Pregnancy Induced Hypertension in Women at a Particular Municipality in Lagos State, Causes and Factors
Chapter One
Objectives of the study
The main objective of the study is to examine the pregnancy induced hypertension in women in Lagos State General Hospital, Lagos state.
- To determine the prevalence of PIH and its complications among women attending ANC at Lagos State General Hospital.
- To assess the knowledge of pregnant women on PIH and its related complications.
- To assess the management of PIH and its related complications by health workers (Doctors, Midwives/Nurse-Midwives).
- To determine the factors influencing the prevalence of PIH and its complication among women attending ANC at Lagos State General Hospital.
CHAPTER TWO
LITERATURE REVIEW
Introduction
Pregnancy Induced Hypertension (PIH) is a kind of high blood pressure associated with pregnancy. Pregnancy Induced Hypertension continues to be a primary cause of high mortality and morbidities amongst women who are pregnant worldwide (Ayele et al., 2016). Aside elevated blood pressure levels, PIH is also characterized by protein in urine (proteinuria) and abnormal edema (Tesfaye et al., 2018). The American College of Obstetricians and Gynaecologists (ACOG) in collaboration with the United Nations (UN) Organization classifies hypertensive disorders in pregnancy as: Chronic Hypertension, Gestational Hypertension, Preeclampsia/Eclampsia (Tebeu et al., 2011).
Pregnancy Induced Hypertension can be categorized as mild or severe. The former is when there is a new onset of hypertension with the systolic blood pressure being ≥ 140 mmHg and or diastolic blood pressure ≥ 90 mmHg, emerging from 20 weeks’ gestation whereas the latter diagnoses is made when blood pressure measures ≥ 160 mmHg systolic and ≥ 110 mmHg diastolic continually (Ribowsky and Henderson 2012). Due to the severity of the condition in some women, high mortalities are associated with PIH and is heavily documented.
Globally, approximately three hundred and fifty thousand women who are pregnant pass away yearly from pregnancy associated causes and over 50% of such mortality taking place in SubSaharan Africa (SSA). It is estimated that 12% of pregnant women’s deaths are associated with PIH (Middendrop et al., 2013). Globally, 10 % of pregnant women are affected by hypertension (Muti., 2015).
A systematic review by WHO concluded that PIH and its related complications is ranking third as the cause of maternal deaths in Africa , whereas in Latin America and the Caribbean , it contributes to 25.7% of mortality (WHO, 2011). In Africa, 9.1 % of mothers who die is because of hypertensive disorders of pregnancy (Arshad et al., 2011).
Aside the enormous mortalities, PIH is linked with delivery before term, Intra Uterine Growth Retardation, Abruption Placentae and Intra Uterine Foetal Death (Muti, et al., 2015). In addition, complications arising from PIH has the tendency of affecting both the mother and baby (Jones et al., 2017).
A number of risk factors have been documented to predict risk for PIH (Solomon and Seely, 2011). These include; Nulliparity, Multiple Pregnancies, History of Chronic Hypertension, Gestational Diabetes, Foetal Malformation and Obesity are associated with PIH (Khosravi et al., 2014).
Maternal age less than 20 or over 40 years, occurrence of PIH in previous pregnancies, pre-existing diseases Like kidney Disease, Diabetes Mellitus (DM), Cardiac disease, undetected chronic hypertension, positive family history of PIH where there is genetic vulnerability, psychological stress, use of alcohol, rheumatic arthritis, low BMI and being obese, and socioeconomic status being low are equally linked to PIH (Tesfaye, et al., 2018).
Surprisingly, most women are not informed on the existence of PIH whilst others have diverse views on the physiological and pathological cause and others liaise its signs with superstitions (Brown et al., 2013). In Sub-Saharan Africa, pregnant women were stated taking the least suitable actions to reduce PIH as they mostly hold evil spirits and witchcraft responsible for the condition (Conde and Belizan, 2010). Evidence suggests that alternative complementary medicine was normally practiced by to keep themselves from harm, regulate the disease and to deal with hypertension (Conde and Belizan, 2010).
In a study conducted in the Tamale Metropolis among women with regards to PIH, it was revealed that 60% of the study participants lack knowledge on self-care management of PIH (Muzakiel,
2013). In addition, a similar study conducted by Musah and Iddrisu (2013) in the Tamale Teaching Hospital revealed that about 40% of pregnant women who attended ANC lack knowledge of selfcare management of PIH and some of the pregnant women even considered oedema and weight gain as normal conditions of pregnancy. Hence, knowledge about PIH and its management is important as it influences health seeking behaviour among pregnant women in the world (Tuovinen et al., 2012).
There is a clear indication from previous studies that most women are challenged in their level of understanding of PIH. This could result to worsening of the condition as well as increase in prevalence of the condition since some may result to their personal ways of handling the condition which might proof ineffective. Studies have shown that, community health workers are instrumental in the management of PIH since they provide basic maternity services at the primary level. In India for instance community health workers are trained to counsel and prepare expectant mothers for safe delivery as well as educate them on the importance of immunization, breastfeeding and early detection of complications such as PIH (Ramadurg et al., 2016). The World Health Organization (WHO) stressed on the periodic screening for high blood pressure. Unfortunately, some countries particularly those in Low and Middle-income countries act contrary to this recommendation (Sheikh et al., 2016). Similar pattern was observed in some developing countries. Studies have shown that, various cadres of health care providers such as nurses, doctors, midwives as well as community health nurses are less knowledgeable on screening and management of pre-eclampsia (Sheikh et al., 2016). In some countries however, the health system has integrated management of maternal complications such as PIH into already existing health initiatives. Pakistan for instance, has included the current global management principles of pre-eclampsia in skilled birth attendant and periodic trainings for nurses.
Women who were diagnosed with Pregnancy Induced Hypertension were observed to be sensitive to a variety of endogenous substances (prostaglandins, thromboxane) that can cause vasospasm and platelet aggregation (Eze et al., 2018). In view of this, proper management must be rendered by health professionals to such women to reduce the adverse events they mostly faced. In Nigeria, there is scarcity of studies that focused on the connection between PIH, self-care, knowledge and hypertension control among pregnant women. Thus, this study was conducted to ascertain the prevalence, causes and effects of the risk factors associated with PIH and also assess how women with PIH are managed.
CHAPTER THREE
Research Method
Study design
A facility-based cross-sectional study will be used to determine the prevalence and determinants of pregnancy induced hypertension attending the Lagos State General Hospital in Lagos state. A cross-sectional study will be appropriate because it measures both outcome and exposure variables at the same time.
Study population
The population of interest is all pregnant women attending the ANC of the hospital as well as health workers (Doctors, Midwives and Nurses-Midwives) on duty at the time of the study.
Inclusion criteria
- Pregnant women aged between 17 and 45 years will be eligible for inclusion into this study.
- All pregnant women attending ANC at the Lagos State General Hospital with gestational age greater than 20 weeks will be included in the study.
- A health worker at the ANC of the Lagos State General Hospital with six months or more work experience will be eligible for inclusion into this study
Exclusion criteria
- All referrals at the time of data collection and pregnant women who would be unable to communicate and or were critically ill were excluded.
- Any health worker at the ANC of the Lagos State General Hospital with less than six months work experience will not be eligible for inclusion into this study
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