Eclampsia: How Timely Care Can Save Two Lives

In 2020, pregnant Black women were twice as likely to experience critical health issues like hemorrhage, preeclampsia and sepsis. Credit: Terry Schmitt/Pool/Sipa USA via REUTERS

Rose Kahandari was determined to give her unborn baby the best possible start in life. She attended antenatal clinics, followed medical advice and hoped to carry her pregnancy to term and deliver safely.

But as her pregnancy progressed, severe headaches, persistent fatigue and difficulties eating began to take a toll. At about 32 weeks, a routine antenatal visit revealed that her blood pressure was high.

“I used to have very severe morning sickness,” Rose recalled, describing the challenges she experienced while balancing pregnancy with her responsibilities as a teacher. She said the pregnancy became increasingly difficult as she developed severe headaches and struggled with everyday activities.

At the antenatal clinic, healthcare workers checked her vital signs and repeated her blood pressure measurement. The reading remained concerning.

“The doctor told me, ‘Mom, your blood pressure is high. I want you to lie down on the bed. We will try again after a while and see if it will get better,’” she recalled.

Rose said she was advised to seek further assessment at a facility closer to where she lived. As a teacher in Kenya her insurance arrangements restricted the hospitals she could visit, accessing care required additional coordination.

She subsequently attended a nearby facility for regular monitoring.

As her pregnancy progressed towards delivery, Rose remained concerned about her baby's wellbeing. She recalled visiting Royal Garden Hospital because she wanted reassurance that her baby was okay.

“I really wanted an ultrasound to check the baby, if she was okay,” she said.

Instead, the medical team recommended a caesarean section. Rose was taken to theatre, and her baby was delivered. She recalled that the umbilical cord had become wrapped around the baby's neck.

But delivery did not immediately resolve her health concerns.

“My blood pressure did not get to normal as quickly as my doctor would have wished,” she said.

Rose said her blood pressure eventually returned to normal towards the end of 2017 a year and a half later. During the recovery period, she also experienced postpartum depression as she struggled to adjust to motherhood and the demands of caring for her newborn.

“I was unable to navigate the whole issue of motherhood,” she recalled.

Her experience illustrates why the dangers of pregnancy-related hypertension do not necessarily end with childbirth. Although Rose's account does not establish that she experienced eclampsia, it highlights the importance of monitoring blood pressure during pregnancy and continuing care after delivery.

Understanding pre-eclampsia and eclampsia

These concerns were among the issues examined during a meeting organised by Kenyatta National Hospital (KNH) and the University of Nairobi (UoN), which brought together maternal and newborn health specialists to discuss practical approaches to managing obstetric emergencies.

The meeting examined how healthcare workers can recognise complications early, stabilise patients, ensure access to essential medicines and strengthen referrals between health facilities.

Dr Loise Nyanjau, Head of the Maternal Health Programme at the Ministry of Health (RMNCAH), said preventing maternal deaths requires more than responding after an emergency occurs.

“Improving maternal outcomes is not only about managing emergencies,” she said. “It's about building the systems that prevent them.”

Pre-eclampsia is a pregnancy complication characterised by new-onset high blood pressure after 20 weeks of gestation, accompanied by protein in the urine or evidence of damage to organs such as the liver, kidneys or brain. It can also affect placental function and the baby's growth.

If pre-eclampsia progresses to eclampsia, the mother develops seizures that require immediate medical attention.

Warning signs can include severe or persistent headaches, blurred vision, pain in the upper abdomen and sudden swelling. However, some women may have few noticeable symptoms, making regular blood pressure checks and antenatal assessments particularly important.

Dr Grace Kanyi, an obstetrician-gynaecologist from Tharaka-Nithi County, explained that protein in the urine is not always necessary to diagnose pre-eclampsia.

“We do not need to have proteinuria anymore for us to say that the patient has pre-eclampsia,” she said.

New-onset hypertension after 20 weeks, alongside evidence of maternal organ dysfunction, can meet the diagnostic criteria even without proteinuria. This distinction matters because relying exclusively on urine protein tests could delay diagnosis in some women.

Although the precise causes of pre-eclampsia are not fully understood, abnormalities in placental development and blood vessel function are believed to contribute to the condition. It can affect several organs and threaten the lives of both mother and baby.

When minutes matter

Caroline Macharia, a midwife and reproductive health coordinator from Murang’a County, illustrated the urgency of early intervention using the case of a 26-year-old woman, identified as Mrs X, who was 38 weeks pregnant.

According to the case presented during the meeting, the woman had experienced severe headaches, blurred vision, upper abdominal pain and swelling of her lower limbs for two days before suffering two seizures on her way to a primary health facility.

Her blood pressure on arrival was 180/115 mmHg, indicating severe hypertension.

The case demonstrated how quickly a pregnancy complication can escalate and why frontline healthcare workers need the skills, medicines and equipment to respond immediately.

Initial management includes protecting the patient's airway, positioning her safely, monitoring her condition and establishing intravenous access. Magnesium sulphate is the standard medicine used to prevent and treat eclamptic seizures, while severe hypertension requires prompt treatment with appropriate medicines.

Labetalol, hydralazine and nifedipine may be used according to clinical protocols and the patient's circumstances.

Macharia called for health facilities to maintain emergency kits containing essential medicines and supplies, supported by clear protocols for stabilisation and referral.

However, stabilisation at a lower-level facility must be accompanied by timely transfer to a hospital capable of providing comprehensive emergency obstetric care.

