Pregnancy Induced Hypertension in Women in Lagos State
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
REVIEW OF RELATED LITERATURE
Introduction
Pregnancy Induced Hypertension (PIH) known as toxemia or preeclampsia is a form of high Blood Pressure (BP) in pregnancy. PIH is one developing after 20 weeks of gestation without other signs of preeclampsia. It is a known cause of premature delivery, intrauterine growth restriction (IUGR), placental abruption and fetal death, as well as maternal mortality and morbidity (Gombe et al., 2011). It is characterized by either blood pressure levels of 140/90 mm Hg or higher after 20 weeks of gestation, or a blood pressure rise greater than 30/15mmHg from early or prepregnancy baseline or a rise of mean arterial pressure of more than 105 mmHg. This due to the development of arterial high pressure in a pregnant mother after 20 weeks of gestation, which may or may not have protein in urine and has a blood pressure of or more than 140/90 mmHg (National Guidelines for Quality Obstetrics, 2004). Of all the pregnancy related complications in the world, pre-eclampsia and eclampsia present 10% major causes of maternal and prenatal morbidity and mortality, with pre-eclampsia affecting 5-7 % of all pregnancies, Srinivas, et al. Hypertensive disorders during pregnancy is among the leading cause of maternal and fetal mortality in obstetric practice that can prevent the baby from getting enough blood and oxygen harming their liver, kidney, brain, and heart, causing end organ damage, Palacios, et al. Pregnancy induced hypertension is a major cause of maternal morbidity and mortality in the United States. There is an approximately one maternal death due to preeclampsia-eclampsia per 100,000 live births, with a case-fatality rate of 6.4 deaths per 10,000 cases Livington, et al. The outcome of hypertension in pregnancy is affected by multiple factors. These include gestational age at onset, severity of disease, and the presence of comorbidities like diabetes mellitus, renal disease, thrombophilia, or pre-existing hypertension Heard, et al.. Similarly, a study conducted in Latin America and Caribbean, Pakistan, New York, and Sri Lanka identified null parity, multiple pregnancies, history of chronic hypertension, gestational diabetes, fetal malformation and obesity as the risk factors for developing pregnancy induced hypertension Dolea. Furthermore, life-threatening maternal age (less than 20 or over 40 years), history of PIH in previous pregnancies, preexisting diseases like renal disease, diabetes mellitus, cardiac disease, unrecognized chronic hypertension, positive family history of PIH, which shows genetic susceptibility, psychological stress, alcohol use, rheumatic arthritis, very underweight and overweight, and low level of socioeconomic status are the risk factors for PIH Abeysena, et al. One important aspect of diagnosing and managing hypertension in pregnancy is presiding out secondary causes. These causes can add to both the maternal, fetal morbidity and mortality. Records from the Nationwide Inpatient Sample (NIS) of hospitalizations for delivery between 1995 and 2008 showed that out the patients with chronic hypertension (1.15% of the sampled population), 11.2% had secondary causes. Secondary hypertension had higher odds of adverse maternal and fetal outcomes when compared to essential hypertension (odds ratio (OR), 11.92 vs 10.18 for preeclampsia, 51.07 vs 13.14 for acute renal failure, 4.36 vs 2.89 for spontaneous delivery < 37 weeks) Bateman, et al. Examples of secondary forms of hypertension are chronic kidney disease (most common cause), hyperaldosteronism, Reno vascular disease, obstructive sleep apnea, Cushing’s syndrome, pheochromocytoma, thyroid disease, rheumatologic diseases (e.g. scleroderma or mixed connective tissue disease), and coarctation of the aorta; lack of understanding on how to diagnose and treat these conditions during pregnancy may lead to a higher morbidity and mortality Malha.
CHAPTER THREE
RESEARCH METHODOLOGY
INTRODUCTION
In this chapter, we described the research procedure for this study. A research methodology is a research process adopted or employed to systematically and scientifically present the results of a study to the research audience viz. a vis, the study beneficiaries.
RESEARCH DESIGN
Research designs are perceived to be an overall strategy adopted by the researcher whereby different components of the study are integrated in a logical manner to effectively address a research problem. In this study, the researcher employed the survey research design. This is due to the nature of the study whereby the opinion and views of people are sampled. According to Singleton & Straits, (2009), Survey research can use quantitative research strategies (e.g., using questionnaires with numerically rated items), qualitative research strategies (e.g., using open-ended questions), or both strategies (i.e., mixed methods). As it is often used to describe and explore human behaviour, surveys are therefore frequently used in social and psychological research.
POPULATION OF THE STUDY
According to Udoyen (2019), a study population is a group of elements or individuals as the case may be, who share similar characteristics. These similar features can include location, gender, age, sex or specific interest. The emphasis on study population is that it constitutes of individuals or elements that are homogeneous in description.
This study was carried to examine an pregnancy induced hypertension in women in Lagos State. Selected pregnant women in general hospital Lagos form the population of the study.
CHAPTER FOUR
DATA PRESENTATION AND ANALYSIS
INTRODUCTION
This chapter presents the analysis of data derived through the questionnaire and key informant interview administered on the respondents in the study area. The analysis and interpretation were derived from the findings of the study. The data analysis depicts the simple frequency and percentage of the respondents as well as interpretation of the information gathered. A total of eighty (80) questionnaires were administered to respondents of which only seventy-seven (77) were returned and validated. This was due to irregular, incomplete and inappropriate responses to some questionnaire. For this study a total of 77 was validated for the analysis.
TEST OF HYPOTHESIS
H1: there is no prevalence of PIH and its complications among women attending ANC at Lagos State General Hospital
H2: there are no factors influencing the prevalence of PIH and its complication among women attending ANC at Lagos State General Hospital.
CHAPTER FIVE
SUMMARY, CONCLUSION AND RECOMMENDATION
Introduction
It is important to ascertain that the objective of this study was to ascertain pregnancy induced hypertension in women in Lagos state. In the preceding chapter, the relevant data collected for this study were presented, critically analyzed and appropriate interpretation given. In this chapter, certain recommendations made which in the opinion of the researcher will be of benefits in addressing pregnancy induced hypertension in women in Lagos state
Summary
This study was on pregnancy induced hypertension in women in Lagos state. Four objectives were raised which included: 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) and to determine the factors influencing the prevalence of PIH and its complication among women attending ANC at Lagos State General Hospital. A total of 77 responses were received and validated from the enrolled participants where all respondents were drawn from selected pregnant women in Lagos state. Hypothesis was tested using Chi-Square statistical tool (SPSS).
Conclusion
The prevalence of pregnancy induced hypertension among pregnant women receiving antennal care service was. Among pregnancy induced hypertension, preeclampsia was the most common especially among those pregnant women admitted to maternity ward. The rural residence, positive family history of chronic hypertension, positive family history of pregnancy induced hypertension, chronic renal diseases (kidney diseases) and psychological stress during pregnancy were the associated factors with pregnancy induced hypertension.
Recommendation
Large cross sectional study may be undertaken to estimate the exact burden of hypertensive disorders during pregnancy and their consequences so as to develop an appropriate strategy for prevention and timely management of the disorders at antenatal care visits. Implementation of effective interventions like pre conception counselling of pregnant women’s health seeking behaviour would provide a chance to diagnose preeclampsia as early as possible that improve maternal and child health status.
References
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