By: Ruth Abi, B. Pharm. Freelance Health Writer and Datelinehealth Africa Volunteer. Medical review and editorial support provided by the Datelinehealth Africa Team
Pregnant black woman posing outside. Image credit: Freepik
• In 2020, the World Health Organization estimated that 531 pregnant African women on average died per 100,000 live births. This accounted for 69% of maternal deaths worldwide in that year.
• The major contributors to most pregnancy related deaths in Africa are severe haemorrhage, infection, high blood pressure during pregnancy (pre-eclampsia and eclampsia), complications during childbirth (obstructed labour) and unsafe abortion.
• Collaboration among health stakeholders is crucial to significantly reduce the death rate of pregnant women in Africa.
Introduction
Pregnancy is a journey that most married couples are thrilled to embark on. Understandably so, because the person being born is a little of mom and dad. Who wouldn’t be excited?
However, there is a catch! The period of pregnancy is also one that can turn into tragedy super-fast due to the numerous conditions that put pregnant women at risk of death.
This article intends to highlight some common conditions that endanger the life of pregnant women in Africa; it will help create awareness and stop needless deaths.
Globally, a woman dies of pregnancy-related causes every two minutes. Most of these deaths are preventable with the right care if given at the right time. [1]
Despite the global decline in the rate at which pregnant women die (i.e. maternal mortality ratio, or MMR) to 34.2% between 2000 and 2020, MMR is still a disaster in the African region. In 2020, the maternal mortality rate in Africa was 531 deaths per 100,000 live births and the region accounted for 69% of global maternal deaths during the period. [1]
African countries with extremely high maternal mortality rates are South Sudan with 1223 deaths, followed by Chad with 1063 deaths and Nigeria with 1047 deaths per 100,000 live births. [1]
Here are six most significant conditions that put pregnant African women at risk of death:
Let us dive in and learn about each condition further.
What is anaemia?
Anaemia is a condition where the number of red blood cells or the concentration of haemoglobin within them is lower than normal. [2] Haemoglobin helps to carry oxygen to organs and tissues. When there is anaemia, there isn’t enough haemoglobin in the body to carry out that function, hence, the body suffers. [3]
In low and middle income countries, anaemia during pregnancy is still one of the leading causes of death and poor health. [2] Globally, it is estimated that 37% of pregnant women are affected by anaemia. [3] In Sub-Saharan Africa the prevalence of anaemia in pregnancy is 45.8% [2].
Complications of anaemia in pregnancy
Severe anaemia in pregnancy is associated with poor maternal outcomes such as increased heart rate, difficulty in breathing, bleeding after childbirth, high blood pressure and heart failure - which can be fatal. For the unborn baby, anaemia in pregnancy may cause premature birth, foetal growth restriction, low birth weight, spontaneous abortion, and even death in the uterus if left untreated. [4]
What is pre-eclampsia and eclampsia?
Pre-eclampsia is a medical term that describes newly discovered or worsening high blood pressure accompanied with protein in the urine after 20 weeks of pregnancy. [5]
Eclampsia is unexplained generalised seizures in patients with pre-eclampsia. Pre-eclampsia leads to eclampsia. [5]
How common is pre-eclampsia and eclampsia in African women?
According to the World Health Organization (WHO), the incidence of preeclampsia ranges between 2% and 10% of pregnancies worldwide. About 1.8-16.7% of the incidents are reported in developing countries like those in Africa, while in developed countries, the rate is 0.4%. [6]
Complications of pre-eclampsia in pregnancy
Pre-eclampsia takes a negative toll on both mother and child. They include: premature delivery, slow growth of the foetus (unborn baby), organ damage to the pregnant woman’s kidneys, heart, liver, and lungs, stroke, seizure, coma and separation of the placenta from the uterus before delivery. When severe, the separation can lead to heavy bleeding and death. [7]
What is postpartum haemorrhage?
