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Patient case: Pre-eclampsia in Sub-Saharan Africa.

Patient case: Pre-eclampsia in Sub-Saharan Africa.

Patient details
Patient details.
- Name: Mrs R - Age: 35 years - Gravida/Parity: G3P2 - Gestational Age: 32 weeks - Location: Rural clinic in Southern Nigeria
Patient case fields
Medical History

Mrs R, a 35-year-old woman, presented to a rural clinic in Northern Nigeria at 32 weeks of gestation. This is her third pregnancy; her previous two pregnancies were unremarkable, resulting in healthy full-term deliveries. Mrs R had limited antenatal care due to the distance from her village to the nearest clinic and only attended her first appointment at 24 weeks.

History of Present Illness

Mrs R reported a two-week history of severe headaches, visual disturbances (seeing spots), and swelling in her hands and face. She also mentioned that she had gained a significant amount of weight in a short period. Mrs R had been feeling unusually tired and experienced upper abdominal pain.

Physical Examination

On examination, Mrs R 's blood pressure was found to be 160/110 mmHg. She had noticeable pitting oedema in her lower limbs, and her reflexes were brisk. 

Investigation

Mrs R’s urine dipstick test showed 3+ proteinuria.

Diagnosis

Based on her symptoms and examination findings, Mrs R was diagnosed with severe pre-eclampsia.

Management

Given the severity of her condition, Mrs R was urgently referred to a regional hospital with better facilities. She was given antihypertensive medication to manage her blood pressure and magnesium sulphate to prevent seizures. At the regional hospital, after careful assessment, a decision was made to deliver the baby via emergency Caesarean section due to concerns about the risks to both Mrs R and the baby.

Outcome

Mrs R delivered a preterm baby girl weighing 1.8 kg. The baby required neonatal care but showed promising signs of health. Amina's blood pressure gradually stabilised postpartum, and she was closely monitored for any signs of eclampsia. With proper care, both mother and child were discharged after two weeks, with follow-up appointments scheduled at the nearest clinic. 

Discussion
Discussion

This case highlights the challenges of managing pre-eclampsia in rural sub-Saharan Africa, where access to healthcare is limited, and antenatal care is often delayed. Timely intervention and access to emergency care are crucial in reducing maternal and neonatal mortality associated with pre-eclampsia in this region.

Questions
1. What was the most significant clinical finding that led to the diagnosis of severe pre-eclampsia in Mrs R?

(a). Headaches and visual disturbances  

(b). Swelling in hands and face  

(c). Blood pressure of 160/110 mmHg and 3+ proteinuria  

(d). Upper abdominal pain

2. Why was Mrs R urgently referred to a regional hospital?

(a). For routine antenatal care  

(b). To receive nutritional supplements  

(c). Due to the severity of her pre-eclampsia requiring specialised care  

(d). To prepare for a normal delivery

3. Which medication was administered to Mrs R to prevent seizures?

(a). Antihypertensive medication  

(b). Magnesium sulphate  

(c). Iron supplements  

(d). Antibiotics

4. What was the final mode of delivery for Mrs R?

 (a). Vaginal delivery  

(b). Emergency Caesarean section  

(c). Assisted vaginal delivery with forceps  

(d). Induced labour

Reveal answers

Answers

  1. (c). Blood pressure of 160/110 mmHg and 3+ proteinuria
  2. (c). Due to the severity of her pre-eclampsia requiring specialised care
  3. (b). Magnesium sulphate
  4. (b). Emergency Caesarean section