EFFECT OF PREGNANCY ON PACKED CELL VOLUME AMONG PREGNANT WOMEN ATTENDING ANTENATAL CLINIC AT KWARA STATE SPECIALIST HOSPITAL

CHAPTER ONE

INTRODUCTION

1.1     BACKGROUND TO THE STUDY

Pregnancy is a critical period in a woman's life that involves numerous physiological changes, including alterations in the hematological profile. This period is a unique physiological state, a transformative and dynamic period in a woman's life that brings about numerous changes in a woman's body to support the growth and development of the foetus. It is characterized by many haematological changes, which may appear to be pathological in the non-pregnant state (Purohit et.al. 2015).  These changes extend to various organ systems, including the haematological system, where alterations in blood parameters occur to meet the increasing demands of the mother and the developing baby. One important haematological parameter that undergoes changes during pregnancy is the packed cell volume (PCV), which is a measure of the proportion of red blood cells in relation to the total volume of blood.  The parameter used to assess the red blood cell status is the packed cell volume (PCV), which represents the volume of red blood cells in relation to the total blood volume. Therefore, understanding the effect of pregnancy on PCV levels is crucial for appropriate antenatal care and intervention strategies.

Packed cell volume (PCV) is a measure of the percentage of red blood cells in a unit volume of blood. It is an important indicator of a person's overall health, and it can be used to diagnose anemia and other blood disorders. During pregnancy, there are a number of physiological changes that can affect PCV. These changes include:

•        Increased blood volume: The volume of blood in the body increases by about 50% during pregnancy. This is due to the increase in the volume of plasma, the liquid part of blood.

•        Decreased red blood cell production: The production of red blood cells decreases during pregnancy. This is because the body's resources are diverted to supporting the growing foetus.

As a result of these changes, PCV typically decreases during pregnancy. The average PCV for a non-pregnant woman is 37%. However, the PCV for a pregnant woman can range from 32% to 40%. A low PCV during pregnancy can be a sign of anemia. Anemia is a condition in which the body does not have enough healthy red blood cells. This can lead to symptoms such as fatigue, shortness of breath, and pale skin. 

Many studies have identified the haematological profile of the pregnant woman as one of the factors affecting pregnancy and its outcome (Akinbami et.al. 2013). These changes include alterations in various haematological parameters, such as the packed cell volume (PCV), which represents the volume of red blood cells in a given volume of whole blood. PCV is an essential indicator of the oxygen-carrying capacity of blood and plays a crucial role in maternal and foetal health. During pregnancy, the body undergoes significant adaptations to meet the increasing demands of the growing foetus. These adaptations involve an expansion of the maternal blood volume, an increase in the number of red blood cells, and a dilution effect caused by a relatively greater expansion of plasma volume compared to red blood cell mass. These changes aim to ensure an adequate oxygen supply to the developing foetus (AduBonsaffoh et.al. 2014). However, despite the physiological adjustments, pregnancy can also predispose women to various haematological disorders, such as anaemia which is characterized by a decrease in the number of red blood cells or the amount of haemoglobin in the blood, resulting in reduced oxygen-carrying capacity (Rahmati S, Delpishe A, Azami M, et al. 2017).

Furthermore, plasma expansion and haemodilution contribute to the majority of these changes during pregnancy, there is increase in plasma volume as well as in red cells and white blood cells volume (Anberbir S, Hussein M, Tiebu M, 2016). The total blood volume increases in order to supply the demands of the new vascular bed and also to compensate for blood loss occurring at delivery. Modifications in the production of red cells and changes in plasma volume has some effects on some of the haematological indices such as red blood cells count, packed cell volume, haemoglobin concentration, platelet count, and white blood cell count (Soma-Pillay P, Nelson-Piercy C, Tolppanen H, Mebazaa A. 2016). Some of these are decreased like Red Blood Cell (RBC) and Platelet (PLT) counts partly as a result of the physiological haemodilution that occurs in pregnancy, while others are increased, such as the White Blood Cell (WBC) count.

