One of the farmers who works our fields lost his wife on Christmas day. She was eight months pregnant and had no problems delivering her other children, so she didn’t bother to visit the village midwife until she suddenly felt sick, started to swell up, and had trouble breathing.

The midwife examined her, discovered her blood pressure was high and that she had a twin pregnancy, and called the city ambulance to take her to the hospital. But the poor lady went into seizures before the ambulance arrived, and after our local hospital stablized her, she was transferred to the big city nearby, where CT scan showed cerebral edema. They did an emergency Caesarian section, and the twins are fine. But mother despite treatment ended up with either fatal cerebral edema or a stroke, and despite a respirator and treatment in Intensive care, she died.

The irony? Her treatment was as good as she could have gotten in the USA, but because she didn’t bother to see a midwife for prenatal care, she died.

And the cause of her deaths is something dreaded by doctors worldwide: Toxemia of pregnancy, now called AKA Eclampsia or Pre Eclampsia. ( it is called Eclampsia if the woman has seizures). At one time it was thought that the fetus was poisoning the mother, ergo the poisonous fetus, but now most theories suspect the problem is the placenta.

Despite years of reasearch, no one really knows the cause of the disease.  It is more common in very young women, in older (over 35) women with their first baby, in women with poor nutrition, and in women who already have high blood pressure, diabetes, or kidney disease. It is also more common with a twin pregnancy, and when there is a family history of the problem.

The treatment? You deliver the baby.

Over the last 40 years I’ve seen dozens of different treatments tried and discarded after they didn’t really work: Here’s a list.

Oh, there are other treatments we use. We give blood pressure medicine if the pressure is high, Magnesium sulfate injections if the woman’s reflexes are brisk, low dose aspirin (maybe), but the only “cure” is to deliver the baby as soon as possible.

Doctors know that well nourished women don’t tend to get Eclampsia as often, and deaths are rare in the US. However, there are 56,000 deaths a year worldwide from the problem. It is one of those underfunded diseases that Bill Gates got interested in: Website here.

The way to stop these deaths is to diagnose the disease early. That means prenatal care, and in the third world, that means training midwives and birth attendents to diagnose the problem early and refer to a specialist.
The bad cases need an expert’s judgement to determine when to do the delivery (before mother gets too sick, but not so early the baby dies of prematurity).

Alas for this poor woman, despite a well trained RN as the village midwife, the failure to get early prenatal care meant that her problem wasn’t diagnosed in time to prevent her death from complications. The good news is that the children survived.

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Nancy Reyes is a retired physician living in the rural Philippines. Her website is Finest Kind Clinic and Fishmarket, and she writes medical essays at HeyDoc Xanga Blog 

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