THE INCIDENCE AND RISK FACTORS OF PREECLAMPSIA AND ECLAMPSIA ADMITTED IN ANTENATAL AND POSTNATAL WARDS AFTER 20 WEEKS OF GESTATION

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                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).

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.
    1. To determine the relationship between Preeclampsia and hypertension.
  • 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.
    • To interview the pregnant women with the illness about Preeclampsia and how they manage the disease
    • 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.

                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.

                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

Preeclampsia and Eclampsia. Preeclampsia / Eclampsia remains one of the most common causes for maternal death during pregnancy worldwide (Sahin, 2003).

              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)

                              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

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

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

the early stage of pregnancy in order to reduce the risk of developing Preeclampsia (Sibai, 2003).