HEALTH: Pregnancy Complications

Kidney complications caused me my unborn child’s life

                      

“When I went to the toilet, something like a ball with strings came out. I could not tell what it was so I put it in a paper bag and threw it away.”

These are the words of *Cheptoo, 24, a worker in a flower farm in Salgaa Area, Rongai in Nakuru Town. She had lost her pregnancy months prior to these remarks. Her journey down the Gusty Pregnancy Complications Lane began in May 2012.She had missed her ‘regulars’ for three months. Being married and a mother of one already, she believed she was pregnant. Few weeks into May, however, she began to bleed profusely. It was on and off heavy vaginal bleeding. Farm work can be hectic. Furthermore, the climate in Nakuru is the perfect definition of unpredictable. One minute it is scorching hot, the next it is bitterly cold. These factors may disorient hormonal balance of any sex. A research done by the College of Life Sciences, Nanjing Normal University, in June this year, confirmed that changes in hormonal profile are correlated to changes in temperature and rainfall.*Cheptoo did not know this fact. Nevertheless, like the ordinary Kenyan, she chose to monitor the bleeding for a week or so. “It could be anything!”She thought.

The situation actually worsened. There was a cutting pain in her abdomen. Distressed, she reported to the organization's nurse: *Beatrice. The medical practitioner did a physical examination and confirmed that *Cheptoo was indeed pregnant. A prescription was given to stop the bleeding. The medication was effective but after two weeks, it was the same old story. This time, the nurse, referred her to the Provincial District Hospital in Nakuru Town. Here, again, a physical examination showed that she was expectant. The doctor decided to have her begin on pre-natal care at the clinic. Her husband *James, is a security guard at the Gogar Farm in Rongai. Aware of their grand expectation, he worked even harder. It meant doing extra shifts and doing other casual jobs. The time called financial boost.*Cheptoo was worried as to why the pregnancy had been so troubling. However, just like any normal mother, she hoped for the best. Devotedly, she continued with clinical care, four months on. All was Bliss.

 The doctor told her that she would give birth in November. This would be a later date than she expected. Later, *Cheptoo understood that this was so, because of her complication (bleeding).*James and his wife were contented. Better late than never. “It would give us time to buy more new baby items and clothes as well.” Athletes wear such straight faces through their races. When they reach the final round, the winners begin to smile. The smile reigns all the way to the finish line. They have brought forth new records and sweet victory. The couple was headed for their finish line. They were in the athlete’s boat. “It was joyful.”

  A month shy off the due date, the bleeding came on again. This time *Cheptoo said, “Niliskia ni kama mtoto anatoka.”(As though the baby is coming out).She was given Buscopan at the Sister Mazolda clinic. This drug usually reduces muscle cramps in the stomach, intestines, bladder and urethra. A nurse then did a physical test. “She felt there was nothing in the stomach.”For further check up, she was sent to Rongai Health Centre. The doctor felt no child, as well. Later,*Cheptoo went for scan at the Provincial District Hospital. The scan was done but the doctor who could ‘read’ the results was absent. They administered medicine to halt the bleeding. When the scan results were finally out, she was informed. Her pregnancy was not growing.”It must be terminated,” the doctor declared. *Cheptoo’s kidney had also dropped and needed to be returned to position. “I was shocked beyond words, she mumbled, struggling to not succumb to tears. It was double trouble for Miss *Cheptoo.

 The society has unshakable faith in doctors. It is such a glorified profession that the thought of quacks is subtle especially in the remote areas.*Cheptoo neither sought to understand the concept of termination nor declined. Every mother would be disheartened by this. The dawn of October twelfth, was when she passed ‘a bloody thing that looked like a ball with strings.’ She could not tell what it was. This is definitely the last thing, any woman, with the hope of bearing a child should see. Many have been through the misfortune of still births. It is such a shame that anyone can go through the hands of so many medical specialists but end up with such a loss. So what may have happened, exactly?

