Preeclampsia and Eclampsia: What Africans Need to Know

Author: Azuka Ezeike, MBBS, FWACS (Obstetrics and Gynaecology), FMCOG, MSc. (Public Health). Medically reviewed by the DLHA Team.

November 8, 2025

A pregnant Black woman wearing a blue maternity top sits in an examination room. Beside her are a digital blood pressure monitor, a stethoscope, and vials labelled “Magnesium Sulfate.” Image is AI generated with ChatGpt. Click to enlrge.

 

Highlights 

• Preeclampsia is a pregnancy-related condition that causes high blood pressure and can harm vital organs like the kidneys, liver, and brain.

• Eclampsia is a severe complication of preeclampsia marked by seizures or coma and requires emergency medical care.

• The condition can develop after 20 weeks of pregnancy or even after childbirth.

• Common warning signs include persistent headaches, swelling of the face and hands, blurred vision, and upper abdominal pain.

• Early detection through regular antenatal visits greatly reduces complications for both mother and baby.

• Treatment focuses on controlling blood pressure, preventing seizures, and planning the safe delivery of the baby.

 

 Introduction 

Whenever raised blood pressure (hypertension) is mentioned, your mind often may connect it with old age. So, for Mrs. Patience, the last thing on her mind when she got pregnant was hypertension. She was just 25 years old. 

But in the seventh month of her pregnancy, during a routine antenatal visit, her blood pressure was found to be elevated. In addition, when her urine was checked, there was protein, which should not normally be present. This was how her journey with preeclampsia started. Preeclampsia is a condition that can endanger both mother and baby if not detected and treated early.

 

What is Preeclampsia?

Info-poster captioned "Understanding Preeclampsia" and showing a pregnant tAfrican woman and a list of the features of the condition. Click on image to enlarge. 

 

Preeclampsia is a disease of pregnancy characterised by elevated blood pressure (≥140/90 mm Hg) after the 5th month of pregnancy (20th week). It is associated with protein in the urine and damage to multiple organs in the body [1]. It can also occur after delivery, up to six weeks after delivery. 

According to the International Society for the Study of Hypertension in Pregnancy (ISSHP), the diagnosis of preeclampsia can also be considered if there is elevated blood pressure with evidence of organ dysfunction, even if there is no protein in the urine

 

What is Eclampsia?

Table comparing the features of preeclampsia and eclampsia. Click on imge to enlarge.

 

Eclampsia is the onset of seizures (convulsions) or unexplained coma in a pregnant woman with preeclampsia in the absence of a neurological disease [2]. It is often considered a complication of preeclampsia. It can occur after the 20th week of pregnancy or even within six weeks after delivery. Sometimes, eclampsia can occur without preeclampsia manifesting first.

Infographics showing pregnancy related death rate attributed to preeclampsia in sub-Saharan Africa. Click on image to enlarge.

 

Preeclampsia affects 2 to 8% (i.e., 2 - 8 out of 100) pregnancies worldwide and results in the deaths of up to 46,000 women and 500,000 babies. In Asia and Africa, it accounts for up to 1 in 10 pregnancy-related deaths. In sub-Saharan Africa, hypertensive disorders are among the leading causes of pregnancy-associated deaths [3].  

This article will help you understand what preeclampsia and eclampsia are, the factors that increase your risk, and how they can be detected early through antenatal care. You will also learn about the symptoms to watch out for, how doctors diagnose and manage the condition, and the steps you can take to protect yourself and your baby.

 

Who Is at Risk of Preeclampsia and Eclampsia?

Risk factors of preeclampsia grouped into high and moderate. Click on image to enlarge.

 

Any pregnant woman can develop preeclampsia or eclampsia, but certain conditions increase the risk [1].
 These risks are divided into two categories:

• High risk
• Moderate risk

You are at high risk of developing hypertension in pregnancy if:

• You had preeclampsia in a previous pregnancy
• You have chronic hypertension
• You have kidney disease
• You have an autoimmune disease like systemic lupus erythematosus
• You have diabetes

You are at moderate risk if:

• You’ve never delivered before (nulliparous)
• You got pregnant with a new partner (primipaternity)
• You are older than 40 years
• You are obese
• You are carrying multiple babies
• Your last delivery was more than 10 years ago
• You conceived through assisted reproduction
• You have a family member who has had the disease.

Having these risk factors calls for vigilance. It doesn’t mean that preeclampsia or eclampsia must occur.

 

What Causes Preeclampsia?

The exact cause of preeclampsia is not yet fully known [4].  This is why it was once known as the disease of theories. However, scientists are gaining a better understanding of the disease every day [5]. It is now believed the problem originates from the placenta.

