Hypertension after childbirth.
Image Source: CNN
Angela Onwuzoo
Nigeria is replete with stories of women who died weeks after successfully going through the rigours of childbirth and returning home with their bundle of joy.
The sudden demise of such new mums, maternal health experts in Nigeria say, may not be unconnected to undiagnosed hypertension after delivery, known as postpartum hypertension.
This condition is associated with when a new mom’s blood pressure gets too high.
The gynaecologists revealed that the stress of labour could trigger hypertension in women after childbirth, especially in those with risk factors that include having a family history of hypertension and kidney diseases.
According to them, untreated hypertension during or after pregnancy can lead to death.
The World Health Organisation says a woman dies every two minutes and 287,000 women yearly during pregnancy or childbirth, noting that maternal health setbacks in many parts of the world have contributed to the disturbing finding.
According to a new report from the WHO, maternal deaths have either increased or stagnated nearly everywhere – from 223 maternal deaths per 100,000 live births in 2020, down from 227 in 2015 and 339 in 2000.
It listed leading causes of maternal death to include severe bleeding, high blood pressure, pregnancy-related infections, complications from unsafe abortion and underlying conditions that could be aggravated by pregnancy, such as HIV/AIDs and malaria.
WHO warned that unless progress is made on global targets for reducing maternal deaths – most of which are preventable – the lives of over one million more women could be at risk by 2030.
The physicians who spoke exclusively to PUNCH Healthwise said there was a huge knowledge gap among pregnant women about developing hypertension after delivery, noting that a lot of them are only aware of pregnancy-induced high blood pressure and not after delivery.
A renowned Professor of Obstetrics and Gynaecology, with over 40 years of experience in healthcare delivery and development work, Oladapo Ladipo, told our correspondent that a woman without high blood pressure could develop it after childbirth.
Professor Oladapo Ladipo
Ladipo, who is the co-founder, Association for Reproductive and Family Health, advised that a woman who feels unwell after delivery should see a maternal health expert immediately, especially for signs of headache, lethargy or general weakness.
According to Mayo Clinic, postpartum preeclampsia is a rare condition that occurs when a woman has high blood pressure and excess protein in her urine soon after childbirth.
It notes that most cases of postpartum preeclampsia develop within 48 hours of childbirth.
“But postpartum preeclampsia sometimes develops up to six weeks or later after childbirth. This is known as late postpartum preeclampsia.
“Postpartum preeclampsia requires prompt treatment. If left untreated, postpartum preeclampsia can cause seizures and other serious complications”, the clinic stated.
Further speaking on the medical condition, the gynaecologist, Ladipo said, “It is true that a woman that just had a baby and doesn’t have high blood pressure before and during labour can suddenly develop postpartum hypertension.
“You can have it before, you can have it during labour and you can have it after delivery too. You can have high blood pressure at any time. It can suddenly start at any time. It is for the midwife or obstetrician to monitor and be on the lookout.”
The maternal health expert restated the need to monitor a new mum for high blood pressure after childbirth, noting that the clinical chemistry of the woman often determines whether she will have postpartum hypertension or not.
He explained, “If you are predisposed to hypertension, for example, you have a family history of hypertension, are obese, or even if you don’t have it, the stress of delivery can trigger it.
“The important thing is to diagnose and have it treated. A woman can have hypertension immediately after delivery.
“Anything can trigger it if you are predisposed to it. So, the stress of delivery can trigger hypertension in women who are predisposed to it. If left untreated, they could die from it. Hypertension could rupture the brain vessels and cause stroke.
The professor urged women having sustained headaches after delivery to see a midwife or doctor for medical evaluation.
He also counselled new moms to reduce stress, sleep well and avoid things that could predispose them to hypertension.
The American Heart Association says high blood pressure is likely to linger after pregnancy in women who have preeclampsia.
The association noted that women with the condition are more likely to have high blood pressure after delivery compared to women who maintained normal blood pressure during their pregnancies.
Also speaking, a Consultant Obstetrician and Gynaecologist, Dr. Joseph Akinde, said inadequate rest and lack of sleep during pregnancy could increase the risk of a woman developing hypertension.
Dr. Akinde Joseph
He urged pregnant women to always get sufficient rest and sleep, warning that failure to do so would expose them to the risk of premature labour, miscarriage, and hypertension.
According to Akinde, pregnant women who are advised by their doctors to observe some rest should do so, further warning that stress and lack of rest usually have adverse effects on pregnancy.
He identified poverty as a key hindrance to women’s well-being, especially during pregnancy, noting that this often results in malnutrition, anaemia, low birth babies, or foetal loss.
The gynaecologist said a pregnant woman needs to have between six to eight hours of sleep daily.
Akinde who is a former chairman of the Society of Gynaecology and Obstetrics of Nigeria, Lagos State Chapter, said, “When pregnant women are advised to take rest and they do not, they might end up having premature labour, which may come sooner than expected.
“This will cause them to spend more money and they may have miscarriages. Again, they could develop complications in pregnancy like hypertension that may even lead to pre-eclampsia and claim their lives.
“As much as possible, pregnant women should heed their doctors’ advice rather than being penny wise, pound foolish. A pregnant woman needs to sleep for six to eight hours a day.”
The maternal health expert appealed to busy pregnant women to slow down from 36 weeks upward.
“The truth of the matter is that when you are stressed, you will have elevated blood pressure. And we know that hypertensive disorder in pregnancy is one of the real causes of maternal and infant mortality in Nigeria,” he added.
The gynaecologist urged the government to make normal delivery at its health facilities free and to offer minimal charges to those who deliver through caesarean section.
Meanwhile, researchers from the University of Zurich, Switzerland, said if an expectant mother is strongly stressed over a longer period, the risk of the unborn child developing mental or physical illness later in life – such as attention deficit hyperactivity disorder or cardiovascular disease, increases.
The 2018 Demographic and Health Survey showed that Nigeria’s latest maternal mortality ratio is 512 per 100,000 live births, which experts say is still very high.
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