CHAPTER ONE

Introduction
1.1 Background of the Study
The morbidity and mortality of mothers and children associated with pre-
eclampsia are major public health problems especially in low and middle
income countries (Duley, 2019). Forty percent of pregnant mothers
experience delivery complications during labor and/or during
preconception. Worldwide, 2-10% of mothers are affected by pre-
eclampsia and between 0.03 to 0.05% are affected by eclampsia
(Rosmans, 2016). Globally, the incidence of preeclampsia ranges between
2% and 10% of pregnancies and the incidence of preeclampsia, the
precursor to eclampsia, varies greatly. Pre- eclampsia has remained a
public health threat to both developing and developed countries as World
Health Organization (WHO) states that the incidence is seven times higher
in developing countries (2.8% of live births) than in developed countries
(WHO, 2016).
The higher incidence of pre-eclampsia in developing countries is due to
missed opportunities in preventing hypertension-related disorders due to
substandard quality of care delivered in those countries, such as Nigeria,
Tanzania, and Ethiopia (Masgee, 2019). For example, in Nigeria, the
prevalence of pre- eclampsia ranges from 2% to 16.7%, with
approximately 37,000 women dying from pre- eclampsia annually
(Osungbade, 2017). In Northern Nigeria, pre- eclampsia accounts for 40%
of maternal deaths with significant correlation to poor knowledge of health
care providers and poor referral system, while in Southern Nigeria,
prevalence rate of pre-eclampsia is between 5.6% and 7.6%. Reports have
shown that risk factors for pre-eclampsia may include low-socio economic
status, poor diet (diet low in vitamins C and E), poor access to antenatal
care, past history of pregnancy induced hypertension, abject poverty, poor
reproductive care seeking behavior, lack of access to quality maternal
services and low level of knowledge of health care providers (WHO,
2016).
Preeclampsia has the greatest impact on maternal mortality which
complicates nearly a tenth of pregnancies worldwide (WHO, 2016). It is
the second leading cause of direct maternal death and directly responsible
for 70,000 maternal deaths annually at the global level although the exact
prevalence of morbidity and mortality related to preeclampsia is not
reported in the developing countries.
Preeclampsia is one of the top five maternal mortality causes and
responsible for 16 % of direct maternal death in globally (Abalos, 2018).
The majority of deaths related to preeclampsia could be averted by
evidence-based, effective, and timely interventions by increasing mother's
knowledge and changing attitudes towards preeclampsia.
Studies indicated that pregnant mothers have poor knowledge and wrong
perception about preeclampsia despite its relevance for early identification
and management of the Problem (Townsend, 2016). Lack of knowledge is
found to be the predisposing factor to practice risky behaviors for
preeclampsia. In the same way, poor understanding of the disease leads to
anxiety and becomes a source of stress to the family as well (Firoz, 2017).
Globally, the maternal mortality ratio declined to 216 per 100, 000 live
births from 385 to 100,000 live births in 2015 despite the reduction was
not consistent across countries. Countries have to strive hard to
accomplish the Sustainable Development Goals (SDGs) which demands
more commitment than Millennium Development Goals (MDGs) (Gaym,
2018). Morbidity and mortality related to preeclampsia might be attributed
to poor knowledge and negative attitude of pregnant mothers.
Pre-eclampsia (PE) is a pregnancy-associated multisystem disorder with
no definite causes. The primary cause of PE is still under investigation.
However, it is thought to occur in two stages. The first stage encompass
the impairment of fetal trophoblastic invasion of the decidua and local
placental hypoxia (Hung, 2018). The second stage is the release of
placental blood-related factors into the maternal circulation and aberrant
expression of pro-inflammatory, antiangiogenic and angiogenic factors
(Soleymanlon, 2015). PE is usually characterized by elevated blood
pressure and proteinuria, with the clinical manifestation usually occurring
during the 20th week of gestation or late in pregnancy and regressing post-
delivery. It is grouped into two main types: early-onset PE (occurring
before 34 weeks of gestation) and late-onset PE (occurring after 34 weeks
of gestation) (Turpin, 2015). Although the presenting features of early-
and late-onset PE may overlap, early-onset PE is associated with increased
odds of complications, particularly preterm birth, fetal growth restriction
and maternal morbidity and mortality compared to late onset PE (Kim,
2017).
Mothers with PE also present with diverse signs and symptoms associated
with multiple organ systems. Headaches, visual disturbances, abnormal
kidney function, severe hypertension, chest pain, pulmonary oedema and
low oxygen saturation, nausea and abnormal liver function are among the
common outcomes of the multi-organ system dysfunction in PE
(Osungbade, 2012). Risk factors of PE include first pregnancy, age
(pregnancy at an advanced age or under 18 years of age), family history of
PE, personal history of PE, obesity, gestational diabetes, multifetal
gestation and preexisting medical conditions such as chronic hypertension
(Wickinson, 2018).
There are several problems related to preeclampsia prevention and
diagnosis such as challenges in the prediction, prevention, delay in
transport, and management of preeclampsia which are complemented by
the shortage of trained health personnel and poor health infrastructures in
developing countries (Berham, 2014). To address the burden of
preeclampsia-related consequences, shifting from clinic-based care to
community-based case-ascertainment and treatment are key intervention
strategies especially in resource-limited areas. However, it is against this
background that the study is set to assess the Awareness on the Causes and
prevention of preeclampsia among pregnant mothers attending Antenatal
care in general hospital Auna, magama local government area of Niger
State.

1.2 Statement of the Study

Preeclampsia remains one of the leading causes of maternal mortality and
morbidity, complicating an estimated 2–8% of pregnancies worldwide and
up to 10% in developing countries. It is one of the top five leading causes
of maternal and neonatal deaths. Preeclampsia can progress to eclampsia
and cause adverse fetal outcomes such as preterm birth, small-for-
gestational-age babies, placental abruption, perinatal death and increase
the risk of cardiovascular and cerebrovascular diseases and venous
thromboembolism later in life (Raymond, 2017). Furthermore, mothers
who suffer from Preeclampsia are predisposed to mental health issues such
shame, guilt, feelings of failure, loss of control, personal inadequacy and
postpartum depression.
Adequate knowledge about a disorder contributes greatly to its prevention,
control and management. Reports indicate that patients’ knowledge about
a disease has significant benefits on compliance to treatment and helps to
abate complications associated with the disease (Portilli, 2018). In Nigeria,
one major hurdle in combating Preeclampsia is the late reporting of
mothers to healthcare centers following an experience of a sign or
symptom. Preeclampsia is a disease of signs and symptoms which requires
prompt attention. Equipped with knowledge, mothers experiencing
Preeclampsia would report early to the hospital, receive timely medical
intervention and have fewer adverse outcomes.
This emphasizes the need for mothers to have adequate knowledge of the
disease. For this to be achieved, there is the need to assess the baseline
knowledge of Preeclampsia, especially among high risk group such as
pregnant mothers (Gabbe, 2016). However, there is currently no study that
evaluates the awareness on the causes and prevention of Preeclampsiain
general hospital Aunamagama local government. This study, is however, is
set out to determine the awareness on the Causes and prevention of
preeclampsia among pregnant mothers attending Antenatal care in general
hospital Aunamagama local government area of Niger State.
1.3 Purpose of the study
The main purpose of this study is to determine the Awareness on the
Causes and prevention of preeclampsia among pregnant women attending
Antenatal care clinics in Auna Magama local government area of Niger
State. Therefore, the following specific objectives guide the study;
1. To assess the level of awareness on the causes of pre-eclampsia
among pregnant mothers attending Antenatal care in general hospital
Aunamagama local government area of Niger State.
2. To identify the level of knowledge on the effects of pre-eclampsia
among pregnant mothers attending Antenatal care in General
hospital AunaMagama Local Government Area of Niger state.
3. To investigate the level of knowledge on the prevention of pre-
eclampsia among pregnant mothers attending Antenatal care in
general hospital Aunamagamalocal government area of Niger State.
1.4 Research Questions
The following research questions were posed to guide the study;
1. What is the level of awareness on the causes of pre-eclampsia among
pregnant mothers attending Antenatal care in general hospital
Aunamagama local government area of Niger State.
 2. What is the level of knowledge on the effects of pre-eclampsia
among pregnant mothers attending Antenatal care in General
hospital AunaMagama Local Government Area of Niger state
3. What is the level of knowledge on the prevention of pre-eclampsia
among pregnant mothers attending Antenatal care in general hospital
Aunamagama local government area of Niger State.
1.5 Significance of the Study
The outcome of this study will show more light to the pregnant mothers
attending Antenatal care who are prone to pre-eclampsia and eclampsia to
know more about causes and ways to prevent pre-eclampsia and eclampsia
among themselves.
The outcome of this study will also be of immense importance as it will
add to the existing body of literature in this field of study.
Finally, this study when completed will serve as a guideline to other
research in some area related to this topic.