 Floating kidney (nephroptosis) is a condition where the kidney drops downwards. I mean it descends five centimeters from its usual position. It is also referred to as renal ptosis, hyper mobile or wandering kidney. It is a disorder that is common in women more than men. Those mostly affected are thin women with long waists. *Cheptoo is this kind. Exerting too much pressure onto your abdomen area can cause it. This includes hard blows onto the abdomen area or even lifting heavy loads. Other causative agents are deficiency in the potassium or perirenal fascicle. The latter is the tissue that supports the kidney. In this case, the kidney can drop to levels as low as the pelvis, even coil around other organs; the ureter, for example. This leaves the kidney and some other affected organs malfunctioned. In the end, waste is not effectively eliminated from the body. Accumulation of wastes inhibits oogensis (production of ova) therefore preventing menstruation and pregnancy. It also causes blood poisoning (Septicemia).This is because it is inefficient in filtering bacteria out of the blood. Other symptoms include very high blood pressure, chills, nausea, severe abdominal pains, pain while passing urine or even having blood in urine. When a woman is pregnant the situation is worse. The body has to struggle to sustain both the mother and child. The expectant woman will retain much more wastes and thus have much higher blood pressure .Very high blood pressure in the mother leads to :Hypertension, Preeclampsia (,(fluid retention, and protein in the urine),  Premature labor, Miscarriage, Decreased kidney function, Greater risk of urinary tract infections, Acute renal failure. In fact women with HBP and excess protein in their urine face a 60 percent risk of infant death during their pregnancy. 

Research on kidney cancer in the United Kingdom showed that some people live with nephroptosis for years without knowing. “It is asymptomatic.”Doctor Amir Javed, London, says. “However when symptomatic it is characterized by violent, sharp pains that radiate into the groin.”(Renal paroxysm).Tricky bit about this disease is that it cannot be diagnosed when lying down. This is because the kidney drops when you stand but returns to position when you lie down. The abdominal pain and pressure even subsides in the latter position. CT Scans and ultra sounds cannot detect it. A physical examination when standing and an x-ray on both the kidney and bladder should be done. 

For pregnant women, it is recommended that they have a credible medical practitioner monitor their blood pressure, creatinine levels, blood urea levels, protein levels, cholesterol and urine potassium and mineral levels. This should continue for the first 32 weeks of the pregnancy. Women planning to have children should consult a nephrologist before getting started. Kidney complications not only mean kidney failure but also breakdown of the immune system, central nervous system, heart and bones. They also dictate the kind of contraception to use and diet to follow if pregnant. The best contraceptives for such patients have been reported to include the diaphragm, sponge and condom .Those which contain spermicidal creams, foams or jellies are out of bounce. The last thing anyone with kidney complication needs is more chemicals in their system. Good news though! The cure is readily available.

Laparoscopic Nephropexy can be used to re-position the kidney. It is a surgical procedure. When floating kidney overcomes an expectant woman the doctor induces birth or recommends a caesarian section. The born one may then be placed in the neonatal intensive care unit. Here it is monitored in case of any complications. Other less expensive measures may be gaining weight or doing exercises that tighten the abdomen.

The world experiences 2.6 million still births annually. Africa ranks highest. The proliferation of this experience has to be diminished instantly. Pregnant women or couples trying to have children do need to understand the status of their kidney. In Kenya, there are 488 deaths per 100,000 live births. This is mainly because of infection, hypertensive disorders, and obstructed labor according to a research done by United Nations Development Programme. Mr. Twahir Ahmed, a kidney specialist at Parklands Medical Centre, agreed that high blood pressure, diabetes and urinary tract infections are the highest causes of kidney failure hence pregnancy complications.

Head of the kidney unit at Kenyatta National Hospital Dr John Ngige once mentioned that over 10 per cent of the entire Kenyan population have kidney complications with the majority being between 20 and 45 years .This is according to a report prepared by Kenyatta National Hospital. Well expectant mothers need to watch out for Nephroptosis among other kidney complications. Besides the Government launched a Maternal and Newborn Health (MNH) Road Map in August 2010.Thanks to this, user fees in all public maternity hospitals and clinics has been abolished. It is possible to deal with childbirth complications before they worsen.

“I feel lucky to be alive,*Cheptoo said smiling. Let us not wait to be lucky. Prevention is always better than cure.


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