maternal
Dr Uwakwe-mangse Hanna (MBBS, MRCS)

Going through my facebook pictures I came across one that really affected me in a negative way. I was staring at Chioma my cousin who died few days to her expected day of delivery. Her death was very preventable only if our healthcare system is good and functional.

99% of maternal death happens in developing countries and Nigeria is among such unfortunately despite the vast majority of wealth we are blessed with.


In one the study done by WHO, it is estimated that 73% of maternal death are obstetrics caused meaning we can avoid 73% of women dying during pregnancy and childbirth alone if we can develop our maternal healthcare to such an accepted level as that which is obtainable in the Western nations.

Today’s article will be anchored more on some of the causes of maternal deaths and how we can prevent them by adopting healthy lifestyles before and during pregnancy.

The above graph from UNICEF showed a summary of maternal death in West Africa. From the graph one can see that 64% of them are preventable and those caused by Sepsis/Infection, Hypertensive disorders, HIV/AIDS, Anaemia, Haemorrhage and complication of abortions.

SEPSIS/INFECTIONS

Sepsis is a life-threatening complication of an infection when the body’s immune defences react in an extreme way.
Many different microbes can cause sepsis.

Although bacteria are most common causes, viruses and fungi can also cause sepsis. Infections in the lungs (pneumonia), bladder and kidneys (urinary tract infections), skin (cellulitis), abdomen (such as appendicitis), and other organs (such as meningitis) can spread and lead to sepsis.

In Nigeria the commonest cause of sepsis in pregnant women is malaria. This is one reason a good antenatal clinic recommends or even prescribes malaria prophylaxis tablets and advises on the use of mosquito nets and clean environment.

If by any chance you develop signs of sepsis like fever, chills and rigors etc… I seriously recommends going to a good hospital instead of the chemist near you for proper treatments.

HYPERTENSIVE DISORDERS

Any woman who suffers from hypertension (high BP) or who has a strong family history of hypertension or who had high BP in any previous pregnancy MUST as a matter of urgency first of all look for a good hospital to do all her antenatal and give birth there.

NEVER GO TO THE CHEMIST FOR MIXTURE OF DRUGS.

You need to know your baseline BP and if you can’t afford to own your own BP machine insist on visiting your local antenatal clinic for BP checks and urinalysis (urine test to look for protein, glucose etc…)
If you are prescribed any medication, take them regularly. Take salt away from your diet entirely and make sure you go for at least 30mins brisk walk every day.
NEVER ACCEPT TO HAVE YOUR BABY IN A MATERNITY CENTRE.

HIV/AIDS

If you are pregnant and have HIV/AIDS, this is the time to visit your obstetrician and ask for advice regarding taking your antiretroviral drugs.

You need to keep your viral load as low as possible.

I want to believe the medications are now free in Nigeria as it is all over the world. You and your obstetrician should be able to seat down and decide on the possible options of delivery that you want to adopt bearing in mind that C-section gives the lowest risk of maternal-child transmission of the disease.

In the hand of a good obstetrician and also in a good hospital, a planned C-section is very safe and a better choice for both mum, baby and healthcare professionals.

ANAEMIA
It is usually defined as a decrease in the total amount of red blood cells (RBCs) or haemoglobin in the blood.

This very common amongst our women and to be honest is one of the easily treatable causes of maternal death. The reason is the fact that iron tablets are very cheap and are given to women in most antenatal clinics.

Not only that Iron rich foods are available such as Ugu leaves, cow liver etc…
If you have anaemia before pregnancy, make sure you correct that by taking Iron tablets at least 3 months preconception and continue taking it at least 6 months post-delivery of your baby.

HAEMORRHAGE

This is a very vast topic in itself. I think I will have to discuss it on its own merit but will give just a little tip on what we can do to avoid it.

The first and basic cause of maternal death due to haemorrhage in pregnancy is a lack of experienced caregivers who might be able to successfully manage it when it occurred.

This is where I really fault women who go to maternity centre to give birth when they may have had previous experience with haemorrhage or heavy bleeding in the past. Women with obesity or big babies, or with twins run the risk of this, so technically should never deliver in a quack hospital or a maternity centres.

Lack of blood transfusion services, anaesthetic services, and operating capabilities also plays a role. This is where I really fault our healthcare system BUT the way round this is to go to a good hospital if possible a tertiary centre for delivery.

If you have a planned C-section, make sure you have at least 2 units or blood bag around and ready for use as precautionary measures. If you are obese, or are having multiple births or have had postpartum haemorrhage in previous pregnancies also make sure you have blood available for you should you need them.

Most time deaths due to haemorrhage occurs because no blood was available to replace the loss while the doctors are trying to stop the cause of the bleeding.
Such death is so painful.

COMPLICATION OF ABORTIONS

Abortion is a very broad topic I think I may have to discuss next week. It’s sad that in 2017, many women still die of this.

I am a pro-life but recognise that that there are circumstances when abortion is needed especially if the life of the mother is at stake or in the case of rape or even when the baby is badly deformed and or in the case where the foetus is dead.

My advice to anyone hoping for any reason to have an abortion is to do it within the confinement of a good hospital and not by a friend or a quack.

Many women have died due to perforation of the womb, retained products of pregnancy. To me this is a careless and avoidable death.
To many a condom would have saved their lives.

In summary there are many things we can do to avoid maternal deaths. It starts with knowing yourself and your health status. If you are diabetic, for example, you need to know in and out about managing diabetes in pregnancy.

Thanks to the internet you can go to educational sites and read more on how to manage yourself BUT the bottom line still lies in having your baby in a good and reputable hospital no matter the cost.

If you can’t afford a good hospital, please avoid pregnancy at all cost especially if you are comorbid or have health conditions that will warrant regular hospital checks and delivery.
I will have to take a leave now.




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