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Pregnancy Related Medical Problems at a Tertiary Care Hospital

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Pak J Med Res Original Article
Vol. 52, No. 3, 201
2013

Pregnancy Related Medical Problems at a Tertiary

Care Hospital
Zahra Ali, Iffat Shabbir, Saira Bashir, Tayyaba Rahat, Syeda Saadia Fatim Ali
PMRC Research Centre, Fatima Jinnah Medical College, Lahore.

Abstract

Objectives: To estimate pregnancy related medical problems in cases visiting tertiary care hospital for antenatal care.
Study type, settings and duration: Retrospective OPD based study done at medical research laboratory of Ganga Ram
Hospital, Lahore from January 2011 to December 2011.
Materials and Methods: A total of 1806 pregnant cases visited the biochemistry laboratory out of which 1000 cases
fulfilled the criteria and had complete record available and were selected for analysis. Variable including hemoglobin,
blood group and Rh factor, fasting and post prandial plasma glucose, viral markers like HBsAg, Anti-HCV and Anti-HIV
I/II and complete urine examination. Data was analyzed using Statistical Package for Social Sciences (SPSS-15).
Results: The mean age of women was 25.4±4.29 years and 78.1% were between 21-30 years. The mean fasting and post
parandial glucose levels were 84.03±15 mg/dl and 134.30±23 mg/dl respectively. Gestational diabetes mellitus was found
in 96 cases (6.9%). HBsAg was present in 1.2%, HCV in 8.5% and both B and C were present in 1 case. None had HIV
I/II infection. Blood group ‘B’ was commonest (34.2%), followed by group ‘O’ (30.6%), group ‘A’ (24.5%) and ‘AB’
(10.7%). Rhesus factor (Rh) showed 94% Rh-positive cases and 6.0% Rh negative. Overall anemia was present in 61.1%
cases with mild anemia in 87.5%, moderate in 12.2% and severe in 0.1%. Urinary tract infection was seen in 10.1 % cases.
Conclusion: Anemia was common in pregnancy. Urinary tract infection (10%), hepatitis C virus exposure (8.5%) and
gestational diabetes mellitus (7%) were common.
Policy message: Although the screening of HCV is not recommended internationally but the rate of HCV infection is on
increase in Pakistan so there is a need of proper screening of HCV along with routine antenatal screening. It will help to
identify asymptomatic women, who may benefit from antiviral therapy at a time when they are more receptive to medical
intervention.
Key words: Antenatal, anemia, gestational diabetes mellitus, hepatitis B virus, hepatitis C virus, urinary tract infection.

Introduction threat to their care providers9. Urinary tract infections are

aternal mortality is a serious health problem all
M over the world. In Pakistan despite advances in
medical technology, maternal mortality rate is high due to
multiple factors1. Good antenatal care can contribute to
good pregnancy outcome2. Pakistani women are at high
risk for gestational diabetes, anemia and viral infections
like hepatitis C virus (HCV) and hepatitis B (HBV)3.
Anemia in pregnancy affects both mother and fetus4. In
Pakistan the prevalence of anemia ranges between 33-
75%5-7.
Pregnant women are likely to be more
predisposed to viral and another infections8. In Pakistan
the HBsAg positivity is 12.6% and HCV is 16.5% in
among pregnant women. These mothers are not only at
risk of having cirrhosis and liver cancer, but are also a
Corresponding Author:
Zahra Ali
PMRC Research Centre
Fatima Jinnah Medical College
Lahore.
Email: alixahra@yahoo.com
also common in pregnant women with estimate of 10-
20% in women at some point in life10. There are
epidemiological evidences that improved detection and
care for women have improved the maternal outcome11.
The current study was done to see pregnancy
related medical problem from the existing record of
antenatal clinic, to help the health personnel delivering
antenatal care and need to be watchful for the following
conditions: gestational diabetes, anemia, and hepatitis.
Materials and Methods
The targeted population included pregnant cases
between 18-35 years, having gestational age of 28th week,
visiting Gynae OPD for antenatal check up. Patients are
referred daily to the biochemistry laboratory of Pakistan
Medical Research Council from gynecology and
obstetrics OPD for biochemical and viral tests. From
January to December 2011, 1806 cases were seen in the
laboratory. Out of whom only 1000 women who had
complete documentation of the study parameters like
fasting and post prandial plasma glucose, HBsAg, Anti-

