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SAKINATU ABDULLAHI LAMORDE

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  • Name: THE INCIDENCE AND RISK FACTORS OF PREECLAMPSIA AND ECLAMPSIA ADMITTED IN ANTENATAL AND POSTNATAL WARDS AFTER 20 WEEKS OF GESTATION
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  • Length: [60] Pages

 

ABSTRACT

Main Objective: This study was therefore to access the incidence of Preeclampsia in
women admitted to FMC Yola in their pre and postnatal wards during their last
trimester.
Study Design: The study was carried out among pregnant women who are admitted
in antenatal and postnatal wards after 20 weeks of gestation and was carried out at
FMC Yola Adamawa State from February to April 2015.
Method: Structured Questionnaires from patients in antenatal and postnatal wards at
FMC Yola.
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Results: The number of women who were diagnosed with either Preeclampsia or
Eclampsia was thirty in number. About 90% of the participants who were presented
to the hospital during their last trimester were unbook and have high level of blood
pressure of 140/90 mmHg and above. They women with the normal blood pressure
of 120/80 mmHg are 3 (10%), 160/110 are 17(56.7%), BP 140/80 mmHg are 4
(13.3%), BP 150/110mmHg are 6 (20%) and they also have high level of proteinuria
in their urinary analysis with, Proteinuria of +3 (61.3%) and Proteinuria of +2
(32.3%) and (3.3%) were negative for the latter biomarker in their urine respectively.
A greater number of the women don’t show up for antenatal visits with (56.7%),
those that show up once during their pregnancies were (13.3%), those that show up
twice were (10.0%), three times (6.7%), four times (3.3%), five times (6.7%) and six
times (3.3%) respectively.
Conclusion: The fact that most of the causes of Preeclampsia and Eclampsia is due
to high level of blood pressure and proteinuria, measures should focus on how to
reduce this problem and patients should come on time to the hospitals. The exact
etiology of Eclampsia remains speculative for now and most are presenting to health
facility for the first time and the study showed the importance of antenatal care.
Key Words: Preeclampsia, Eclampsia, Hypertension, Proteinuria, Gestational
Hypertension, Pregnancy induce hypertension, antenatal care, chronic Hypertension,
pregnant women, FMC Yola

 

TABLE OF CONTENTS

Title page …………………………………………………………………………………………………… i
Certification page ………………………………………………………………………………………. ii
Reader’s Approval Page …………………………………………………………………………….. iii
Dedication Page ……………………………………………………………………………………….. iv
Acknowledgements ……………………………………………………………………………………. .v
Abstract ………………………………………………………………………………………………….. vi
Table of Contents ……………………………………………………………………………………. viii
Definition of Terminologies and Meaning of Acronyms ………………………………… xi
1.0 Introduction ………………………………………………………………………………………….. 1
1.1 Limitations …………………………………………………………………………………………… 2
1.2 Comparison of Eclampsia in Nigeria with other parts of the world …………….. 3
1.3 Maternal health……………………………………………………………………………………… 4
1.4 Complications of maternal health ……………………………………………………………. 4
1.5 Antenatal care……………………………………………………………………………………….. 7
1.6 Aim and objectives of antenatal care ……………………………………………………… 7
1.7 Life style concerns ………………………………………………………………………………. 8
1.8 Screenings done during antenatal for maternal complications …………………. 11
1.9 Hypertension ………………………………………………………………………………………. 12
2.0 Classification of hypertensive disorders ………………………………………………… 14
2.1 Pre-existing (Chronic) Hypertension ……………………………………………………. 14
2.2 The definition and diagnosis of hypertensive Disorders …………………………… 15
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2.3 Etiology and pathophysiology of Preeclampsia and Eclampsia …………………. 17
2.4 Types of Eclampsia …………………………………………………………………………… 18
2.5 Complications of Eclampsia ………………………………………………………………. 19
2.6 Diagnosis of Preeclampsia and Eclampsia …………………………………………….. 20
2.7 Epidemiology and risk factors ……………………………………………………………… 20
2.8 Treatment, solutions and management ……………………………………………………. 21
2.9 NGOs and health organizations …………………………………………………………….. 22
3.0 Methods ………………………………………………………………………………………………   25
3.1 Study Area …………………………………………………………………………………………..   27
3.2 Subjects ………………………………………………………………………………………………    27
3.3 Sample Collection ……………………………………………………………………………….. 27
3.4 Age of the subjects ………………………………………………………………………………. 28
3.5 Known History of Preeclampsia ……………………………………………………………28
3.6 Number of children …………………………………………………………………………….   28
3.7 Ethical consideration …………………………………………………………………………..   28
3.8 Data Management ………………………………………………………………………………..  28
4.0 Results ………………………………………………………………………………………………..       29
4.1 Graphical Representation of the Background of the Participant …… 29
4.2 Background information of Preeclampsia ……………………………………………30
5.0 Discussion and Conclusion ………………………………………………………………….   43
5.1 Discussion …………………………………………………………………………………………..      43
5.2 Conclusion …………………………………………………………………………………………     . 46