1.6 Scope and Delimitation of the Study

The study focuses on the Awareness on the Causes and prevention of
preeclampsia among pregnant mothers attending Antenatal care in general
hospital Aunamagama local government area of Niger State. Therefore,
the study is delimited to only pregnant mothers attending Antenatal care in
general hospital Aunamagama local government area of Niger State.

CHAPTER TWO
REVIEW OF RELATED LITERATURE
2.1 Introduction
This chapter deals with the review of relevant literature related to the
study and it is discussed under the following headings and sub-headings;
2.2 Concept of pre-eclampsia
2.3 Epidemiology
2.4 Pathophysiology
2.5 History, Sign and symptoms
2.6 Diagnosis of Preeclampsia
2.7 Immediate emergency management
2.8 Management following delivery
2.9 Complications
2.10 Difference and patient education
2.11 Prevention
2.12 Empirical studies
2.13 Summary

2.2 Concept of pre-eclampsia

Preeclampsia is considered an important cause of maternal mortality and
severematernal morbidity (Sibai, 2015). For everymothers who dies, it is
estimated that around 20 othermothers sufferfrom severe morbidity and
disability. In view of the social and economic implications of this
condition, great effort has been made to expeditiously prevent, diagnose
and treat preeclampsia (Pottecher, 2019). The magnitude of the problem in
some places across the world is still not fully known, especially in low and
middle-income countries. In particular, the actual incidence of
preeclampsia remains largely unknown. There is usually suboptimal
reporting of the disease, leading to constraints on public health
applicability. Another important aspect is the identification of
pregnantmothers at risk of developing preeclampsia, especially in
nulliparous mothers with no track record of any pregnancy outcomes.
From clinical risk factors to ‘omics’ technology, there is still currently no
single good predictor of preeclampsia (Carty, 2010). Clinical factors
remain an inexpensive and rapid way to predict the occurrence of
preeclampsia. This current study intends to evaluate the incidence of
preeclampsia and its sub-phenotypes (early-onset and late-onset),
socio-demographic and clinical risk factors for preeclampsia, as well
as assess the ability to predict this disorder in a cohort of healthy
nulliparous Brazilian pregnant mothers.
The criteria that define pre-eclampsia have not changed over the past
decade. These are: onset at >20 weeks’ gestational age of 24-hour
proteinuria ≥30 mg/day or, if not available, a protein concentration ≥30
mg (≥1+ on dipstick) in a minimum of two random urine samples
collected at least 4–6 hours but no more than 7 days apart, a systolic blood
pressure >140 mmHg or diastolic blood pressure ≥90 mmHg as measured
twice, using an appropriate cuff, 4–6 hours and less than 7 days apart, and
disappearance of all these abnormalities before the end of the 6th week
postpartum (Duley, 2019). Nonetheless, some presentations of pregnancy-
related hypertension combined with clinical or laboratory abnormalities or
intrauterine growth restriction should also be considered as potential pre-
eclampsia.
2.3 Epidemiology
Pre-eclampsia is a multisystem disorder that complicates 3%–8% of
pregnancies in Western countries and constitutes a major source of
morbidity and mortality worldwide. Overall, 10%–15% of maternal deaths
are directly associated with pre-eclampsia and eclampsia (Zhang, 2018).
Some epidemiological findings support the hypothesis of a genetic and
immunological etiology. The risk of pre-eclampsia is 2-fold to 5-fold
higher in pregnant mothers with a maternal history of this disorder.
Depending on ethnicity, the incidence of pre-eclampsia ranges from 3% to
7% in healthy nulliparas and 1% to 3% in multiparas. Moreover,
nulliparity and a new partner have been shown to be important risk factors
(Barton, 2018).
Other risk factors have been identified, including a medical history of
chronic hypertension, kidney disease, diabetes, obesity, birthplace in
Africa, age ≥35 years, and pregnancy characteristics, such as twin or
molar pregnancy, previous pre-eclampsia, or fetal congenital abnormality.
High altitude has also been shown to increase the incidence of pre-
eclampsia, and is attributed to greater placental hypoxia, smaller uterine
artery diameter, and lower uterine artery blood flow (Rijhsinghani, 2017).
Pre-eclampsia may be life-threatening for both mother and child,
increasing both fetal and maternal morbidity and mortality. In the mother,
pre-eclampsia may cause premature cardiovascular disease, such as
chronic hypertension, ischemic heart disease, and stroke, later in life,
while children born after pre-eclamptic pregnancies and who are relatively
small at birth, have an increased risk of stroke, coronary heart disease, and
metabolic syndrome in adult life. The sole curative treatment being
delivery, management must continuously balance the risk–benefit ratio of
induced preterm delivery and maternal–fetal complications. Screening
mothers at high risk and preventing recurrences are also key issues in the
management of pre- eclampsia (Julian, 2011).
2.4 Pathophysiology
During normal pregnancy, the villous cytotrophoblast invades into the
inner third of the myometrium, and spiral arteries lose their endothelium
and most of their muscle fibers (Meads, 2018). These structural
modifications are associated with functional alterations, such that spiral
arteries become low-resistance vessels, and thus less sensitive, or even
insensitive, to vasoconstrictive substances.
Pre-eclampsia has a complex Pathophysiology, the primary cause being
abnormal placentation. Defective invasion of the spiral arteries by
cytotrophoblast cells is observed during pre-eclampsia. Recent studies
have shown that cytotrophoblast invasion of the uterus is actually a unique
differentiation pathway in which the fetal cells adopt certain attributes of
the maternal endothelium they normally replace (Osmond, 2017). In pre-
eclampsia, this differentiation process goes awry. The abnormalities may
be related to the nitric oxide pathway, which contributes substantially to
the control of vascular tone. Moreover, inhibition of maternal synthesis of
nitric oxide prevents embryo implantation. Increased uterine arterial
resistance induces higher sensitivity to vasoconstriction and thus chronic
placental ischemia and oxidative stress. This chronic placental ischemia
causes fetal complications, including intrauterine growth retardation and
intrauterine death. In parallel, oxidative stress induces release into the
maternal circulation of substances such as free radicals, oxidized lipids,
cytokines, and serum soluble vascular endothelial growth factor. These
abnormalities are responsible for endothelial dysfunction with vascular
hyper permeability, thrombophilia, and hypertension, so as to compensate
for the decreased flow in the uterine arteries due to peripheral
vasoconstriction (Ericsson, 2017).
Endothelial dysfunction is responsible for the clinical signs observed in
the mother, ie, impairment of the hepatic endothelium contributing to
onset of the HELLP (Hemolysis, Elevated Liver enzymes and Low
Platelet count) syndrome, impairment of the cerebral endothelium
inducing refractory neurological disorders, or even eclampsia. Depletion
of vascular endothelial growth factor in the podocytes makes the
endotheliosis more able to block the slit diaphragms in the basement
membrane, adding to decreased glomerular filtration and causing
proteinuria (Barker, 2018). Finally, endothelial dysfunction promotes
microangiopathic hemolytic anemia, and vascular hyper permeability
associated with low serum albumin causes edema, particularly in the lower
