AUTHORS:  Matovu Brian, Sekyonda Zoe, Angunda Collins, Evatt Nahurira.

Note: The basis of coming up with this document (Problem statement) was to design a new diagnostic technique for health care providers to bring preeclampsia to a drain.

Preeclampsia is a multisystem disorder characterized by hypertension and proteinuria (≥ 0.3g/d in 24hour urine collection) (medical dictionary, 5th Edition) in pregnant women who are usually beyond 20 weeks of gestational age and it’s one of the leading causes of maternal and infant morbidity and mortality worldwide (Duley 2009).

During the second half of the pregnancy (20 weeks), women with this condition tend to experience a pregnancy induced hypertension with a blood pressure of above 160/140mmmHg (i.e. systolic/ diastolic), proteinuria (albumin- which differentiates it from gestational hypertension), increased urinary calcium and creatinine level and increased urinary concentration of activin A and inhibitin A (Muttukrishna, Hyett et al. 2006; Bai, Rudrappa et al. 2014). This further indicates that the kidneys are shutting down which would result into serious complications to both the mother and the neonate (Hladunewich, Karumanchi et al. 2007)despite the fact that the etiology of the condition is currently unknown though there are theories that explain it in terms of placentation abnormalities, placenta ischemia, genetic factors, environmental factors, and cases of women having more partners have also been reported. Other factors include smoking of women during pregnancy, poverty, stress, obesity, and nulliparous women (Helewa, Burrows et al. 1997).

According to the WHO, 40% of pregnant women (Endeshaw, Ambaw et al. 2014) experience delivery complications during labor and or experience complications during preconception, prenatal terms to mention but a few. Specific to preeclampsia, 2- 10% of the women worldwide are affected by this condition and 0.03-0.05% worldwide by eclampsia (Sidani and Siddik-Sayyid 2011; Kiondo, Wamuyu‐Maina et al. 2012). While preeclampsia complicates 6%–10% of all pregnancies in the United States, the incidence is believed to be even higher in underdeveloped countries. Recent evidence suggests that preeclampsia accounts for approximately 15.9% of all maternal deaths in the United States. Preeclampsia has remained a significant public health threat in both developed and developing countries as WHO estimates show that the incidences of preeclampsia are seven times higher in developing countries (2.8% of live births) than in developed countries (0.4%) (Trogstad, Magnus et al. 2008).

In developing countries particularly in Sub-Saharan Africa where maternal services including prenatal care are limited (Wandabwa 2004), the prevalence of preeclampsia in these countries reaches up to 16.7% and it is estimated to account for about 40% to 60% of maternal deaths (Xiong, Buekens et al. 2006). A study conducted In Ethiopia showed, that among the major five obstetric causes of maternal deaths, the proportion of maternal deaths due to severe preeclampsia or eclampsia shows increasing trend while that of abortion is decreasing and no grossly notable reductions in the proportions of maternal death in ruptured uterus, obstructed labor and sepsis are indicated. In addition, induction of women for delivery to prevent the progression of preeclampsia is responsible for 15% of all preterm births (Wandabwa 2004). The onset of preeclampsia is only 5% from 20 weeks to 34 weeks of gestation, 90% from 34 weeks to labor and delivery, and the remaining 5% post-partum within 48 hours after delivery (Wandabwa, Doyle et al. 2010).

The present high rates of fertility of about 6.7 births per woman in most undeveloped countries, like Uganda, with an environment of poor access to quality maternal and neonatal care, has continued to expose mothers and infants to a high risk of death from pregnancy related causes inclusive of preeclampsia. According to Dr. Kiondo (MBChB, MMed), an Obstetrics and Gynecologist of Mulago National referral Hospital, reports that at Mulago Hospital labor ward, about 3 to 4 women with pre-eclampsia are admitted daily and this constitutes 8.2% of the admissions and, severe pre – eclampsia/eclampsia contributes 17.6% of near misses and 21% of maternal mortality(Vikse, Irgens et al. 2008; Kiondo, Wamuyu‐Maina et al. 2012).The incidence of preeclampsia/eclampsia in Uganda is high and is associated with high maternal morbidity and mortality.

