CHAPTER ONE
- INTRODUCTION
Hypertensive disorders of pregnancy such as pre-eclampsia (PE) and pregnancy-induced hypertension (PIH) are a major cause of maternal morbidity (Magee et al., 2014). Pre-eclampsia has remained a significant public health threat in both developed and developing countries contributing to maternal and perinatal morbidity and mortality globally (Shah et al., 2009). Pre-eclampsia is a disorder of pregnancy characterized by the onset of high blood pressure and often a significant amount of protein in the urine (Eiland et al., 2012).This condition begins after 20weeks of pregnancy (Al-Jameil et al., 2014).In 2013, the American College of Obstetricians and Gynecologists defined this blood pressure as high, when it is greater than 140mmHg systolic or 90mmHg diastolic at two separate times, more than four hours apart in a woman after 20weeks of pregnancy. Pre-eclampsia can present as late as 4-6 weeks postpartum. Postpartum pre-eclampsia is the occurrence of hypertension and proteinuria after delivery. Hypertension is a common but not universal finding in postpartum pre-eclampsia, proteinuria may occur less often than in pre-eclampsia during pregnancy (Mattlys et al., 2004).
Despite being one of the leading causes of the maternal morbidity and mortality, the aetiology and pathogenesis of pre-eclampsia remain to be elucidated. It has been termed the ‘’disease of theories’’ because of the multiple hypotheses that have been proposed to explain its occurrence(Solomon and Seely, 2004).There is strong evidence that a major cause predisposing a susceptible woman to pre-eclampsia is an abnormally implanted placenta(Al-Jameil et al., 2014; Steegers et al., 2010). A major consequence of this sequence of events is generalized endothelial dysfunction (Eiland et al., 2012; Young et al., 2010). This disorder is mediated by placental products that reach the maternal circulation and trigger endothelial dysfunction, thereby evoking cardiovascular diseases, such as vasospasm, increased endothelial permeability and activation of thrombogenic mechanisms, and leading to the early events of atherosclerosis (Airoldi and Weinstein, 2007). The abnormal implantation may stem from the maternal immune system’s response to the placenta, specifically a lack of established immunological tolerance in pregnancy. Endothelial dysfunction results in hypertension. Several other factors including genetic, immune, vascular and oxidative stress are also implicated in the pathogenesis of pre-eclampsia (Eiland et al., 2012; Young et al., 2010). Women with pre-eclampsia present arterial lesions at the uteroplacental implantation site. These morphological lesions are usually observed in cases of acute atherosclerosis, and are characterized by areas with fibrinoid necrosis surrounded by lipid-laden macrophages (Ross, 2010). Lipid deposits are also seen in the glomeruli of pre-eclamptic patients, a finding known as glomerular endotheliosis (Airoldi and Weinstein, 2007).
Proteinuria, which is significant amount of protein in urine seen in pre-eclampsia is caused by damage of the glomeruli of the kidney. Normally, protein being a large molecule is not supposed to be found in urine but because of the damage of the glomeruli of the kidney in a pre-eclamptic patient, there are usually presence of protein in urine (Neithardth et al., 2012). Therefore, in a pre-eclamptic patient, there are usually decreased protein (albumin, globulin and total protein).Also, because of hemodilution and increased demand of the developing fetus, serum albumin decreases during all the trimesters in a pre-eclamptic patient (Harold et al., 2006). Therefore, serum total protein, also known as total protein is a biochemical test for measuring the amount of protein in serum and it is decreased in pre-eclamptic patients (Harold et al., 2006).
The physiological hyperlipidemia observed in healthy pregnant women is further exacerbated in pre-eclampsia especially triglyceride (Ray et al., 2006). Lipids are large and diverse group of naturally occurring organic compounds that are related by their solubility in non-polar organic solvents (Swapnali et al., 2011). Lipid profile is a blood test done in order to assess the status of fat metabolism in the body and its importance in heart disease. Pre-eclampsia is characterized by intense changes of lipid profile. The lipid profile include the total cholesterol, triglyceride, high density lipoprotein and low density lipoprotein (Swapnali et al., 2011).
1.1 Justification
Pre-eclampsia is a pregnancy specific disorder characterized by an impaired blood perfusion of vital organs including the fetal-placental unit. It is a multi-systemic syndrome, involving genetic and environmental factors in its pathophysiology and the only known treatment is delivery of the fetus and placenta (Romero and Chaiworapongsa, 2013).The prevalence of pre-eclampsia although presents some variations in the literature particularly for different populations.
The changes of total protein and lipid profile are worth assessing for in pre-eclamptic patients, since studies in the field of cardiovascular research have shown that serum lipids have a direct effect on endothelial function and this way, abnormal serum lipid profiles are associated with endothelial dysfunction (Sima et al., 2009). Recent published works have suggested that a maternal pre-disposition to pre-eclampsia may be explained by altered lipid profile, but the reported findings are inconsistent (Enquobahrie et al., 2004; Baksu et al., 2005). However, the intensity of pre-eclampsia, socio-economic and cultural practices vary in various parts of the country, Nigeria. This work is therefore expected to address the biochemical dynamics of pre-eclampsia by evaluating the alteration in serum lipid profile and total protein with a view to provoking further research especially in the areas of its aetiology, pathogenesis and management since pre-eclampsia is the precursor to eclampsia.
1.2 Aim and specific objectives
- A) Aim
To evaluate the levels of total protein and lipid profile in pre-eclamptic patients undergoing antenatal care in Abia State University Teaching Hospital Aba, Abia State (ABSUTH)
- B) Specific Objectives
1) To determine the levels of total protein in pre-eclamptic women
2) To determine lipid profile (TC, TG, HDL-C and LDL-C) levels in pre-eclamptic patients
3) To compare the levels of total protein and lipid profile in preeclamptic women with the normotensive pregnant women.
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