limbs or lungs.
The crucial issue to understand is that the prime mover of pre-eclampsia is
abnormal placentation. Two common theories appear to be interlinked, ie,
a genetic theory and an immunological theory. Several susceptibility genes
may exist for pre-eclampsia. These genes probably interact in the
hemostatic and cardiovascular systems, as well as in the inflammatory
response. Some have been identified, and in candidate gene studies they
have provided evidence of linkage to several genes, including
angiotensinogen.
Pre-eclampsia can be perceived as an impairment of the maternal immune
system that prevents it from recognizing the fetoplacental unit (Fisher,
2019). Excessive production of immune cells causes secretion of tumor
necrosis factor alpha which induces apoptosis of the
extravillouscytotrophoblast. The human leukocyte antigen (HLA) system
also appears to play a role in the defective invasion of the spiral arteries, in
that women with pre- eclampsia show reduced levels of HLA-G and HLA-
E. During normal pregnancies, the interaction between these cells and the
trophoblast is due to secretion of vascular endothelial growth factor and
placental growth (Duran, 2016).
factor by natural killer cells. High levels of soluble foams-like tyrosine
kinase 1 (sFlt-1), an antagonist of vascular endothelial growth factor and
placental growth factor, have been found in women with pre-eclampsia
(Roberts, 2015). Accordingly, assays of sFlt-1, placental growth factor,
endoglin, and vascular endothelial growth factor, all of which increase 4–8
weeks before onset of the disease, may be useful predictors of pre-
eclampsia. Recent data show the protective role of hemeoxygenase 1 and
its metabolite, carbon monoxide, in pregnancy, and identify this as a
potential target in the treatment of pre-eclampsia.
2.5 History, Sign and symptoms
Although preeclampsia typically presents with hallmark history and
physical signs and symptoms, several atypical presentations exist. This
section will review the most common presentations of preeclampsia and
those that should prompt further investigation and diagnostic testing when
present (Sibai, 2015).
The most common history findings in patients with preeclampsia are
patient complaints of a new-onset headache not accountable by any other
alternative diagnosis (i.e., history of headaches or migraines) that is
unresponsive to medication. This complaint may or may not be
accompanied by additional complaints of visual disturbance. Patients may
also endorse right upper quadrant or epigastric pain, with associated
nausea or vomiting. Shortness of breath and a perceived increase in
swelling, both worsening from baseline pregnancy-related symptoms, may
also be reported (Pottecher, 2019).
Patients who present with any single feature or combination of these
history findings should undergo a thorough physical exam. This begins
with an evaluation of vital signs, more specifically, blood pressure.
Patients with a systolic blood pressure of 140 mmHg or greater, or a
diastolic pressure of 90 mmHg or greater, should increase suspicion for
preeclampsia. In patients at greater than 20 weeks gestation, blood
pressure readings on two measurements at least 4 hours apart should be
evaluated with further diagnostic workup. Recent reevaluation of
diagnostic blood pressure readings had expanded to include sustained
severe hypertensive readings within minutes of repeat readings to allow
for timely intervention with antihypertensive therapy (Duley, 2019).
These blood pressure readings include systolic pressure of 160 mmHg or
greater or diastolic of 110 mmHg or more. As per the American College of
Obstetrics and Gynecology (ACOG), patients previously diagnosed with
gestational hypertension presenting with these severe range blood
pressures should be diagnosed with preeclampsia with severe features,
regardless of the presence of other diagnostic criteria. Suppose patients
present with shortness of breath, auscultation, and percussion of lungs
should be undertaken to examine for pulmonary disturbances. Palpation of
the right upper quadrant and epigastric areas should also be done to
evaluate for tenderness. Overall evaluation for edema should also be
completed, specifically evaluating areas of dependent (gravity-related)
edema like the lower extremities or independent edema, such as in the face
or hands (Zhang, 2018).
2.6 Diagnosis of Preeclampsia
Following a detailed history and physical exam, patients who present with
signs and symptoms of preeclampsia should undergo timely diagnostic
testing. This includes pregnancy-induced hypertension laboratory testing,
consisting of a urinalysis to evaluate the presence of proteinuria (either
with a urine dipstick result of 2+ or greater if other methods are not readily
available, a 24-hour urine collection sample significant for 300mg or
greater, or a urine protein to creatinine ratio significant for 0.3 or greater),
complete blood count to evaluation for thrombocytopenia (defined as a
platelet count of less than 100 K/ mm), a complete metabolic panel to
assess for impaired liver function (with liver enzymes greater than two
times the upper limit of normal), and renal insufficiency (defined as a
serum concentration of 1.1 mg/dLor greater, or levels two times greater
than baseline). All abnormal laboratory findings must exclude any
preexisting aberrations or secondary causes for abnormalities in order to
be significant for diagnosis. Although elevated blood pressure with
companying proteinuria is typically thought to be required for the
diagnosis of preeclampsia (Barton, 2018),
It may not be present in several cases. In such cases, where the absence of
proteinuria and new-onset hypertension is discovered, other new-onset
symptoms such as thrombocytopenia, renal insufficiency, pulmonary
edema, impaired liver function, or new-onset headache with or without
visual disturbance may be used for diagnosis. This typically is referred to
as preeclampsia without severe features, including new-onset severe range
blood pressures (systolic pressure of 160 mmHg or greater, diastolic
pressure of 110 mmHg or greater on two readings at least 4 hours apart),
with or without the findings previously mentioned (Abalos, 2018).
2.7 Immediate emergency management
Delivery is the only curative treatment for pre-eclampsia (Mutze, 2018).
Management is multidisciplinary, involving an obstetrician, an anesthetist,
and a pediatrician. In some cases consultation of maternal fetal medicine
and hypertension or nephrology subspecialists may be required.
Management decisions must balance the maternal risks of continued
pregnancy against the fetal risks associated with induced preterm delivery.
The criteria for delivery are based on two often interrelated factors, ie,
gestational age at diagnosis (estimated fetal weight) and severity of pre-
eclampsia (Genbacell, 2017).
Severe pre-eclampsia requires treatment with a dual aim, ie, preventing the
harmful effects of elevated maternal blood pressure and preventing
eclampsia. Management of severe pre-eclampsia begins with transfer of
the mother in a fully equipped ambulance or helicopter to a maternity
ward providing an appropriate level of care for both mother and child
(Colbern, 2018). At admission and daily thereafter, clinical,
cardiotocographic, laboratory, and ultrasound testing are required to detect
the severity of pre-eclampsia and tailor management accordingly.
Regardless of the severity of pre-eclampsia, there is no advantage in
continuing the pregnancy when pre-eclampsia is discovered after 36–37
weeks. Nor is expectant management justified for severe pre-eclampsia
before 24 weeks, in view of the high risk of maternal complications and
