Anitha Kamasa, a mother of two, recalls how she nearly died during her first pregnancy due to a serious blood pressure condition known as preeclampsia that her doctors had not detected.

At six months of pregnancy, her feet were swollen. Despite regular visits to the doctor where her blood pressure appeared normal, one doctor eventually identified the condition as preeclampsia—a potentially dangerous pregnancy complication characterised by high blood pressure.

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"Not all healthcare providers recognise this illness in expectant women, but prompt tests confirmed my diagnosis. I exhibited numerous symptoms including shortness of breath, constant sweating, nausea, headaches, and overall body pain. Consequently, I was admitted at King Faisal Hospital for two months where both my baby and I were under intensive care.”

During this period of bed rest, medical professionals informed her that her baby could be born prematurely, which indeed occurred at around eight months. Born weighing only 1.3 kilos, the baby’s premature birth was unexpected and traumatic, especially for a first-time mother.

"Preeclampsia posed risks, as it resulted in swelling for me while hindering my baby’s weight gain and nutrient absorption,” she said.

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Although she started to get well after six weeks, her next pregnancy required strict monitoring to prevent a relapse. Despite the pain, she received support during her time in hospital and her baby was given a shot every day to strengthen its lungs.

The experience was crushing but diligent healthcare and monitoring helped manage her post-birth complications effectively. As a pregnant woman with preeclampsia, she noted, stress can raise blood pressure but she learned to be alert; recognising the symptoms, and taking measures to manage it effectively.

She was advised to stay active and engage in regular physical activity to prevent her legs from swelling, in addition to adhering to thorough medication. Thankfully, early detection allowed her to receive appropriate treatment, alleviating some of the risks associated with the condition.

She said: "I have observed that many people are unaware of the potential dangers. Preeclampsia can be life-threatening for mothers and their babies, particularly if premature delivery becomes necessary.

"Witnessing the loss of a fellow mother’s child, born prematurely at 28 weeks, was very hard for me. And despite our shared experiences, I feared for my own child’s well-being, knowing that premature birth carries significant risks,” Kamasa said.

The financial burden of medical expenses added another layer of stress, even with partial insurance coverage. The family’s out-of-pocket expenses exceeded Rwf 5.6 million as extensive care was required for both the premature baby and its mother.

"The challenges of caring for a premature infant are daunting, with constant monitoring, specialised treatments, and the emotional toll of uncertainty.”

She spent a month awaiting discharge and another month in postnatal care. When she was discharged, her baby remained in the intensive care unit where she pumped breast milk from home and took it to the hospital every day.

The Kangaroo care technique, where the baby is held to the mother’s bare chest to have direct skin-to-skin contact for warmth and comfort, became a daily procedure shared "between myself and my husband for 12 hours each day,” Kamasa explained. The target was for her toddler to get to the weight of 2 kilos and be able to breastfeed so that discharge from the hospital would be permitted.

"Traveling between home in Kabeza and King Faisal Hospital became routine to oversee my baby’s recovery. The trips lasted two weeks until his health improved.”

"Our baby’s eventual discharge from hospital was cause for celebration,” she said, noting that the child is now six years old.

"Witnessing my baby’s miraculous progress instilled hope and gratitude. Before my second pregnancy, I endured four miscarriages due to undiagnosed preeclampsia. The last miscarriage prompted medical advisories on conceiving and continuous monitoring due to the condition’s associated risks. Waiting a year before attempting conception, I adhered to medication and regular check-ups,” Kamasa stated.

The delivery of her second child, weighing 4.2 kilos, made things better. She is now expecting her third child with cautious optimism. Doctors are monitoring her condition, regularly, to ensure that, despite the persistent discomfort and swelling, she remains vigilant.

Kamasa urges all pregnant women to seek medical attention if they notice signs such as swelling, abnormal breathing, or excessive sweating to safeguard their health.