Pakistan Journal of Medical Research, 2013 (July - September) 71

 Zahra Ali, Iffat Shabbir, Saira Bashir, Tayyaba Rahat, Syeda Saadia Fatim Ali

HCV and Anti-HIV I/II and complete urine DR were Blood group B (34.2%) was commonest
selected for final analysis. All those with missing record followed by O (30.6%), A (24.5%) and AB (10.7%).
of any parameter and those coming 2nd time for antenatal Among all blood groups 94 % were Rh positive and 6%
screening were excluded from the study. were Rh negative.
Laboratory data that was retrieved from the Urine microscopy showed that 101(10%)
files included hemoglobin, viral markers (HbsAg, anti- women had bacterial infection falling in the category of
HCV and HIV), blood group and blood glucose level and urinary tract infection.
urine DR. Gestational diabetes was diagnosed according
to American diabetes association criteria 201112. Discussion
Screening of HBsAg, HCV and HIV were done
using rapid testing devices and those found positive were In the present study anemia followed by HCV
confirmed by ELISA. Blood glucose was measured by infection were most commonly encountered in the
glucose oxidase method13. Hemoglobin was estimated pregnant population. Antenatal care enables obstetricians
by Drabkin's method14. Five ml urine was tested for to identify potential problems in the early stages of
proteinurea using chemical testing and glucose using pregnancy which, if not managed in time could result in
urine dip stick (Cumbi 3). Microscopy of urine was done increased risk for mother and baby. In the present study
to diagnose urinary tract infection (UTI). Anemia was 61.1% women had anemia and similar results were
defined using World Health Organization’s definition of reported by others5,16,17.
hemoglobin < 11.0 g/dl)15. Age influences the blood glucose level of
pregnant women and those between 31-36 years were
Results noted to have raised blood glucose level as compared to
other groups18. Similar were the findings in the present
The mean age of 1000 women was 25.4±4.29 study. The need for diet planning for pregnancy therefore
years. Age was less than 20 years in 130(13.05%) cases, becomes very relevant and periodic screening is
between 21–30 years in 781(78.1%) while, 89(8.9%) recommended for all pregnant women19. In 2008, the
were 31 years and above. study by Metzger et al on hyperglycemia and adverse
The mean fasting and random plasma glucose pregnancy outcomes was a turning point in increasing
levels were 84 mg/dl and 134 mg/dl respectively. Mean awareness in healthcare community about hazards of
blood glucose level in different age groups are shown in gestational diabetes mellitus20. In the present study 69
Table. Out of 1000 cases 69 had gestational diabetes (6.9%) cases had gestational diabetic mellitus. A slightly
mellitus, and none of them had any previous history of higher figure (7.8%) was reported by another study in
diabetes mellitus. universal screening for gestational diabetes mellitus21.
The treatment of gestational diabetes mellitus improves
Table: Blood glucose levels and hepatitis status of pregnant pregnancy outcomes and this was reported by the
women.
Australian Carbohydrate Intolerance Study in Pregnant
Women (ACHOIS) where the incidence of serious
≤20 21-30 ≥31 Total
Age Group perinatal complications was 4% among women
n=130 n=781 n=89 n=1000 randomized to routine care compared with 1% who
81.5± 83.8± 90.4± 84± underwent intervention22.
Blood BSF 10.0 14.8 22.1 15 The present study showed high percentage of
Glucose 128.0± 134.7± 140.3± 134± Rh-positive cases which is similar to other studies and the
BSR 14.1 22.7 31.6 23
global trend23,24.
Viral HBsAg 4(3.08) 6(0.77) 2(2.25) 12(1.2) Pakistan is highly endemic for Hepatitis B and
Markers C. The frequency of HBsAg and HCV was 1.3% and
HCV 7(5.38) 62(7.94) 16(17.98) 85(8.5)
2.5% respectively in one study while, others reported
Frequency of the HBsAg and anti-HCV was high figures of 5.7% and 12.8% respectively25,26. In this
1.2% and 8.5% respectively. The distribution of these study, prevalence of HBsAg and HCV antibody in
infections in different age groups is shown in Table. Only pregnancy was 1.2% and 8.5% respectively. Nigeria
one case had co-infection of hepatitis B and C. All cases being highly endemic reported 12.5% HBV frequency
were negative for HIV infection. and 3.6% HCV frequency in pregnant cases27. Globally
Anemia was found in 61% cases, among them HBV screening is recommended in the antenatal period to
535(87.56%) had mild anemia (hemoglobin 9.0-10.9 treat HBV DNA positive mothers and reduce their
g/dl), 75(12.27%) had moderate anemia (hemoglobin 7.0- viremia and thus their capacity to transmit disease to the
8.9 g/dl), and only one had severe anemia (hemoglobin neonate. Neonates of these mothers are vaccinated with
<7.0 g/dl). HB vaccine and immunoglobulin on the day of delivery
to prevent vertical transmission28. HCV screening is not

72 Pakistan Journal of Medical Research, 2013 (July - September)

 Pregnancy Related Medical Problems at a Tertiary Care Hospital
indicated in pregnancy as interferon treatment is
contraindicated during pregnancy29,30. In view of the
strong recommendations for breast feeding, it is
universally agreed that if possible mother’s treatment
may be delayed and she may breast feed her child.
Screening of high risk cases for HCV needs to be carried
out as this might be their only visit to a health care
facility, and can help to capture further spread of
disease31.
Pregnancy induced changes in urinary tract
produces urinary symptoms and these were reported in
almost 46% cases during pregnancy10. Almost similar
(42%) results were reported from Pakistan29,32 but our
results showed that only 10.1% had microscopic urinary
tract infection. The reason for low figures in the present
study could be due to the use of microscopy and not the
symptoms in the present study.
In Finland, almost the entire (99.8%) pregnant
population attends antenatal care and the average number
of antenatal care visits is high33 and this in turn reduces
the maternal and perinatal mortality rates34.
In Pakistan all health care providers (registered
and unregistered) should be regularly trained to convince
the pregnant cases on regular antenatal checkups so that
simple pregnancy related issues could be picked early and
treated accordingly.
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