the poor neonatal prognosis. The obstetric team must then discuss with the
parents the possibility of a medical interruption of pregnancy.
Prolongation of pregnancy in the event of mild pre-eclampsia can be
discussed and re- evaluated on a regular basis. At 34 –37 weeks,
management depends on the severity of the pre-eclampsia (Nilsson, 2014).
Expectant management is possible for mild pre-eclampsia to limit the risk
of induced preterm delivery, but for severe pre-eclampsia, delivery
remains the rule due to the increased risk of maternal and fetal
complications (Ahmed, 2018).
Similarly, at 24–34 weeks, management depends on the severity of pre-
eclampsia. The presence of one or more of the following signs indicates
the need for immediate delivery: uncontrolled severe hypertension (not
responsive to dual therapy), eclampsia, acute pulmonary edema, abruption
placentae, sub capsular hepatic hematoma, or thrombocytopenia
<50,000/mm. Delivery after corticosteroid therapy for pulmonary
maturation is necessary if any of the following criteria is present:
persistent epigastria pain, signs of imminent eclampsia (headaches or
persistent visual disorders), de novo creatinine>120 µmol/L, oliguria
below 20 mL/hour, progressive HELLP syndrome, prolonged or severe
variable decelerations with short-term variability less than 3 milliseconds.
When emergency delivery is not required, labor can be induced by
cervical ripening (Haddad, 2017).
Antihypertensive treatment is useful only in severe pre-eclampsia because
the sole proven benefit of such management is to diminish the risk of
maternal complications (cerebral hemorrhage, eclampsia, or acute
pulmonary edema). There is no international consensus concerning
antihypertensive treatment in pre- eclampsia. The four drugs authorized
for the treatment of hypertension in severe pre- eclampsia in France are
nicardipine, labetalol, clonidine, and dihydralazine. There is no ideal target
blood pressure value, and too aggressive a reduction in blood pressure is
harmful to the fetus. Therapy with a single agent is advised as first-line
treatment, followed by combination treatment when appropriate.
Pulmonary maturation using corticosteroids must be considered, taking
gestational age into account. Betamethasone remains the gold standard at a
dosage of two injections of 12 mg 24 hours apart; this treatment reduces
the risk of hyaline membrane disease, intraventricular hemorrhage, and
neonatal mortality (Koopmans, 2019).
Magnesium sulfate (MgSO4) may be part of the therapeutic
armamentarium for severe pre- eclampsia. It is indicated in the treatment
of eclamptic convulsions as well as for secondary prevention of eclampsia,
thus replacing treatment by diazepam, phenytoin, or the combination of
chlorpromazine, promethazine, and pethidine. The efficacy of MgSO4 in
the reduction of maternal and neonatal complications of eclampsia is well
established. It is administered intravenously, first at a loading dose of 4 g
over 15–20 minutes, which can be repeated at a half dose (2 g) if
convulsion recurs, and then at a maintenance dose of 1 g/hour for 24
hours. MgSO4 treatment must be monitored in the intensive care unit
because organ failure may occur.
This monitoring is based on repeated checking for a Glasgow score of 15,
tendon reflexes, respiratory frequency >12 per minute, and diuresis >30
mL/hour. Any manifestation of overdose requires stopping the infusion,
considering injection of calcium gluconate, and measuring blood
magnesium levels. Eclampsia is generally considered an indication for
emergency cesarean section. Nonetheless, a decision to delay a cesarean,
albeit rare, may be based on fetal status and justified if the mother’s
condition is stable and reassuring after treatment (Jenkins, 2012).
2.8 Management following delivery
Although delivery is the only effective treatment for pre-eclampsia, and
despite the fact that clinical symptoms and laboratory abnormalities
usually regress in the hours afterwards, the risk of complications persists
for some time following delivery (Budden, 2016). Pre-eclampsia is
associated with long-term morbidity and mortality. Approximately 20% of
women with pre-eclampsia develop hypertension or microalbuminuria
during long- term follow-up, and the risk of subsequent cardiovascular and
cerebrovascular disease is doubled in women with pre-eclampsia and
gestational hypertension compared with age-matched controls.
A recent prospective epidemiological study with a median follow-up
duration of 30 years provides evidence that pre-eclampsia is a marker of
increased mortality from cardiovascular disease.
Hemodynamic, neurological, and laboratory monitoring is necessary
following delivery for patients with severe preeclampsia. Hemodynamic
monitoring includes frequent blood pressure measurements to enable
adjustment of antihypertensive treatment and frequent monitoring of
diuresis and weight according to intake (oliguria should prompt
progressive fluid resuscitation and sometimes diuretic use). Neurological
monitoring consists of checking for signs of imminent eclampsia,
including headaches, phosphene signals, tinnitus, and brisk tendon
reflexes. Clinical monitoring must be done several times daily during the
week after delivery, a period considered at high risk for complications. If
necessary, monitoring can be performed in an intensive care unit.
Laboratory monitoring should be done several times daily in the first 72
hours after delivery and thereafter adapted according to progress of the
indices. It must include a complete blood count, liver function tests, and
measurement of lactate dehydrogenase. Discharge from hospital cannot be
considered until all clinical and laboratory indices have returned to
normal, and regular monitoring by the patients general practitioner as
necessary if treatment for hypertension is to be continued after discharge.
The risk of recurrence of pre-eclampsia during a subsequent pregnancy
has to be considered. This risk is estimated to be less than 10% for all
cases of pre-eclampsia, but is greater when pre-eclampsia is discovered
before 28 weeks. The relative risk is 15 if pre-eclampsia occurs at 20–33
weeks, 10 at 33–36 weeks, and 8 after 37 weeks (Olsen, 2017).C
Three months after delivery, screening for underlying renal or
hypertensive disease may be requested by the patient’s primary physician
(Amorin, 2019). Such screening is intended to check for normalization of
blood pressure values and disappearance of proteinuria, and if
abnormalities persist, a referral should be made to a nephrologist or a
hypertension expert to determine the cause. This examination is important
because pre- eclampsia may unmask previously undiagnosed systemic or
kidney disease or thrombophilia. It should include a specific set of
questions, blood pressure measurement, a clinical examination looking for
signs of autoimmune conditions, and a urinary dipstick test. Testing for
antiphospholipid antibodies is recommended after severe pre-eclampsia.
The search for hereditary thrombophilia by assays for protein C and S,
antithrombin III, and a test for resistance to activated protein C is
recommended in the case of a personal or family history of venous
thromboembolic disease, early pre-eclampsia, or pre-eclampsia with any
intrauterine growth retardation, abruptio placentae, or in utero death.
Percutaneous needle biopsy of the kidney should be performed only if
kidney failure persists at three months postpartum or if signs of a systemic
underlying condition or proteinuria persist at 6 months. Patients who have
had severe pre-eclampsia may share predispositions with nonpregnant
patients who have cardiovascular risk factors. Accordingly, long-term
monitoring of cardiovascular, renal, and metabolic risk factors is
