Hypertensive disorders in pregnancy are very common problems in pregnancy with the prevalence of 5–10%(Rana, Lemoine, Granger, & Karumanchi, 2019). These are among the causes of maternal and fetal morbidity and mortality, in Sweden the prevalence is 1.5%, 7.5% in Brazil, 3.8% in Ethiopia, 2.6% in Saudi Arabia(Bodur, Tan, & Ayd, 2005). The hypertensive disorders in pregnancy are classified as pre Eclampsia, gestation hypertension, Eclampsia, preeclampsia superimposed in chronic hypertension and chronic hypertension in pregnancy. Preeclampsia is defined as blood pressure of systolic ranging from 140mmhg and above and diastolic blood pressure of 91mmhg and above with proteinuria(Maembe, 2012). When the blood pressure is 160 and above systolic and 110 and above diastolic with or without sigs of end organ damage like blurred vision, severe headache, epigastric pain, raised serum cretinine, low platelets, and raised liver enzymes which are ALAT and ASAT indicating the severe preeclampsia even if there is no protein in urine.
The cause of preeclampsia is unknown but there are various risk factors which can contribute to the condition which are family history of preeclampsia, Primigravida, a woman with history of preeclampsia in previous pregnancy, change of partner in the current pregnancy, obesity, age below 18yrs and above 35 years, multiple pregnancy, women with diabetes mellitus and in nulliparity women(Mahande et al., 2013).The abnormal placentation is due to failure of the trophoblast to penetrate to the spiral vessels which cause the spiral blood vessels failed to be remodeled failure of remodeling of the spiral arteries result into narrowing of blood vessels and ischemia nutrition to the fetus(Tomimatsu, Mimura, Endo, Kumasawa, & Kimura, 2017). Normally the trophoblast penetration to the myometrium start at the 12 weeks of gestation and is completed at 20 weeks of gestation, this is the reason of the preeclampsia to develop after 20 weeks of gestation age, The condition is associated with adverse maternal fetal outcomes like Intra uterine fetal death(IUFD), Intra uterine fetal growth retardation(IUFGR), Low birth weight, early neonatal death, maternal convulsions, prematurity, premature labour, anemia, Hemolysis, elevated Liver Enzymes and low Platelets syndrome(HELP), Post Partum Hemorrhage(PPH), Renal failure, Cardiac failure, abruption placenta(Basak, Begum, Rashid, Yasmin, & Begum, 2015). This abnormal placentation also leads to production of toxic factors in the maternal circulation which result into inflammation and endothelial dysfunction.
This preeclampsia and Eclampsia have multisystem effects, the system which are commonly affected are the central nervous system which there is blurred vision, severe headache, and convulsions, in Gastrointestinal system there is liver failure which can result into raised liver enzymes. In Respiratory system there is pulmonary edema. The other system is urinary system which present with anuria and raised serum cretinine.
The hematological system is commonly affected in this there is low platelets, low hemoglobin level, raised hematocrit which are commonly affected(Martanti, Octaviani, Ariyanti, & Prasko, 2020)(Martanti et al., 2020). The causes of low platelets is due to excessive consumption of the platelets due to endothelial damage, the low hemoglobin level is due to microangiopathic hemolysis and high hematocrit level is due to the contracted circulatory volume following edema(Jhajharia & Verma, 2019).
The effects of the preeclampsia and the changes in hematological indices can result into various obstetric outcomes like post partum hemorrhage, increased caesarean deliveries, maternal death, premature labor intrauterine feta death, low apgar score, low birth weight, prematurity, increased NICU admission and early neonatal death. This study is done to assess patterns in hematological indices and associated obstetric outcomes among women with preeclampsia and severe preeclampsia at IRRH
In Tanzania many studies has been done but not yet published. At Iringa Regional Referral hospital no any study done in hematological indices in preeclampsia and severe preeclampsia. The study will bring good understand of the patterns of hematological indices which will result into better care of the women with preeclampsia and reduce bad maternal outcomes.