Postpartum haemorrhage (PPH) is commonly defined as blood loss exceeding 500 millilitres following vaginal birth and 1000 millilitres following caesarean section. [8]
PPH is often classified as primary/immediate if it occurs within 24 hours of birth, or secondary/delayed if it occurs more than 24 hours post-birth and up to 12 weeks after. In addition, PPH may occur before or after delivery of the placenta, respectively. [8]
How common is postpartum haemorrhage in African women?
Every year, about 14 million women experience PPH resulting in about 70,000 maternal deaths globally. [9] In sub-Saharan Africa, postpartum haemorrhage (PPH) is considered responsible for 30% to 50% of maternal deaths. [10]
Complications of postpartum haemorrhage
Some of the complications of postpartum haemorrhage include: an emergency condition in which severe blood or other fluid loss makes the heart unable to pump enough blood to the body (hypovolemic shock), complete interruption of the supply of oxygen to the brain (cerebral anoxia), kidney failure, severe anaemia and infections associated with childbirth. The rate of blood loss influences the outcome of the haemorrhage. [11]
What are postpartum infections?
Postpartum infections comprises a wide range of entities that can occur after vaginal and caesarean delivery or during breastfeeding. [12] The postpartum period is traditionally defined as six weeks following delivery. [13]
How common are postpartum infections in African women?
Postpartum infections (PPI) are relatively common, affecting an estimated 5 to 7% of women globally. [13] The reported prevalence rate in some African countries is much higher (11.2%, 17.9%, and 39% in Tanzania, Cameron, and Uganda respectively). [14]
Complications of postpartum infections
All postpartum infections can progress to sepsis, bacteremia (presence of bacteria in the blood), shock, maternal anxiety, heightened risk of depression and interference with breastfeeding.
When not treated appropriately, postpartum infections accounts for 10 to 15% of deaths in women globally. [13] This rate is much higher in many African countries. [14].
What is obstructed labour?
According to the World Health Organization, obstructed labour means that, in spite of strong contractions of the womb (uterus), the foetus cannot descend through the pelvis because there is an unbeatable barrier preventing its movement. The obstruction can occur anywhere along the birth canal, but it usually occurs at its beginning. [15]
Although there are several conditions that can cause obstructed labour, the most common cause is because the size of the foetus is bigger than that of the mother’s birth canal. [16]
How common is obstructed labour?
Worldwide, obstructed labour occurs in an estimated 5% of pregnancies and accounts for 9% of maternal deaths. [17]
In sub-Saharan African countries, obstructed labour is responsible for 24% of maternal deaths. [18]
Complications of obstructed labour
Maternal complications due to obstructed labour include infection within the uterus, a hole between the birth canal and bladder and/or rectum (obstetric fistula), and rupture of the uterus with subsequent bleeding, shock, or even death. [19]
For the unborn child, obstructed labour can result in complications such as loss of consciousness due to interruption of breathing (asphyxia), brain damage or death. [19]
What is unsafe abortion?
Before we talk about what an unsafe abortion is, what is an abortion? An abortion means a pregnancy interruption before the foetus is able to live independently outside the uterus, usually before the 20th week. [20]
When carried out using a method recommended by WHO appropriate to the pregnancy duration, and by someone with the necessary skills, abortion is a safe healthcare intervention. [21] Otherwise, it is termed an unsafe abortion.
How common are unsafe abortions in African women?
Unsafe abortion is a neglected public health problem contributing to 13% of maternal deaths worldwide. In Africa, 99% of abortions are unsafe resulting in one maternal death per 150 cases. [22]
The high rate of unsafe abortions in Africa is associated with laws restricting abortion, poor awareness and poor quality of health services. [22]
Complications of unsafe abortion
Complications that occur due to unsafe abortion include: septicemia (a serious infection from elsewhere that enters the bloodstream), severe bleeding, kidney failure, uterine perforation (a hole in the uterus), injuries to the genital and gastro-intestinal tract. Where expert emergency treatment for these is not available, women die. [23]
We have run through a series of conditions that put pregnant African women at risk of dying. Among them are anaemia, hypertension in pregnancy, postpartum haemorrhage, postpartum infections, obstructed labour and unsafe abortion. To prevent unnecessary death of pregnant African women due to these conditions, appropriate counselling and care before, during and after pregnancy are vital.
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