Rachael W., 40

Rachael Wairimu is a 40-year-old mother of four from Thogoto, currently in her fifth pregnancy. She depends on irregular casual work to support her children, as her husband is frequently absent and provides minimal support. At approximately 30 weeks’ gestation (G5P4),she had not attended antenatal care and was advised to enrol for comprehensive ANC assessment. She was referred to Barika by Joyce, the Helpster Charity coordinator. On evaluation, Rachael had severe hypertension (190/127 mmHg), bilateral leg swelling, facial puffiness and lower abdominal pain. Investigations included CBC, liver function tests, urinalysis and obstetric ultrasound, which reportedly showed severe oligohydramnios and placental calcification. Given the markedly elevated blood pressure and concerning clinical findings, she received initial treatment including IV medication and some oral medication to stabilize the blood pressure. She was subsequently referred to Kenyatta National Hospital for specialist obstetric management, close maternal and fetal monitoring, delivery planning and possible newborn-unit care for the baby.

Rachael has a high-risk pregnancy with severe hypertension suggestive of severe pre-eclampsia, associated with oedema, severe oligohydramnios and placental changes. Her condition places her at risk of eclampsia, stroke, placental abruption and other maternal complications, while the baby is at risk of fetal compromise, growth restriction and premature delivery. Specialist obstetric care and close maternal-fetal monitoring are essential. Prognosis is guarded but may be favourable with timely management and appropriate delivery planning.