recommended after severe pre- eclampsia (Pryde, 2019).
2.9 Complications
Delayed delivery of the fetus in preeclamptic patients in the late preterm
period increases the risk of severe hypertension, with severe consequences
such as eclampsia, HELLP syndrome, pulmonary edema, myocardial
infarction, acute respiratory distress syndrome, stroke, renal and retinal
injury, and fetal complications including fetal growth restrictions,
placental abruption, or fetal or maternal death (Smith, 2016).
Common complications exist with the initiation of medical management
for adequate blood pressure control. These include tachycardia,
hypotension, headaches, fetal heart tracing abnormalities using labetalol,
hydralazine, or nifedipine. The use of magnesium sulfate for seizure
prophylaxis also carries additional side effects and complication risks such
as respiratory depression and cardiac arrest. Thus, frequent laboratory
testing of serum magnesium levels and physical examinations every 4 to 6
hours for magnesium sulfate therapy patients is recommended (Funai,
2015).
2.10 Deterrence and Patient Education
Early diagnosis, timely medical management, and adequate surveillance
and monitoring are imperative to decreasing both maternal and fetal
morbidity and mortality associated with preeclampsia (Tan, 2017). An
essential part of providing adequate patient care is patient education and
identifying patient-specific barriers to receiving care. This begins with
proper counseling of patients by healthcare providers regarding the
definition of preeclampsia, associated “red-flag” signs and symptoms, and
patient-specific factors that place the patient at high risk (Mostello, 2017).
Maternal mortality associated with preeclampsia is significantly higher
among low-socioeconomic and lower education populations. It is the
healthcare provider's onus to understand the community to which they
serve, to establish a strong rapport with patients at greatest risk of
developing preeclampsia, and to identify several methods of delivering
complex medical education and associated complications from non-
adherence to suit the level of understanding for each patient (Irgens,
2011).
2.11 Prevention
Primary prevention of pre-eclampsia is based on the detection of
modifiable risk factors. The literature is plentiful regarding the risk factors
for pre-eclampsia, but should be interpreted with caution (Conde-Agudelo,
2014). Mothers at high risk are those with a personal history of severe pre-
eclampsia, while those at low risk are defined as those who have never had
pre-eclampsia but have at least one risk factor. There are numerous risk
factors, including genetic risk factors, family history of pre- eclampsia,
immunologic factors, nulliparity, a new partner, and demographic factors
such as a maternal age >35 years, the mother’s own gestational age and
birth weight (with elevated risks for mothers born before 34 weeks or
weighing less than 2500 g at birth), factors related to the pregnancy, such
as multiple pregnancy, congenital or chromosomal anomalies, a
hydatidiform mole, or urinary infection, risk factors associated with
maternal disease, including chronic hypertension, kidney disease, obesity,
insulin resistance, and diabetes, as well as thrombophilia, and
environmental factors such as living at a high altitude and stress. Although
the search for these risk factors is important, they may not effectively
predict this pre-eclampsia by themselves. However, accurate prediction of
pre-eclampsia would enable early and optimal management of mothers at
high risk. Several predictive tests are being assessed currently (Mostello,
2017). These include clinical tests, such as blood pressure measurement
during the second trimester or 24-hour ambulatory blood pressure
monitoring, but these lack sensitivity and specificity.
Laboratory tests for oxidative response have been assessed, including
assays for uric acid, urinary kallikrein, and fibronectin, but no evidence of
their relevance has so far been found (Franko, 2017). Among the markers
used to screen for trisomy 21 during the second trimester (beta human
chorionic gonadotropin, alpha fetoprotein, and unconjugated estriol),
elevated alpha fetoprotein is associated with a higher risk of pre-eclampsia
(unless there are neural tube abnormalities, as when beta human chorionic
gonadotropin is elevated). Frequent monitoring of mothers with elevated
levels could be useful, but these tests may not be carried out for screening
purposes due to their low negative predictive value. Serum markers for
trisomy 21 in the first trimester (pregnancy- associated plasma protein A,
inhibin A, corticotropinreleasing hormone, and activin) have been tested,
but their likelihood ratios seem to be insufficient. Imaging tests have been
evaluated, including uterine artery Doppler ultra-sound.
Uterine artery Doppler ultrasound is not advised during the first or second
trimester in low-risk populations due to the excessive variability of
likelihood ratios in this population, which allows for the prediction of only
one-third of pre-eclampsia cases. In a high-risk population, the definition
of which is often imprecise, uterine artery Doppler can be performed
during the second trimester morphologic ultrasound examination and
checked 1 month later in case of abnormal results (resistance index >0.58
or 90–95th percentile, unilateral or bilateral notch). The combination of a
uterine artery Doppler examination during the first trimester and a three-
dimensional ultrasound assessing placental volume may predict the risk of
pre-eclampsia as early as the first trimester.
In clinical practice, because no single marker effectively predicts the risk
of pre-eclampsia, the current trend is to test a combination of markers. The
most commonly used combination of markers assesses sFlt-1, placental
growth factor, endoglin, and vascular endothelial growth factor during the
first or second trimester. Increased vascular endothelial growth factor and
endoglin levels, combined with increased sFlt-1 and decreased placental
growth factor during the first trimester, is associated with a significantly
increased risk of pre-eclampsia. Improved prediction of pre-eclampsia has
been noticed when serum markers are combined with Doppler indices. In a
recent nested case- control study, second trimester maternal serum cystatin
C, C-reactive protein, and uterine artery mean resistance index were
observed to be independent predictors of pre-eclampsia.
Secondary prevention is based on antiplatelet aspirin therapy, which
reduces the risk of pre- eclampsia by 10% in mothers who have at least
one risk factor (WHO, 2016). No study currently allows determination of
the exact dosage or the best time for initiation of aspirin. However, aspirin
should be initiated as early as possible, ie, before 12–14 weeks, which
corresponds to the beginning of the first phase of trophoblast invasion.
The efficacy of aspirin has been shown only in mothers with previous pre-
eclampsia associated with intrauterine growth retardation and without
thrombophilia. Low molecular weight heparin is indicated only in cases of
complicated thrombophilia (history of thromboembolic complications or
of pre- eclampsia). Calcium supplementation at a dosage of 1.5 g/day,
beginning at 15 weeks and continued throughout the pregnancy, is
recommended for prevention of pre- eclampsia in mothers with a daily
calcium intake <600 mg/ day. The statins, which stimulate HO-1
expression and inhibit sFlt-1 release, could have the potential to
ameliorate early-onset pre-eclampsia. Other treatments, such as
antioxidant treatment by vitamins C and E, oligoelements, and nitric oxide
have no proven efficacy.

