The patient about whom I had mentioned in my previous blog, PD who was in HELLP and on the ventilator passed away sometime around noon time couple of days back. . .
As I sat with the relatives for filling up the institutional Maternal Death Review forms, I was stunned to find out that PD had been having symptoms of sudden onset of swelling of the leg and episodes of severe headache along with nausea, vomiting and abdominal pain since about a week before she had more than a dozen episodes of seizures. She had consulted one of the local quacks and she was told that this was common in the first pregnancy . . .
PD had her last antenatal check ups couple of weeks before she had the acute onset of seizures . . . And she had quite regular antenatal check ups . . . Unfortunately, they did not help her to realize that she was having complications setting in . . .
We have quite a large number of patients who come with various forms of hypertension in pregnancy . . . Most of them are managed without much problems . . . However, last month, we've had 5 deaths due to eclampsia . . . Mind you, we had given the option to all of them to be taken to a higher centre . . . However, I suspect, if anyone would have tolerated the four hour journey to Ranchi.
I'm sure it is very much evident that prevention of eclampsia requires much more than a routine ante-natal check up. Explaining to the patient and relatives about the warning signs, such as swelling of the legs, headache, nausea etc has to be done very thoroughly.
Nobody is quite sure about the aetiology of the condition . . . Theories abound . . . I wonder if it has some relation to some vitamin or mineral deficiency . . Something else which I've noticed is the aspect of the husband being away from the patient for quite a long time in almost all the cases of eclampsias. . .I would love to do a case control study . . . Provided I've the time and required help. . .
However, till we have definite evidence about the aetiopathogenesis of the condition, the best we can do is to education communities and families about the warning sings of pre-eclampsia which should ultimately have them rushing to their health-providers for help . . .