Dr Kanyi also highlighted preventive interventions, including low-dose aspirin and calcium supplementation for eligible women, depending on their clinical risk factors and applicable guidelines.

Once pre-eclampsia develops, management depends on the severity of the condition, the gestational age and the wellbeing of both mother and baby.

Delivery of the baby and placenta is the definitive treatment for the underlying pregnancy-related condition. The timing and method of delivery depend on the mother's stability and the clinical circumstances, with essential maternal stabilisation a priority whenever possible.

Careful management of intravenous fluids is equally important because severe pre-eclampsia can increase the risk of pulmonary oedema, a potentially life-threatening accumulation of fluid in the lungs.

The medicines exist. Are they available?

Even when effective treatments are known, weaknesses in the health system can prevent women from receiving them when they need them.

Dr Eric Chomba, a county pharmacist from Makueni County, highlighted challenges in ensuring that essential medicines reach the departments where emergencies occur.

He explained that magnesium sulfate may be available in a hospital's main pharmacy but missing from the maternity unit when clinicians need it.

“There are instances where you may find in the main hospitals magnesium sulfate is available in the pharmacy, but in maternity it's not available,” he said.

The gap points to the importance of coordination between pharmacists and maternity teams, reliable stock monitoring and clear responsibility for replenishing emergency supplies.

A medicine's presence somewhere in the hospital is not enough. It must be accessible at the point of care when clinicians need to administer it.

The same principle applies to blood-pressure monitoring equipment, trained personnel, emergency transport and referral arrangements. A woman may reach a health facility, but her outcome can still depend on whether that facility can provide the required treatment or transfer her without avoidable delay.

Protecting the newborn

The consequences of pre-eclampsia and eclampsia can extend to the baby, increasing the risk of premature birth, restricted growth and complications associated with inadequate oxygen supply around delivery.

Dr Esther Njeri, a paediatric specialist from Nyeri County, emphasised the importance of preparing for newborns who may need specialised care.

“The baby born of a mother with eclampsia or pre-eclampsia... is likely to be a premature infant,” she said.

Where preterm delivery is anticipated and clinical criteria are met, antenatal corticosteroids can help accelerate fetal lung maturation. Eligible very preterm infants may also benefit from antenatal magnesium sulfate for fetal neuroprotection.

After birth, keeping vulnerable newborns warm, providing appropriate resuscitation and arranging specialised neonatal care can improve outcomes.

Njeri stressed that referring a pregnant woman before delivery, where a higher-level facility is available and transfer is clinically appropriate, can allow the baby to be born in a facility equipped to manage complications associated with prematurity.

“Where a baby is born should never determine whether they live or die,” she said.

Her remarks highlighted the need for referral systems that connect lower-level facilities with hospitals offering comprehensive obstetric and newborn services.

Preparing for emergency delivery

For some women with severe pre-eclampsia or eclampsia, delivery may require a caesarean section.

Dr Killian Kariuki, an anaesthesiologist from Kenyatta University Teaching, Referral and Research Hospital (KUTRRH), discussed the considerations involved in providing anaesthesia to these patients.

“The anesthetic of choice is actually a spinal anesthetic,” he said, where clinically appropriate.

The choice of anaesthesia depends on the woman's consciousness, platelet count, blood-clotting status and overall clinical condition.

Kariuki warned that general anaesthesia can present additional challenges in women with severe hypertensive disorders, including airway swelling and dangerous increases in blood pressure during intubation.

He also highlighted the need for anaesthesia teams to account for interactions between magnesium sulfate and certain muscle-relaxing medicines used during surgery.

These considerations reinforce the importance of coordination among obstetricians, anaesthesiologists, midwives, pharmacists and paediatric teams during emergencies.

Dr George Gwako, an obstetrician-gynaecologist from the University of Nairobi, similarly emphasised that managing eclampsia requires several priorities to be addressed simultaneously: controlling severe hypertension, preventing or treating seizures, preparing for delivery and monitoring for complications.

Care must continue after childbirth

For Rose, delivery marked the beginning of another difficult chapter.

Her blood pressure took time to return to normal, and she experienced postpartum depression while adjusting to motherhood and caring for her baby.

“I was forced to take care of the baby at around one month post-delivery, and I was unable to navigate the whole issue of motherhood,” she said, describing the difficulties she faced during recovery.

Her account draws attention to two issues that can be overlooked when maternal emergencies are measured only by whether a mother and baby survive childbirth: continued medical monitoring and the mother's mental wellbeing.

Hypertensive disorders can persist or first present after delivery. Women need appropriate blood pressure checks, clear instructions on warning signs and timely access to treatment after leaving hospital.

Persistent severe headaches, visual disturbances, upper abdominal pain, difficulty breathing or seizures after childbirth require urgent medical assessment.

Emotional recovery matters too. Mothers experiencing depression or struggling to cope after delivery need appropriate assessment, support and access to care.

Rose said her subsequent pregnancies were different. She did not experience the same blood pressure problems during her third pregnancy and was not prescribed blood pressure medication after leaving hospital following that delivery.

Her experience highlights that pregnancy outcomes can differ and that a history of high blood pressure during pregnancy should be communicated to healthcare providers when planning and managing future pregnancies.

For women and families, the difference may lie in whether warning signs are recognised early and whether the health system can respond before a manageable complication becomes a life-threatening emergency.

Timely care can save two lives. But protecting those lives requires a health system that remains prepared before, during and after childbirth.