2.12 Empirical Studies

Jussara, (2019)incidence and risk factors for Preeclampsia in a cohort of
healthy nulliparous pregnant mothers: a nested case-control study the
incidence, socio-demographic and clinical risk factors for preeclampsia
and associated maternal and perinatal adverse outcomes. This is a nested
case-control derived from the multicenter cohort study Preterm SAMBA,
in five different Centre’s in Brazil, with nulliparous healthy pregnant
women. Clinical data were prospectively collected, and risk factors were
assessed comparatively between PE cases and controls using risk ratio
(RR) (95% CI) plus multivariate analysis. Complete data were available
for 1,165 participants. The incidence of preeclampsia was 7.5%. Body
mass index determined at the first medical visit and diastolic blood
pressure over 75 mmHg at 20 weeks of gestation were independently
associated with the occurrence of preeclampsia. Mothers with
preeclampsia sustained a higher incidence of adverse maternal outcomes,
including C-section (3.5 fold), preterm birth below 34 weeks of gestation
(3.9 fold) and hospital stay longer than 5 days (5.8 fold) than controls.
They also had worse perinatal outcomes, including lower birth weight (a
mean 379 g lower), small for gestational age babies (RR 2.45 [1.52-3.95]),
5-minute Apgar score less than 7 (RR 2.11 [1.03-4.29]), NICU admission
(RR 3.34 [1.61-6.9]) and Neonatal Near Miss (3.65 [1.78-7.49]). Weight
gain rate per week, obesity and diastolic blood pressure equal to or higher
than 75 mmHg at 20 weeks of gestation were shown to be associated with
preeclampsia. Preeclampsia also led to a higher number of C-sections and
prolonged hospital admission, in addition to worse neonatal outcomes.
Sean, (2016)Early-onset preeclampsia appears to discourage subsequent
pregnancy but the risks may be overestimated. The study highlighted that
Early-onset preeclampsia is associated with adverse maternal and perinatal
outcomes. For mothers who consider another pregnancy after one
complicated by early-onset preeclampsia, the likelihood of recurrence and
the subsequent pregnancy outcome for themselves and their babies are
pertinent considerations. The purpose of the study was to determine the
subsequent pregnancy rate after a nulliparous pregnancy that was
complicated by early-onset preeclampsia and among those who have a
subsequent pregnancy, the risk of recurrence by gestational week, and
adverse pregnancy outcomes. This was a population-based record linkage
cohort study. The study population included nulliparous mothers with a
singleton pregnancy and early-onset preeclampsia (<34 weeks gestation)
who gave birth in New South Wales Australia from 2001-2010 (the index
birth), with follow-up data for a subsequent birth through 2012. Early-
onset in the index birth was further categorized as <28 vs 28-33 weeks
gestation. Subsequent pregnancy outcomes that were assessed included the
pregnancy rate, preeclampsia recurrence, and maternal and perinatal
morbidity and mortality rates. The risk of preeclampsia necessitating
delivery at each gestational week for mothers who were at risk was
plotted, and the net gain or loss of gestational age when comparing the
index with the subsequent pregnancy was calculated. Among 361,031
nulliparous mothers with singleton pregnancies, 1473 (0.4%) had early-
onset preeclampsia. Mothers with early-onset preeclampsia in their first
pregnancy had a lower subsequent pregnancy rate (59.7%) than mothers
without preeclampsia (67.7%). Of the 758 women with a subsequent
singleton birth, 256 (33.8%) experienced preeclampsia in the next
pregnancy; 57 mothers (7.5%) with recurrent early-onset preeclampsia
were included. Cumulative rates of preeclampsia in the subsequent
pregnancy were higher at every gestation from 23 weeks gestation when
the index birth was <28 weeks compared with 28-33 weeks gestation. The
cumulative rate and gestation-specific risk of recurrent preeclampsia rose
most steeply at 32-38 weeks gestation. Most mothers (94.6%) progressed
to a later gestational age in their subsequent pregnancy. The median
overall increase in gestational age at delivery was 6 weeks (interquartile
range, 4-8); among women with recurrent preeclampsia, the median
increase was 5 weeks (interquartile range, 2-7). Mothers with index birth
<28 weeks gestation compared with 28-33 weeks gestation were more
likely to deliver preterm (38.8% vs 28.7%; relative risk, 1.35; 95%
confidence interval, 1.04-1.75) and have a perinatal death (4.3% vs 1.2%;
relative risk, 3.46; 95% confidence interval, 1.15-10.39) at the subsequent
birth, but live born infants had similar rates of severe morbidity (17.1% vs
15.0%; relative risk, 1.14; 95% confidence interval, 0.73-1.79). mothers
with early-onset preeclampsia in a first pregnancy appear less likely than
mothers without preeclampsia to have a subsequent pregnancy. Maternal
and perinatal outcomes in the subsequent pregnancy are generally better
than in the first; most women will not have recurrent preeclampsia, and
those who do usually will give birth at a greater gestational age compared
with their index birth.
2.13 Summary
The literature reviewed that Preeclampsia is a hypertensive disorder in
pregnancy-related to 2% to 8% of pregnancy-related complications
worldwide. It results in 9% to 26% of maternal deaths in low-income
countries and 16% in high-income countries. Preeclampsia is defined as
New-onset hypertension. The parameters for initial identification of
preeclampsia are specifically defined as a systolic blood pressure of 140
mm Hg or more or diastolic blood pressure of 90 mm Hg or more on two
occasions at least 4 hours apart; or shorter interval timing of systolic blood
pressure of 160 mm Hg or more or diastolic blood pressure of 110 mm Hg
or more, all of which must be identified after 20 weeks of gestation. The
literature also reviewed that the initial presentation of preeclampsia
typically arises in near-term pregnancies. Other significant findings that
may or may not be a part of the clinical presentation include proteinuria,
signs of end-organ damage, such as thrombocytopenia, impaired liver
function, severe persistent right upper quadrant or epigastric pain,
excluding all other alternative diagnoses, new-onset headache
unresponsive to all forms of management, pulmonary edema, or renal
insufficiency with abnormal lab values. Further distinguishing
subcategories of preeclampsia include classification into mild or severe,
which are deemed so based upon presentation and clinical criteria, to be
described further.

CHAPTER THREE
RESEARCH METHODOLOGY
3.1 Preamble
This chapter deals with the research methods to be adopted in conducting
the study. They are organized under the following sub-headings:
3.2 Research Design
3.3 population of the Study
3.4 Sample and Sampling techniques
3.5 Instrument for Data Collection
3.6 Validity of the Instrument
3.7 Reliability of the Instrument
3.8 Method of Data Collection
3.9 Method of data Analysis

3.2 Research Design

This study employs a descriptive research design to determine the is to
determine the Awareness on the Causes and prevention of preeclampsia
among pregnant mothers attending Antenatal care in general hospital
Aunamagama local government area of Niger State. Saunders and Miller
(2019) opined that descriptive research portrays an accurate profile of
persons, events, or situations. This design offers to the researchers a
profile of described relevant aspects of the phenomena of interest from an
individual, organizational, and industry-oriented perspective. Therefore,
this research design will enable the researcher to gather data from a wide
range from the respondents.
3.3 population of the Study
According to Uma (2007), population is referred to as the totality of items
or object which the researcher is interested in. It can also be total number
of people of an area of study. Hence, the population of this study
comprised of all the pregnant mothers attending Antenatal care in general
hospital Aunamagama local government area of Niger State, which is
made up entire population of the Study totaling 1231 based on the data
from thegeneral hospital.
3.4 Sample and Sampling techniques
Sample is a manageable section of a population but elements of which
have common characteristics. Also, it’s refers to any portion of a
population selected for the study and on whom information needed for the
study is obtained (Awoniyi, Aderant&Tayo, 2011; Akinade&Owolabi,
2009; Adedokum, 2003). However, Akinade and Owolabi (2009) views
that sampling is the selection of subject (statistical sample) and of
individual within a statistical population to estimate characteristics of all
population.
However, simple random sampling will be use to develop the sample of
the research under study. According to this method which belongs to the
category of probability sampling techniques, sample members will be
selected on the basis of their knowledge and their free will, regarding the
research subject (Freedman et al. 2007). And a total of one hundred 100
pregnant mothers will be developed for the study.