The Nigeria Demographic and Health Survey conducted in 2013 reported that approximately 58% of pregnant women in the country were anaemic, indicating the urgent need for comprehensive understanding and interventions to address this issue. Determining the effect of pregnancy on PCV levels among pregnant women attending antenatal clinics is crucial for effective antenatal care and appropriate interventions to improve maternal and foetal health outcomes. Specifically, Kwara State, Nigeria, like many other regions, faces a significant burden of anaemia among pregnant women. Factors contributing to this high prevalence include poor nutritional status, socioeconomic factors, inadequate antenatal care, and limited access to quality healthcare facilities among others. Therefore, understanding the effect of pregnancy on PCV levels among pregnant women attending antenatal clinics in Kwara State Specialist Hospital, Sobi and Cottage Hospital Adewole, Ilorin, Kwara State, Nigeria, is of utmost importance. Investigating the changes in PCV during pregnancy and identifying potential risk factors associated with lower PCV levels will provide valuable insights for healthcare providers and policymakers. Such knowledge can help in the early detection, management, and prevention of Anaemia, ultimately improving maternal and foetal health outcomes. Additionally, comparing PCV levels between the two healthcare facilities will shed light on any regional variations in haematological parameters and guide interventions to address them.

By investigating the effect of pregnancy on PCV levels among pregnant women attending Kwara State Specialist Hospital, Sobi and Cottage Hospital Adewole Ilorin, this study aims to provide valuable insights into the prevalence of anaemia and its relationship with PCV levels during pregnancy in Kwara State, Nigeria. 

1.2     STATEMENT OF THE PROBLEM

Packed cell volume (PCV) is a crucial parameter used to assess the prevalence of anaemia and the red blood cell status during pregnancy. However, there is a limited understanding of the specific effect of pregnancy on PCV levels among pregnant women attending antenatal clinics at Kwara State Specialist Hospital, Sobi and Cottage Hospital Adewole Ilorin in Kwara State, Nigeria. There is also lack of comprehensive data on the effect of pregnancy on packed cell volume (PCV) among pregnant women attending antenatal clinics.

Investigating the effect of pregnancy on PCV levels in this specific population is important for several reasons:

•        Prevalence of Anaemia: Anaemia is a major health issue among pregnant women in Nigeria, but the prevalence and severity of anaemia may vary across different regions of the country. Therefore, determining the specific prevalence of anaemia and its relationship with PCV levels in Kwara State will provide valuable insights into the magnitude of the problem in this particular region.

•        Maternal and Foetal Health Outcomes: Understanding the effect of pregnancy on PCV levels is crucial for assessing the risk of anaemia and its potential impact on maternal and foetal health outcomes. Determining the relationship between PCV levels and adverse pregnancy outcomes, such as preterm birth and low birth weight, can help healthcare providers develop targeted interventions to improve maternal and foetal health in Kwara State.

•        Antenatal Care Strategies: Antenatal care plays a vital role in the prevention, detection, and management of anaemia during pregnancy. By investigating the effect of pregnancy on PCV levels among pregnant women attending antenatal clinics at Kwara State Specialist Hospital, Sobi and Cottage Hospital Adewole Ilorin, this study can provide valuable information to guide antenatal care strategies and interventions aimed at reducing the prevalence of anaemia in the region. 

By addressing these gaps in knowledge, this study will contribute to the existing literature on the effect of pregnancy on PCV levels among pregnant women attending antenatal clinics in Kwara State, Nigeria. The findings will inform healthcare professionals and policymakers about the prevalence of anaemia and its impact on maternal and foetal health outcomes, enabling them to develop evidence-based interventions and strategies for improved antenatal care in the region.

1.3     OBJECTIVES OF THE STUDY

The main objective of this study is “Effect of Pregnancy on Packed Cell Volume (PCV) among

Pregnant Women attending Antenatal Clinic at Kwara State Specialist Hospital, Sobi and Cottage Hospital Adewole Ilorin, Kwara State, Nigeria”. Based on this fact, the specific objectives of this study are given below: 

i.        To determine the packed cell volume (PCV) levels among pregnant women attending antenatal clinics.

ii.      To evaluate the effect of maternal age on PCV levels among pregnant women attending antenatal clinics. iii. To evaluate the effect of gestational age on PCV levels among pregnant women attending antenatal clinics.

iv.        To evaluate the effect of parity on PCV levels among pregnant women attending antenatal clinics.

v.         To evaluate the effect of nutritional status on PCV levels among pregnant women attending antenatal clinics.