Antepartum diagnosis of preeclampsia is based on a series of symptoms that occur especially during after 20 weeks of gestation. When not detected earlier, preeclampsia results in severe preeclampsia which is normally called eclampsia that is characterized by convulsions and the only recommended cure for it according to WHO is the termination of pregnancy(Helewa, Burrows et al. 1997). Without early detection of this disease and with increased risks of terminating pregnancy, the babies are exposed to further risks of developing respiratory distress syndrome (RDS), transient tachypnea of the new born (TTN), persistent pulmonary hypertension (PPHN) and respiratory failure as compared with babies born at full term. In decision making, of either to terminate the pregnancy, normally there are limited number of options suggested in management of preeclampsia that are known to benefit the infant(Hladunewich, Karumanchi et al. 2007). Antepartum management involves administering of antenatal steroids in anticipation of preterm delivery.

From the recent studies conducted by family care international, it’s shown that only 48% of our mothers have at least one clinical visit for antenatal care and about 3% (Vikse, Irgens et al. 2008)of lower health facilities in low reset countries like Uganda can manage handling sever complications of preeclampsia. In the few health facilities that can handle the condition, they use screening tests (methods) like using urine dipsticks to detect protein in urine, blood pressure machines to monitor patient blood pressure, etc. these tests enable to predict the disease before becoming severe and diagnose it(Bai, Rudrappa et al. 2014).

However, these methods are inefficient, unreliable and not specific to the biomarkers of the disease and much research has been done on the prevalence of the disease but less research has been done on improving these screening methods(Kaye 2004). With that there is need to predict, prevent and diagnose preeclampsia in these countries since the majority of deaths due to pre-eclampsia and eclampsia are avoidable through the provision of timely and effective care to the women presenting with these complications.

REFERENCES:

  • Medical Dictionary ISBN: 978-0-19-955715-8 5TH edition- university oxford press.
  • Bai, T., G. Rudrappa, et al. (2014). “Study of Serum and Urinary Calcium Levels in Pregnancy Induced Hypertension Cases in and around Chitradurga.” Global Journal of Medical Research 14(4).
  • Duley, L. (2009). The global impact of pre-eclampsia and eclampsia. Seminars in perinatology, Elsevier.
  • Endeshaw, M., F. Ambaw, et al. (2014). “Effect of Maternal Nutrition and Dietary Habits on Preeclampsia: A Case-Control Study.” International Journal of Clinical Medicine 5(21): 1405.
  • Helewa, M. E., R. F. Burrows, et al. (1997). “Report of the Canadian Hypertension Society Consensus Conference: 1. Definitions, evaluation and classification of hypertensive disorders in pregnancy.” Canadian Medical Association Journal 157(6): 715-725.
  • Hladunewich, M., S. A. Karumanchi, et al. (2007). “Pathophysiology of the clinical manifestations of preeclampsia.” Clinical Journal of the American Society of Nephrology 2(3): 543-549.
  • Kaye, D. (2004). “Antenatal and intrapartum risk factors for birth asphyxia among emergency obstetric referrals in Mulago Hospital, Kampala, Uganda.” East African medical journal 80(3): 140-143.
  • Kiondo, P., G. WamuyuMaina, et al. (2012). “Risk factors for preeclampsia in Mulago Hospital, Kampala, Uganda.” Tropical Medicine & International Health 17(4): 480-487.
  • Muttukrishna, S., J. Hyett, et al. (2006). “Uterine vein and maternal urinary levels of activin A and inhibin A in preeclampsia patients.” Clinical endocrinology 64(4): 469-473.
  • Sidani, M. and S. M. Siddik-Sayyid (2011). “Preeclampsia, a new perspective in 2011.” Middle East J Anesthesiol 21(2): 207-214.
  • Trogstad, L., P. Magnus, et al. (2008). “Previous abortions and risk of pre-eclampsia.” International journal of epidemiology 37(6): 1333-1340.
  • Vikse, B. E., L. M. Irgens, et al. (2008). “Preeclampsia and the risk of end-stage renal disease.” New England Journal of Medicine 359(8): 800-809.
  • Wandabwa, J., P. Doyle, et al. (2010). “Risk factors for severe pre-eclampsia and eclamsia in Mulago Hospital, Kampala, Uganda.” East African medical journal 87(10).
  • Wandabwa, J. N. (2004). Investigation of risk factors for severe maternal morbidity and progression to mortality: a case control and follow up study in Mulago Hospital Complex Uganda, London School of Hygiene & Tropical Medicine.
  • Xiong, X., P. Buekens, et al. (2006). “Periodontal disease and adverse pregnancy outcomes: a systematic review.” BJOG: An International Journal of Obstetrics & Gynaecology 113(2): 135-143.

 

Advertisements