Abstract

Preeclampsia is a multisystem hypertension disorder of unknown etiology affecting pregnant women across the globe. It is also a deviously silent and oftentimes discrete killer of women.it is characterize by a sudden increase in blood pressure, proteinuria and edema at or after the 20th week of pregnancy. This study was a cross sectional study aim at “Assessing Nurses/Midwifeknowledge On The Prevention And Management Of Preeclampsia” at the Buea Regional Hospital, Fako Division of the South West Region. A convenient sampling technique was use to recruit participant in this study with a sample size of 32. Data was collected using a well-structured questionnaire with both closed and open ended questions with a sample size of 32 nurses/midwives and data was analyzed using Microsoft excel 2016. The results obtained shows that 71.87% of them had knowledge on preeclampsia, 71.875% had knowledge on prevention meanwhile, and 75% had knowledge on the management of preeclampsia.

It is recommended that: seminars should be held where healthcare personnel should gain knowledge on the pathology, directors and supervisors in the hospital should also ensure this knowledge learn should be put in to practice. Also, the Director and the General Supervisors of hospital should ensure there are sophisticated materials needed to prevent and manage this pathology

It was then concluded that, nurses/midwives at the Buea Regional Hospital had knowledge on the prevention and management of preeclampsia.

CHAPTER ONE

GENERAL INTRODUCTION

Introduction

The introduction will run from background, statement of problem, general objectives, specific objectives, research questions, significant of the study, justification, scope of the study and operational, and conceptual definition of terms.

1.1 Background of the Study

According to medical review policy (MRP), preeclampsia is a condition by which pregnant women experience sudden increase in blood pressure, after the 20th week of pregnancy and also marked by protein in urine. (National guideline alliance, 2019)

Preeclampsia has been traditionally defined as the onset of hypertension accompanied by significant proteinuria after the 20th weeks of gestation. Recently, the definition of preeclampsia has been broadened. The international agreed definition for preeclampsia is that propose international society for the study of hypertension in pregnancy (ISSHP,2018).

According to the international society for the study of hypertension in pregnancy (ISSHP), 2018 preeclampsia is the new onset of hypertension in pregnancy (≥140mmhg systolic or ≥90mmhg of diastolic blood pressure on at least 2 occasions measured 4 hours apart in previously normotensive women

According to the American college of obstetrics and gynecologist 2013, preeclampsia increases the risk of poor outcome for both the mother and the child. This disorder usually occurs from the 20th week of gestation and if left untreated may result to seizures and at this stage call eclampsia.

In ancient Greece, between the late 5th and early 4th centuries before current era, the Hippocrates subscribe to the theory of the four humors to describe the cause of illness and disease. They believe that the body was made up of four humors that included blood, phlegm, yellow bile and dark bile. Health depended on the balance of the humors and any imbalance in this humors will result to illness (Demand, 1994)

In the 20th century, researchers had failed to uncover the etiology of preeclampsia, much progress was made in the understanding of pathophysiological changes associated with it development. In the 1960s several groups described dramatic differences in placental physiology between placentas from pregnancy affected by preeclampsia versus placentas from pregnancy unaffected by preeclampsia.

Through the examination of placental bed biopsies, it was discovered that placental trophoblast cells failed to adequately invade maternal spiral arteries and convert the arteries from small muscular vessels into large, low resistant vessels in preeclampsia.  With the lack of spiral artery conversion, Arterial lumen diameter and distensibility was limited, resulting to restricted blood flow in the placental and growing fetus. (Robertson et al, 1967). Although these findings were instrumental in laying the groundwork for the current understanding of preeclampsia- eclampsia, not all theories or scientific discoveries have readily been accepted by the scientific community. Publish in the American journal of obstetrics and gynecology in 1983.

At present (21st century), the scientific community has failed to uncover the etiological mechanisms responsible for the development of preeclampsia-eclampsia.

