The dilemma of managing Pre-eclampsia in a typical district Hospital in Sub-Saharan Africa

Pre-eclampsia is a condition that normally occurs after 20 weeks gestation in pregnancy typically presenting with Hypertension, edema ( usually lower limb and abdominal wall edema), and proteinuria. Severe cases will present with complaints of headache, blurred vision and abdominal pain. A good number of these cases will have a discrepancy in fundal height and  weeks of amenorrhea.

Usually an African Doctor will manage  thousands of  cases of Pre-Eclampsia before his/her Mmed. Most of these cases will not be well monitored for obvious reasons. Most district hospitals lack the capacity to carry out simple investigations that are necessary. There are very few mid-wives in these areas. Many of these mothers may end up losing their babies.
This is no different here in Uganda. Nifedipine tablets and Hydralazine are often the available anti-hypertensives available. They are prescribed together despite their known theoretical Interactions. Magnesium sulphate although readily available is not prescribed regularly to every mother who needs it. Calcium gluconate is very rare. Urinalysis is usually done. only one urine test is usually done due to the few and poorly paid mid-wives available. These mid-wives have very heavy workloads delivering several mothers alone. I have seen some faint after during their shifts.
HELLP syndrome is very common here too and often fatal to both the mother and fetus. 

The best treatment is often to deliver these mothers with quickest means available. Despite the severe Thrombocytopenia in most cases of severe Pre-eclampsia, most of these mothers do no bleed after delivery. Magnesium sulphate is the first line drug recommended for management of seizures in eclampsia and prevention of seizures in Pre-Eclampsia.

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