 

CHAPTER ONE

 

1.0 INTRODUCTION

Preeclampsia is one of the hypertensive disorders that affect pregnant women
worldwide; it is characterized by the presence of proteinuria in the pregnant woman’s
urinary analysis and increase in blood pressure above 140/90 mmHg, edema or both.
Preeclampsia is the second largest cause of deaths of both mothers and babies in the
United Kingdom with the death of at least 6 to 9 mothers annually and 175 babies
(Norwitz at el, 2013). Preeclampsia includes a condition known as preeclamptic
toxemia (PET) or gestational proteinuric hypertension, which pregnant women
develop after twenty weeks of gestation, due to the placenta disease. Preeclampsia is
characterized by high blood pressure, proteinuria and edema, without proper
management and intervention it will progress to Eclampsia; this is characterized by
malignant hypertension and epileptiform convulsions which will require emergency
caesarian section to the woman (Attahir et al, 2010).
Preeclampsia is an illness that occurs more in pregnant women living in developing
countries with the estimate of 98% and over 63,000 women nationwide also die of
the complications. It is also known that about 10% of Preeclampsia cases occur in
women with first time pregnancies and the severe stage of Preeclampsia will lead to
multisystem complication, such as hepatic and renal dysfunction, cerebral
hemorrhage, and respiratory compromise (Edmonds, 2007). Women with
preeclamptic condition suffer headache, blurred vision, edema in both legs and the
feet and hands, and blood pressure above 140/90 consistently (NCBI, 2014).
2
Aims/ objectives:
1. To access the incidence of Preeclampsia in pregnant women because it is the
major cause of illness and death for both mother and baby and the incidence
of the disease hasn’t decreased over the last 20 years as obesity seems to
increase the risk.
2. To determine the relationship between Preeclampsia and hypertension.
3. To check if there are ways in which pregnant women can protect their selves
from Preeclampsia, by checking if diet can help in preventing Preeclampsia.
4. To interview the pregnant women with the illness about Preeclampsia and
how they manage the disease
5. Lastly to interview the doctors about the clinical aspects of the disease and
how they monitor the disease.
Hypothesis: High blood pressure in pregnant women usually causes Preeclampsia.
1.1 Limitation of the study
• Limitation to data collection in FMC due to low number of patients with
Preeclampsia and Eclampsia cases.
• Limitation due to strike
• Data from antenatal ward is incomplete because the pregnant women have
not given birth yet.
3
1.2 Comparison of Eclampsia in Nigeria with other parts of the world
The major cause of maternal mortality in Sub-Sahara Africa is globally known and
the problems are still not address by the Millennium Development Goals (MDG 5),
which have a target of reducing 75% of maternal mortality ratio from1990 to 2015
(Ronsmans, et al, 2006). The rate of mortality rate in Sub- Sahara Africa have
dropped globally from 500, 000 in 1986 to 358, 000 in 2008 base on the World
Health Organization records but still developing countries account for 99% of the
maternal deaths(WHO, 2014). Base on the World Bank record, the rate of maternal
mortality had dropped 45% between 1990 and 2013 in most region and countries
except in Sub-Sahara Africa where MDG 5 target of reducing maternal deaths by
75% 1990 to 2015 were not made (Worldbank, 2015). Nigeria’s maternal mortality
rates is one of the worst compare to other countries like Rwanda, Somalia, Libya,
Kenya, Ghana at the same time falls behind its contemporaries in the 1960s like the
oil- producing countries like Saudi Arabia, Kuwait, Iran, and Qatar (Rogo, 2013).
The estimated ratio of maternal mortality per 100,000 live births in Nigerian women
who died from pregnancy related causes while pregnant from 2010 to 2013 had
dropped a little from 610 to 560 (Worldbank, 2015)
The socio-economic impact in developing countries is huge, even more so if we
consider that in Columbia, for example, the rate of maternal mortality is ten times
higher than in the United States. Despite the fact that rate of Preeclampsia and the
number of maternal deaths from hypertensive disorders in pregnancy has fallen
consistently over recent years in some developing countries, in places where
maternal mortality is high the majority of these deaths are connected with
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Preeclampsia and Eclampsia. Preeclampsia / Eclampsia remains one of the most
common causes for maternal death during pregnancy worldwide (Sahin, 2003).
1.3 Maternal Health
Maternal Health is refers to the general health of women during gestation or
pregnancy, childbirth and the postpartum period. While motherhood is often
regarded to as the positive fulfilling experience in a woman life, which a lot of
women experience is associated with suffering, ill-health and even death (WHO,
2015). The major causes of maternal morbidity and mortality are associated with
these complications which includes high blood pressure, unsafe abortion, infection,
haemorrhage and obstructed labour (WHO, 2014)
1.4 Maternal Health Complications
Complications that women encounter during pregnancy involve the baby’s health,