The theory base for this study is the implantation theory of preeclampsia/eclampsia by Robert et al in 1989. This theory posited that preeclampsia represented an endothelia disorder. Drawing on past work that associated preeclampsia with shallow trophoblast invasion and subsequent reduction in placental perfusion, they hypothesized that the ischemic placenta released a damaging factor(s) in to the maternal circulation. Although factor identity was unknown, the circulating factor was hypothesized to have cause endothelia dysfunction and will lead to the activation of the coagulation cascade, abnormal blood pressure and lose of fluids from intravascular space (eg, proteinuria) (Robert et al, 1989).

Preeclampsia is a disorder with a reported incidence of 10% to 15% among all pregnancies, accounting for more than 50,000 deaths worldwide yearly (Duley L, 2009).

It is one of the primary causes of neonatal, fetal and maternal mortality particularly in low socio-economic settings and third world countries with Cameroon being one of the third world country [moll et al 2016]. The incidence of preeclampsia has significant variation in different part of the continent. For instance, 4% in Africa, 3.8% in Europe, and 4.2% in the western pacific region Nwanodi O.B, 2016.

In Somaliland, maternal mortality ratios are the worst in the world, one out of every 15 women has the risk of dying due to maternal related reasons, and there are a little over one hundred experience doctors and mid/wives in the country, both in the public and private sector (Moh, 2011). A steady rise in incidence of preeclampsia cases has been noted over the past five years in Somaliland which poses a grieve burden on the death of mothers. Preeclampsia and related hypertensive disorder are the second leading cause of these deaths with an estimate of 17% and accordingly, death due to these conditions has been on the rise in recent years (2010).

In Cameroon, according to a study carry out by Nkem Ernest et al 2020 in the Mezam Division North West Region showed that preeclampsia accounts for 5.7% to 10.8% of maternal/infant complications. These hypertensive diseases in pregnancy especially preeclampsia makes the woman more vulnerable to future cardiovascular diseases.

Another study carried out by Tebeu et al in Yaoundé Central Reion of Cameroon Found out that 17.5% of maternal death is related to hypertensive disease of pregnancy in 2007 while Foumane et al found out 22.4% in 2010. These hypertensive diseases in pregnancy makes the woman more vulnerable to future cardiovascular diseases.

1.2 Statement of Problem

Preeclampsia turns to be the second leading cause of maternal/infant mortality and morbidity both to the family and community, accounting for 10-15% of maternal deaths worldwide. (Duley et al 2009). The incidence of preeclampsia has significant variation in different part of the continents especially in low socio-economic countries. For instance, 4% in Africa, 3.8% in Europe, 4.2% in the pacific regions and 5.2 to 8.2% in Cameroon. (Nwanobi O.B 2016).

Globally, 292982 women died due to complication of pregnancy and childbirth. Out of those deaths, 85% have occurred in the sub-Saharan Africa, yet the majority of those deaths occur in low resource settings, and most of them could have been preventable. Furthermore, the greatest share of maternal death has been reported in Africa as compare to other regions. (wagnew M.,et al, 2016)

The intent during her early days in the university witness a case where the uncles’ wife was diagnosed of preeclampsia during her ANC visits and after all the follow up, she died during labor as she developed eclampsia fits and the reasons to her death was not clear to me as I thought the management, she required was not applied due to reasons I could not comprehend thus the necessity of this study.

Also, one of my neighbor was diagnosed of preeclampsia a year ago, at the Buea regional hospital and after all her ANC visits, and all the interventions made by the healthcare team during labor, she lose her baby as she develops eclamptic fits and before she was taken for surgery, fetal distress was beyond control and she lose her baby to the cold hands of death.

Findings revealed poor management during labor as she was to be booked for cesarean section before then, in order to save her life and that of the baby there by decreasing infant and maternal mortality. Therefore, I was motivated to carry out this research on investigating nurses’/midwives knowledge on the causes, prevention and management of preeclampsia at the Buea Regional Hospital.

1.3 Research Objectives

1.3.1 General objective

To assess nurses’/midwives’ knowledge on the prevention and management of preeclampsia.

1.3.2 Specific Objectives

1. To determine nurse’s/midwives’ knowledge in preeclampsia at the Buea Regional hospital
2. To assess nurses’/midwives’ knowledge in the prevention of preeclampsia at the Buea Regional hospital
3. To explore nurses’/midwives’ knowledge in the management of preeclampsia at the Buea Regional hospital

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