3.5 Instrument for Data Collection

Des Morries University (2019) states that research instruments are
measurement tools (for example, questionnaire or scales) design to obtain
data on a topic of interest from the research subjects. The instrument to be
adopt in collecting data for this study is structured questionnaire. A
questionnaire is defined as a research instrument that consist a set of
questions or other types of prompts that aims to collect information from a
respondents. The questionnaire is to have some response on the Awareness
on the Causes, Effects and prevention of preeclampsia among pregnant
women attending Antenatal care in general hospital Aunamgama local
government area of Niger State, and will be developed base on the
objectives of this research. The questionnaire consist of two section
"A","B"section"A" deals with personal information of the respondents,
while section "B" sought information on the variable under study. The
close ended type of questionnaire of four point modified likert scale
format of SA- strongly agree, A - Agree, D- Disagree, SD - Strongly
Disagree will be use.
3.6 Validity of the Instrument
This is said to be the judgment regarding the degree to which the
components of the research reflect theory, concept, or variable under study
(Streiner and Norman, 1996). The instrument will be given to the
supervisor and some experts in the department as regards the content
measured, in the Department of Health Education and promotion for
validation.
3.7 Reliability of the Instrument
Laoye (2005) noted that reliability is the extent to which repeat
administration of an item of a measuring instrument provides the same
results. Reliability reflects consistency and reliability overtime.
Furthermore, reliability is seen as the degree to which a test is free from
measurement errors since the more measurement errors occurs the less
reliable the test (Schumacher & Newman, 2006). The test-retest reliability
method is one of the simplest ways of testing the stability and reliability of
an instrument over time. Test-retest approach will be adopted by the
researcher in establishing the reliability of the instrument. In doing this 10
copies of the questionnaire will be administered on thirty pregnant
mothers. After two weeks another 10 copies of the same questionnaire will
be re-administered on the same groupAfter two weeks another 10 copies
of the same questionnaire will be re-administered on the same group.
Their responses on the three occasions will be correlated using Pearsons
Product Moment Correlation. A co-efficient of 0.81 will be high enough to
consider the instrument reliable.
3.8 Method of Data Collection
The researcher will collect data using the questionnaire. Copies of the
questionnaire will be administered by the researcher on the respondents.
All the respondents will be expected to give maximum co-operation, as the
information on the questionnaire are all on things that revolve around their
study. Hence, enough time will be taken to explain how to tick or indicate
their opinion on the items stated on the research questionnaire.

3.9 Method of data Analysis

In order to test and justify the research questions formulated, descriptive
statistics of frequency count and simple percentage analysis will be use.
 CHAPTER FOUR
DATA PRESENTATION, ANALYSIS AND DISCUSSION OF
FINDINGS
4.1 Preamble
This chapter deals with the presentation and analysis of data collected
from the findings of this study. The information was obtained from
pregnant mothers attending Antenatal care in general hospital
Aunamagama local government area of Niger State. This will be presented
using descriptive statistic of frequency count and percentage.
4.2 data presentation and analysis
Table 1: Bio-Data of the respondents
S/N Respondents Bio-data Respons Percentage
es
1 Age of respondents
15 - 25 years 19 19%
26 - 30 years 23 23%
31 - 35 years 32 32%
36 years and above 26 26%
Total 100 100%
2 Marital status of the respondents
Civil servant 46 46%
Business 38 38%
Others 16 16%
Total 100 100%
Source: Researcher's field work 2022
From the above table, it shows that 19% of the respondents are between
the 15-25years of age, 23% are 26-30%, 32% are 31-35% while 26% of
the area between the age of 36-and above. 46% of the respondents are civil
servants, 38% are business while 16% of the respondents are others
respectively.
Table 2: Level of awareness on the causes of pre-eclampsia among
pregnant mothers attending Antenatal care
S/N ITEMS SA A SD D MEAN REMAR
K
1. Hand drugs use during 30 25 10 30 2.5 Disagree
pregnancy can cause the
incidence of still birth among
pregnant mothers
2. Life style such as too much of 39 20 10 11 3.0 Agree
sugar intake increases the
chance of having still birth
among pregnant mothers
3. Placental obstruction during 29 20 20 10 2.9 Agree
pregnancy can affect the baby’s
health there by causing still
birth.
4. Pregnant mothers who uses 35 25 11 9 2.9 Agree
substance from local herbs
during pregnancy can increase
the risk of still birth
5. Inadequate nutritional intake 25 35 9 11 2.9 Agree
can cause still birth pregnant
mothers
Grand mean: 2.86
The above given table written five items 1,2,3,4 and 5 and also
representing the mean score 2.5, 3.0, 2.9, 3.0, and 2.9 respectively.thenthe
items has agreed with the causes of pre-eclampsia among pregnant
mothers which is indicating that pregnant mothers attending antenatal care
in general hospital Auna have the awareness on the causes of pre-
eclampsia

Table 3: knowledge on the prevention of pre-eclampsia among

pregnant mothers attending Antenatal care.
S/N ITEMS SA A SD D MEAN REMAR
K
6 Pre-eclampsia could leads to 30 30 11 9 3.0 Agree
aseperation of the placental
from the uterus (placental
abruption)
7 Pre-eclampsia can lead to 33 23 17 10 2.9 Agree
pregnancy less or still birth
8 Pre-eclampsia can lead to organ 41 27 18 15 2.9 Agree
failure or stroke
9 Pregnant mothers who uses 29 21 19 11 2.8 Agree
substance from local herbs
during pregnancy can increase
 the risk of still birth
10 Lack of good adequate 39 24 20 9 3.0 Agree
nutritional intake can cause still
birth among pregnant mothers
Grand mean 2.36
The above given table wriiten five (5) items 6, 7, 8, 9 and 10 also
representing the mean score 3.0, 2.9, 2.9, 2.8, and 3.0 respectively. Then,
the items has agreed with the effect of pre-eclampsia.
The grand mean is 2.36 representing the effect of pre-eclampsia in the
study area which signifies tht pregnant mothers attending antenatal care in
general hospital Auna have the knowledge on the effect of pre-eclampsia.
table3. level of awareness on the prevention among pregnant mothers
attending antenatal care
S/N ITEMS SA A SD D MEAN REMAR
K
11 Regular antenatl visit can help 40 30 10 10 3.1 Agreed
reduce the risk of having still
among pregnant mothers
12 Adequate dietary intake can 35 31 15 11 2.9 Agreed
promote the optimal health of
mother and the child thereby
reducing the risk of still birth
13 Treatment of minor diseases can 30 20 15 10 2.6 Agreed
help prevent the incidence of
still birth among pregnant
mothers
14 Mothers who keep doing 40 25 10 4 3.6 Agreed
exercise regularly are most
likely to deliver a healthy baby
and not still birth
15 Adequate sleep and resting are 39 20 6 5 3.3 Agreed
the major strategy for the
prevention of still birth among
pregnant mothers
Grand mean: 2.58
The above given table written five (5) items 11, 12, 13, 14, and 15 also
representing the mean score 3.1, 2.9, 2.6, 3.6, and 3.3 respectively.
Then the items has agreed with the preventive measures ofpre-eclampsia
in genralhospital Auna the grand mean is 2.58 representing the preventive
measures of pre-eclampsia.