the mother’s wellbeing or even both. Some women have issues with their health that
emerge during pregnancy, while other women have health issues before they get to
be pregnant that could lead to maternal complication problems such as Preeclampsia,
placental abruption (when the placenta separates from the wall of the uterus), and
gestational diabetes (CDC, 2014). It is important for women to get medical services
before and during pregnancy and to always check their health status in order to
reduce risk factors of diabetes, renal impairment and high blood pressure.
In developing countries, pregnancy-related problems such as hypertension disorders,
gestational diabetes and obesity are known as the primary cause effect of death
amongst women of reproductive age. According to the United Nations (2005) in
developing countries more than 80% of women lose their lives each year during
5
pregnancy or childbirth and twenty times that number suffer serious injury or
disability. Some development has been made in reducing maternal deaths in
developing regions, but not in the countries where giving birth is most risky (United
Nations 2005). Locally, Africa has only 12% of the worldwide populace; however, it
represents a large portion of all maternal deaths and half the deaths of children less
than five year of age. Almost 4.7 million moms, new-borns, and children die each
year in sub-Saharan Africa: 265,000 mothers die because of complications of
pregnancy and childbirth or labor (Bryce & Requero 2010; UNICEF 2009).
Maternal Health complication is made up of several diseases that affect the health of
women during pregnancy and childbirth worldwide; some of the problems are related
to the unborn child while others to the mother. These are some of the issues women
undergo during pregnancy, which are maternal diabetes or gestational diabetes,
hypertension, Preeclampsia, renal impairment and cardiac disease (Sibai, 2013).
Gestational diabetes: This is a condition that occurs during pregnancy when the
insulin resistance level in the mother’s blood is increased and the peripheral uptake
of glucose reduced, which makes the flow and supply of glucose to the fetus in a
continuous process. Gestational diabetes has few risk factors to the mother but rather
has high risk factors to the fetus; such risks factors are exposure to high level of
concentration of glucose, which will result in making the fetus to grow large. When
the fetus grows bigger the mother is in the risk of having a cesarean section delivery
or birth injury during normal delivery (El-Mowafi, 2002).
Gestational diabetes screening test is advise during pregnancy because insulin
resistance has a 50% chance of developing maternal diabetes in subsequent
pregnancy and 40-60% of developing diabetes in future (Norwitz at el, 2013). The
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Glucose Load Test (GLT) machine is used in screening for gestational diabetes for
pregnant women after 24 to 28 weeks of gestation, especially those with a history of
diabetes, obesity, gestational diabetes and sustained glycosuria or fetus macrosomia
(Agboola, 2001).
Renal Impairment: This is a condition that is caused by bacteria that is
asymptomatic, which is likely to progress to pyelonephritis and cause Escherichia
coli. Women suffering from renal disease are advised by doctors to try and conceive
when the degree of their renal impairments is in a controlled stage. That is when the
danger is moderate because if the couple delays it will affect the pregnancy. When
the renal impairment is in its chronic stage, it leads to risk of infertility,
Preeclampsia, spontaneous abortion, fetal growth restriction or death and preterm
delivery. For women that are at the end-stage of renal impairment, it is advised to
have transplant of renal which is their best chance of having a successful pregnancy
(Norwitz at el, 2013).
Gestational Hypertension: This is hypertension that affects pregnant women after 20
weeks of gestation. Women with histories of pre-existing hypertension should be
monitored and their blood pressure should be checked daily and anti-hypertensive
drugs should be given to control the blood pressure (Agboola, 2001).
Preeclampsia: This condition is normally caused by high blood pressure and
proteinuria in the pregnant woman’s urine. Women with low intake of calcium
supplement in their normal diet during pregnancy have the high risk of developing
Preeclampsia and women with histories of Preeclampsia in the previous pregnancies
have 10% risk of recurrence in future pregnancies (Edmonds, 2012). Pregnant
women with or without histories of Preeclampsia are advised to start taking aspirin in
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the early stage of pregnancy in order to reduce the risk of developing Preeclampsia
(Sibai, 2003).
1.5 ANTENATAL CARE
Antenatal care is the professional care and advice given to pregnant women who visit
the hospital/ health center/ clinic for screening, monitoring, advice, nutrition
supplementation and referrals if necessary. This type of healthcare helps mothers to
know the medical condition of the health of their unborn child and their health; it
also helps in identifying women who require specialist support.

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