screening and treatment in order to reduce maternal morbidity and mortality. The training was carried out in two phases.
Dr. Jenifer Adaeze, the Facilitator and State Quality Improvement Co-ordinator (SQIC), explained that the training is part of the RICOM3 (Reducing Indirect Causes of Maternal Mortality and Morbidity) project, which is aimed at improving the quality of care provided to women throughout the pregnancy continuum in order to reduce indirect causes of maternal morbidity and death.
Among the non-communicable diseases that affect women of reproductive age are, among others, breast cancer, sickle cell disease, hypertension, anemia, diabetes, and obesity, according to Draper.
Hypertension in pregnancy is characterized by elevated blood pressure, and the different classifications of hypertension in pregnancy include normal, pre-hypertension, moderate and severe. Dr. Adaeze emphasized that chronic hypertension or gestational hypertension could result in pre-eclampsia or a rupture of the membranes of the womb if not properly diagnosed and treated.
In her words: “Chronic hypertension is defined as when a patient had high blood pressure prior to pregnancy and continues to have high blood pressure during pregnancy; gestational hypertension is defined as hypertension caused by pregnancy; and pre-eclampsia is defined as the presence of severe classical features with or without proteinuria, with or without the presence of some degree of proteinuria as a criterion for severe features. ” Preeclampsia combined with chronic hypertension is a warning sign that the patient needs to be closely monitored and managed.”
For example, personal and family history of high blood pressure, multiple pregnancies, a body mass index of over 35kg or more, race, being overweight or obese, being over 40 years old, having a pregnancy interval of more than ten years, and so on are all risk factors for gestational hypertension.” Preeclampsia is associated with a number of risk factors, including multiple fetal gestation, chronic hypertension, pre-eclampsia in a previous pregnancy, diabetes, being over the age of 35 and under the age of 19, obesity, and being an African-American, she continued.
According to the Coordinator, some of the signs and symptoms of gestational hypertension include pain in the right shoulder, gall bladder, severe headache, epigastric pains, nausea and vomiting, blurred vision, seeing flashes, and temporary blindness, among others.
In his opinion, lifestyle modifications such as losing weight, adopting healthy eating habits, participating in physical activities, increasing intake of fruits and vegetables, among other things, are necessary for achieving treatment goals.
Treating hypertension in pregnancy lowers the risk of pre- and eclampsia, cardiovascular disease, kidney disease, and premature death. She also stated that untreated hypertension results in end-organ damage, heart disease, kidney disease, eye disease (including reduced vision), and stroke.
The Facilitator, on the other hand, suggested that baseline investigations for antenatal patients should include urinalysis, PCV, blood grouping, hepatitis (B and C), genotype, FBS, and RBS, among other things.
Those, according to her, are less expensive and will aid in determining whether hypertension or diabetes is caused by pregnancy or not, as well as assisting in developing a better treatment plan for pregnant women when they come in for antenatal care. They would also go a long way toward improving the overall quality of care provided in all health-care facilities throughout the state, she claims