For her, without medical professionals’ continuous assistance, her first pregnancy could have ended tragically. Despite her previous reassurances from other doctors, it was Dr Mohamed Okasha who recognised the severity of her condition, after noticing her evident swelling and persistent need to eat ice. The doctor then asked her to urgently go and see a doctor at King Faisal Hospital.

Luckily, Kamasa’s condition was diagnosed and proper medical assistance was rendered to her urgently. However, some other women and babies die due to preeclampsia.

What is preeclampsia?

Dr Stephen Rulisa, a chief consultant of obstetrics and gynaecology at the University Teaching Hospital of Kigali (CHUK), said that preeclampsia is usually characterised by high blood pressure proteinuria (protein in urine). He explained that some of its common signs and symptoms are sometimes compromised vision, as it ranges from sensitive to blurred vision among other symptoms such as headache.

Rulisa noted that preeclampsia affects almost all body organs such as the liver, kidneys, and brain, thus urging pregnant women to seek medical attention if such symptoms occur. Preeclampsia puts stress on a woman’s heart and other organs and can cause serious complications. It can also affect the blood supply to her placenta, impair liver and kidney function, or cause fluid to build up in her lungs.

Dr Kenneth Ruzindana, a consultant at CHUK, stressed that preeclampsia is a condition that affects pregnant women, characterised by high blood pressure and protein in the urine after 20 weeks of pregnancy.

"The condition’s exact cause is not fully understood but it is thought to involve problems with the placenta, immune system, blood vessels, and possibly genetics. It is believed that issues with how the placenta develops and works play a big role,” he stated.

Ruzindana further noted that if the placenta does not attach properly to the uterus or does not get enough blood, it can lead to problems with blood vessels and cause preeclampsia.

"We also know that preeclampsia is associated with problems in the lining of blood vessels. This can cause them to narrow and become less flexible, leading to higher blood pressure and other symptoms, and it has a genetic predisposition because there is evidence that genetics might contribute, as preeclampsia tends to run in families,” he stressed.

Certain genes involved in blood vessel function and immune response could increase the risk of developing the condition, Ruzindana highlighted.

Who is at risk?

"Preeclampsia is more common in women who are pregnant for the first time. Women who have had preeclampsia in a previous pregnancy are at higher risk of developing it again in subsequent pregnancies,” he said.

Ruzindana noted that women with a family history of preeclampsia, such as a mother or sister who had the condition, are at an increased risk and importantly, women under 20 or over 40 years of age are at higher risk of developing preeclampsia.

He added that being overweight or obese before pregnancy increases the risk of developing preeclampsia.

One of its risks is that preeclampsia can lead to poor blood flow through the placenta, resulting in reduced oxygen and nutrient supply to the foetus. This can result in restricted foetal growth, leading to a smaller-than-normal baby. Severe preeclampsia may necessitate early delivery of the baby to prevent maternal complications.

Preterm birth can result in various neonatal complications, including respiratory distress syndrome, feeding difficulties, and increased risk of infections, Ruzindana noted.

Research carried out by Rwandan and international doctors published in the Rwanda Medical Journal indicates that preeclampsia and eclampsia (seizures that occur in pregnant people with preeclampsia) have significant impacts on maternal morbidity and mortality in Rwanda.

The study shows that eclampsia is the fourth leading cause of death in Rwanda, accounting for 9.4 per cent of all maternal deaths from 2009 to 2013. There was a demonstration of an increased risk of preeclampsia and eclampsia in the rainy season.

Further studies need to be performed to examine whether eclampsia and preeclampsia are affected by seasonal variations of other diseases, such as malaria, and whether prophylactic treatment affects the prevalence of disease and maternal outcomes.

According to the World Health Organization (WHO), the majority of deaths due to preeclampsia and eclampsia are avoidable through the provision of timely and effective care to women with these complications.

Preeclampsia is often diagnosed during routine prenatal appointments when healthcare providers check a pregnant woman’s weight gain, blood pressure, and urine.

There is no cure for preeclampsia. It can only be cured with delivery. Healthcare providers will still need to monitor a woman for several weeks after delivery to make sure her symptoms go away.