In people predisposed to developing preeclampsia, blood flow to the placenta is reduced very early in pregnancy. The lack of adequate blood supply causes the placenta to produce certain chemicals (biomarkers).

These chemicals damage the lining (endothelium) of tiny blood vessels throughout the body; causing endothelial dysfunction. This explains why preeclampsia can affect multiple organs.

Endothelial dysfunction is believed to be the major cause of preeclampsia, although other factors may also contribute and are still being studied [1].

This damage causes leakage of protein and fluid from blood vessels into surrounding tissues, leading to swelling. When protein leaks from the blood vessels in the kidneys, it results in the presence of protein in the urine.

 

What are the Symptoms of Preeclampsia and Eclampsia?

Preeclampsia is traditionally classified into two types:

Info-poster showing signs and symptoms of preeclampsia. Click on image to enlarge.

 

Mild preeclampsia:
Blood pressure is elevated (more than 140/90 mm Hg but less than 160/110 mm Hg). It is usually not associated with symptoms.

Preeclampsia with severe features:
Blood pressure is above 160/110 mm Hg, or there are symptoms or evidence of organ damage.

The symptoms of preeclampsia may vary among patients, but the common ones include:

• New onset of headache
• Poor vision, sensitivity to light or seeing dark spots
• Swelling of the body, especially in the hands and face
• Upper abdominal pain
• Nausea and vomiting

Eclampsia usually manifests as convulsions or, in some cases, sudden coma.

The presence of these symptoms indicates severity and the need for urgent delivery.

 

Diagnosis of Preeclampsia and Eclampsia

To determine if you have preeclampsia, your doctor will ask you some questions, examine you, and carry out a few tests. 

This is in accordance with the recommendation of the ISSHP.

History

You are likely to be pregnant or have just delivered.

Your doctor will want to know:

• If you have any symptoms, such as a headache or visual problems
• How your pregnancy has been so far
• Whether you are urinating normally, and if your baby is moving well
• Whether you have had any convulsions (this indicates eclampsia)
• Whether you had a similar problem in any previous pregnancy
• If you have any medical conditions, such as hypertension or diabetes
• If any family members have had a similar problem

Checks

Your doctor will:

• Assess your general appearance
• Check for body swelling and where it is located
• Examine your eyes and skin for signs of jaundice (yellowing) or paleness
• Listen to your chest to detect fluid in your lungs (pulmonary oedema)
• Examine your liver to see if it is painful or enlarged
• Feel your abdomen to check for contractions
• Assess your baby’s heart rate and position
• Examine your cervix to see if it is open, which may indicate the onset of labour
   

Tests

These will include:

• Urinalysis - to check for protein in your urine
• Full blood count – to check your blood level (Packed cell volume) and the blood cells
• Kidney function test
• Liver function test and uric acid level
• Clotting profile – to assess how easily your blood clots
• Ultrasound scan – to check how your baby is doing. This may include a biophysical profile to determine if your baby can withstand labour, especially if delivery is needed.

 

Treatment Options for Preeclampsia and Eclampsia

Because the problem that causes preeclampsia/eclampsia originates in the placenta, the best treatment is delivery.
This is usually done if the pregnancy is up to 34 weeks, which is the period when your baby’s lungs are expected to have matured (well-developed)

If the pregnancy is less than 34 weeks, your doctor may decide to admit you for observation, provided: [6]

• You do not have any symptoms
• There are no convulsions (Eclampsia)
• Your blood pressure is well controlled
• Your test results are normal
• Your baby is doing well (the heart rate is normal, and the baby is growing well)

During this period, you will be admitted to the hospital, and the following will be monitored:

• Your blood pressure and pulse
• Your chest for signs of fluid in the lungs
• Your weight
• Your blood tests
• Your baby’s growth, heart rate, and movements

You will also be given some medications, which may include:

• Magnesium sulphate: to prevent convulsions
• Drugs to control hypertension,  such as Nifedipine or Labetalol
• Steroids: to help your baby’s lungs mature faster

You will also be advised to arrange for blood donation at the blood bank, as delivery may become urgent.

Delivery options:

• Caesarean section: if you are not in labour and your cervix is closed
• Vaginal delivery: if your cervix has started to open

After Delivery

Your doctor will observe you in the hospital until your blood pressure returns to normal. In most cases, you may be monitored for up to 7 days, as blood pressure sometimes rises between days 3 and 6  after delivery.

After discharge, your doctor will schedule periodic follow-up appointments until 6 weeks after delivery.