CHAPTER FIVE
SUMMARY, CONCLUSIONS AND RECOMMENDATION
5.1 Preamble
This chapter deals with the summary, conclusions and recommendations
of the study;

5.2 Summary
The purpose of this research work was to determine the Awareness on the
Causes and prevention of preeclampsia among pregnant mothers attending
Antenatal care in general hospital Aunamagama local government area of
Niger State. The areas examined involves, level of awareness on the
causes of pre-eclampsia among pregnant mothers attending Antenatal care
in general hospital Aunamagama local government area of Niger State,
level of knowledge on the prevention of pre-eclampsia among pregnant
mothers attending Antenatal care in general hospital Aunamagama local
government area of Niger State. A descriptive research of survey method
was use and researcher self-structure questionaire consisted of two
sections (A&B) using a modified six points likert scale to gather
information for the research work on the identified variables was adopted.
The results were analysed using frequency table and percentage count to
bring out this agreement or disagreement of the respondents on the
presented statements.
5.3 Restatement of the study
Pre-eclampsia remains one of the leading causes of maternal mortality and
morbidity, complicating and estimated 2-8% of pregnancies worldwide
and upto 10% in developing countries. It is one of the top five leading
cause maternal and neonatal deaths. Pre-eclampsia can progress to
eclampsia and cause adverse fetal outcomes such as preterm birth, small-
for-gestational-age babies, placental abruption, perinatal deaths and
increase the risk of cardiovascular and cerebro vascular disease and venou
thromboembolism later in life (raymord, 2017). Furthermore mothes who
suffer from pre-eclampsia are predisopose to mental health issues such as
shame, guilt, feeling of failures, loss of control, personal inadequecy and
post-partum depression.
Adeqaute knowledge about disorder contribute greatly to it prevention,
control and management. Report indicate that patients knowledge about a
diseases has a signifcant benefit and complinace to treatment and help to
abate complications associated with the diseases (portilli, 2018). In
Nigeria one major hurdle in converting pre-eclampsia is the late reporting
of mothers to hhealth care centres following an expereince of a sign or
symptom. Pre-eclampsia is a disease of signs and symptoms which require
prompt attention. Eqquiped with knowledge, mothers experiencing pre-
eclmapsia would report early to the hospital, receive timely intervention
and have fewer adverse outcomes.
This emphasizes the need for mother to have adeqaute knowledge of the
diseases. For this to be achieved, there is the need to access the base line
knowledge ofpre-eclampsia, especially among high risk group such as
pregnant mothers (Gabbe, 2016). However, there is currnetly n study that
evaluate the awareness on the causes, effects and rprevention of pre-
eclampsiain general hospital Auna magama local government area of niger
state. This study, is however, is set out to determine the awareness on the
causes, effects and prevention of pre-eclampsia among pregnant mothers
attending antenatal care in general hospital Auna magama local
government area of niger state.
5.3 Conclusions
Based on the findings of this research work, the researcher therefore made
the following conclusions that;
1 The majority of pregnant mothers attending Antenatal careinGeneral
Hospital AunaMagama local government area of Niger State have
adequate level of awareness on the causes of pre-eclampsia.
2 Thepregrant mothers attending Antenatal care in General Hospital
AunaMagama Local Government Area of Niger state have more
knowledge on the effects of pre-eclampsia.
3 The pregnant mothers attending Antenatal care in General Hospital
AunaMagama local government area of Niger State are fully aware
of the prevention of pre-eclampsia.

5.4 Recommendations
Considering the conclusions above, the researcher made the following
recommendations that;
1. There should be continue comprehensive and sustainable approaches
measures in order to maintain pregnant mothers knowledge on the
causes of pre-eclampsia.
2. There should continue awareness and enlightenment program to
improve knowledge among pregnant mothers on the effects of pre-
eclampsia.
3. There should be continue knowledge and awareness programs to
improve in awareness among pregnant mothers on the prevention of
pre-eclampsia
5.5 Suggestions for Further Studies
Considering the limitation of this study the researcher therefore suggest
the followings for further studies;
1. Assessment of knowledge and attitude towards use of contraceptives
in the prevention of unwanted pregnancies among adolescents in
secondary schools.
2. Perceived causes and prevention of pregnancy induce abortion
among reproductive age women.

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APENDIX
QUESTIONAIRE
School of Health Technology,
TunganMagajiy,
P.O Box 163
Niger State.
Dear respondent,
I am a final year student of the above mentioned institution Carrying out a
research work on the Awareness on the Causes, Effects and prevention of
preeclampsia among pregnant women attending Antenatal care in general
hospital AunaMagama local government area of Niger State.
The questionnaire is designed to collect data for the above study. It will be
appreciated if you could respond to each item objectively. All responses
will be treated with outmost confidentiality and will be used for the
purpose of this study.
Yours Sincerely,
MujahidYakubu
20/HPTM/053

SECTION A: Bio-Data of the respondents,

Instruction: please tick (√) as appropriate, the options provided.
1. Age of the respondents
a. 18-22 years (__)
b. 23-27 years (__)
c. 28-32 years (__)
 d. 33 years and above (__)
2. Occupation of the respondents
a. Civil servant (__)
b. Business (__)
c. Family (__)

Section B:
Instruction: please tick (√) appropriate considering the keys below:
• SA strongly agreed
• A agree
• D disagree
• SD strongly disagree

1. level of awareness on the causes of pre- SA A D SD

eclampsia among pregnant women
attending Antenatal care
a. Hard drugs use during pregnancy can cause
the incidence of still birth among pregnant
mothers.
b. Lifestyle such as too much sugar intake
increases the chances of having still birth
among pregnant mothers.
c. Placenta obstruction during pregnancy can
affect the baby’s health thereby causing
stillbirth birth.
d. Pregnant mothers who uses substance from
local herbs during pregnancy can increase
the risk of still birth.
e. Lack of good adequate nutritional intake can
cause still birth among pregnant mothers.
2 Level of knowledge on the effect of pre- SA A D SD
eclampsia among pregnant mothers
attending antenatal care
a. Pre-eclampsia can lead to a separation the
placental from the uterus (placental
abruption)
b. Pre-eclampsia can lead to pregnancy loss or
still birth
c. Pre-eclampsia can lead to organ failure or
stroke.
d. Pregnant mother who use substance from
local herbs during pregnancy can increase
the risk of still birth
 e. Lack of good adequate nutritional intake can
cause still birth among pregnant mothers
3. level of knowledge on the prevention of SA A D SD
pre-eclampsia among pregnant women
attending Antenatal care
a. Regular antenatal visits can help reduce the
risk of having still birth among pregnant
mothers.
b. Adequate diatery intake can promote the
optimal health of the mother and child
thereby reducing the risk of still birth.
c. Treatment of minor diseases can help prevent
the incidence of still birth among pregnant
mothers.
d. Mothers who do exercise regularly are most
likely to deliver a healthy baby and not
stillbirth.
e. Adequate sleep and resting are the major
strategy for the prevention of still birth
among pregnant mothers.

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