Ensure you take your drugs as prescribed and follow all instructions from your doctor during this period.

 

What are the Complications of Preeclampsia/Eclampsia?

Preeclampsia and eclampsia can affect several organs in the mother’s body and may also harm the baby [1]. Without proper medical care, both can become life-threatening.

For the Mother

These conditions can lead to serious complications, including:

• Visual disturbances due to retinal changes: This may result in temporary or permanent vision problems.
• Liver damage: The liver may become swollen, painful, or injured.
• Kidney damage: Reduced kidney function can lead to the accumulation of waste in the body.
• Blood clotting problems: Such as low platelet count (thrombocytopenia) or a serious condition called Disseminated Intravascular Coagulation (DIC).
• HELLP syndrome: A severe form of preeclampsia involving Haemolysis (breakdown of red blood cells), Elevated Liver enzymes, and Low Platelets.
• Stroke: Caused by extremely high blood pressure, leading to bleeding in the brain.
• Pulmonary oedema: Fluid buildup in the lungs that causes difficulty breathing.
• Death: Can occur if complications are not promptly treated.

Info-poster: Complications of preeclampsia for mother and baby

 

For the Baby

When preeclampsia affects blood flow to the placenta, the baby may not get enough oxygen and nutrients. This can lead to:

• Intrauterine Growth Restriction (IUGR): The baby grows more slowly than expected.
• Placental abruption: The placenta separates from the womb too early, which can cause severe bleeding.
• Preterm birth: Early delivery may be necessary to save the mother and baby.
• Stillbirth or early newborn death: Due to placental problems or complications of prematurity.
• Long-term complications from prematurity such as delayed development, vision and hearing difficulties.

 

When to See a Doctor 

If you are pregnant, contact your doctor immediately if you notice persistent headaches, unusual swelling of your hands or face, or blurred vision.

 

Conclusion

Preeclampsia and eclampsia remain major causes of illness and death among pregnant women, especially in Africa, but they are preventable and treatable when detected early. Regular antenatal visits, awareness of warning signs, and prompt medical attention can save lives. Every pregnant woman should take blood pressure checks seriously and seek help immediately if she notices symptoms such as severe headaches, swelling, or blurred vision. With proper care and timely delivery, both mother and baby can make a safe recovery.

 

Frequently Asked Questions (FAQs)

1. Can preeclampsia be prevented?
 Although the risk of preeclampsia cannot be eliminated, the World Health Organization (WHO) recommends the following measures for prevention:

• Daily calcium supplementation (1.5–2.0 g) in populations with low dietary calcium intake.
• Low-dose aspirin (75 mg daily) for women at moderate to high risk of preeclampsia, to be started at 12 weeks of pregnancy or as soon as antenatal care begins.

2. Will preeclampsia affect future pregnancies?
 Having preeclampsia does not automatically mean that future pregnancies will be affected. However, women who have had preeclampsia are at a higher risk of developing it again in subsequent pregnancies, especially if it occurred early or was severe. Regular antenatal care and early monitoring are essential in future pregnancies.

 

References

1. Karrar SA, Martingano DJ, Hong PL. Preeclampsia. [Updated 2024 Feb. 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 [Cited 2025 Oct 3]. Available from here.

2. Magley M, Hinson MR. Eclampsia. [Updated 2024 Oct. 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 [Cited 2025 Oct 3]. Available from here.

3. Musarandega R, Nyakura M, Machekano R, Pattinson R, Munjanja SP. Causes of maternal mortality in Sub-Saharan Africa: A systematic review of studies published from 2015 to 2020. J Glob Health. 2021;11:04048. doi: 10.7189/jogh.11.04048. Available from here.

4. Santulli G, Kansakar U, Varzideh F. Epidemiology and pathophysiology of preeclampsia: New mechanistic insights. Hypertension.  2025 May;82(5):800–3. doi: 10.1161/HYPERTENSIONAHA.124.24117. Available from here.

5. Erez O, Romero R, Jung E, Chaemsaithong P, Bosco M, Suksai M, et al. Preeclampsia/eclampsia: the conceptual evolution of a syndrome. Am J Obstet Gynecol. 2022 Feb;226(2 Suppl):S786–803. Available from here. 

6. Sharma DD, Chandresh NR, Javed A, Girgis P, Zeeshan M, Fatima SS, et al. The management of preeclampsia: a comprehensive review of current practices and future directions. Cureus. 2024;16(1):e51512. Available from here.

 

Related: 

Understanding Hypertension in Pregnancy

Social Factors Shaping African Women’s Health

What Africans need to know about Antenatal care 

 

 

Published: November 8 , 2025
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