1.4     RESEARCH QUESTIONS

In presenting a broad overview of the effect of Pregnancy on Packed Cell Volume (PCV) among Pregnant Women attending Antenatal Clinic at Kwara State Specialist Hospital, Sobi and Cottage Hospital Adewole Ilorin, Kwara State, Nigeria, this project examines five points of research questions which are enumerated below:  

i.      What are the packed cell volume (PCV) levels among pregnant women attending

antenatal clinics?

ii.     What is the effect of maternal age on PCV levels among pregnant women attending antenatal clinics? iii. What is the effect of gestational age on PCV levels among pregnant women attending antenatal clinics?

iv.        What is the effect of parity on PCV levels among pregnant women attending antenatal

clinics?

v.         What is the effect of nutritional status on PCV levels among pregnant women attending antenatal clinics?

1.5     RESEARCH HYPOTHESES

A research hypothesis is a predictive statement about the possible outcomes of a study. It predict outcomes, it is important to have a clear idea of the problem that one is studying

(research problem) and what one hope to achieve through the study (research objectives). The following hypotheses will guide the study and also facilitate the data collection. Notably, the hypotheses (H₀ stands for null hypothesis and H_A stands for alternative hypothesis) will be tested in the course of this study in order to answer the research questions and achieve the objectives of the study.  

Hypothesis One`

H₀₁: There is no significant difference in packed cell volume (PCV) levels among  pregnant women attending antenatal clinics.

H₀₁: There is significant difference in packed cell volume (PCV) levels among  pregnant       women attending antenatal clinics.

Hypothesis Two

H₀₂: There is no significant association between PCV levels and maternal age, among  pregnant women attending antenatal clinics.

H_A2: There is significant association between PCV levels and maternal age, among pregnant  women attending antenatal clinics.

Hypothesis Three

H₀₃: There is no significant association between PCV levels and gestational age, among  pregnant women attending antenatal clinics.

H_A3: There is significant association between PCV levels and gestational age, among  pregnant women attending antenatal clinics.

Hypothesis Four

H₀₄: There is no significant association between PCV levels and parity, among pregnant       women attending antenatal clinics.

H_A4: There is significant association between PCV levels and parity, among pregnant women attending antenatal clinics. 

Hypothesis Five

H₀₅: There is no significant association between PCV levels and nutritional status, among  pregnant women attending antenatal clinics.

H_A5: There is significant association between PCV levels and nutritional status, among  pregnant women attending antenatal clinics. 

1.6     SIGNIFICANCE OF THE STUDY

This study is significant in the sense that it will contribute to the existing body of knowledge on the effect of pregnancy on PCV levels among pregnant women in Nigeria and will provide valuable data on the prevalence of anaemia and its relationship with PCV levels during pregnancy. These several important implications and benefits include the followings: 

•        Improved Antenatal Care: Understanding the effect of pregnancy on PCV levels in this specific population will contribute to the improvement of antenatal care services provided at Kwara State Specialist Hospital, Sobi and Cottage Hospital Adewole Ilorin. The findings of this study can help healthcare professionals identify high-risk individuals for anaemia and develop targeted interventions to prevent and manage anaemia

effectively.

•        Maternal Health Promotion: Anaemia during pregnancy can have adverse effects on maternal health, leading to increased risks of complications and poor outcomes. By determining the prevalence of anaemia and its relationship with PCV levels, this study can raise awareness about the importance of maintaining adequate PCV levels during pregnancy, leading to improved maternal health and well-being.

•        Foetal Health and Development: Anaemia in pregnant women not only affects their own health but also poses risks to foetal development and outcomes. By investigating the impact of PCV levels on maternal and foetal health outcomes, such as preterm birth and low birth weight, this study can provide valuable insights into the potential consequences of anaemia on foetal well-being. The findings can inform strategies to mitigate these risks and promote optimal foetal health.

•        Evidence-Based Interventions: The study's findings can serve as a foundation for evidence-based interventions and strategies to address anaemia among pregnant women

in Kwara State. Healthcare professionals and policymakers can utilize this information to develop targeted interventions, such as iron supplementation programs, nutritional counselling, and improved antenatal care protocols, to reduce the prevalence of anaemia and enhance maternal and foetal health outcomes.

•        Contribution to Scientific Knowledge: The study contributes to the existing body of knowledge on the effect of pregnancy on PCV levels in Nigeria, specifically in the context of Kwara State. The findings will add to the limited literature available on this topic, providing valuable data on the haematological changes during pregnancy in the region.

1.7     SCOPE AND LIMITATIONS OF THE STUDY

The study on the effect of pregnancy on packed cell volume (PCV) among pregnant women attending antenatal clinics at Kwara State Specialist Hospital, Sobi and Cottage Hospital Adewole, Ilorin, Kwara State, Nigeria will focus on the following aspects:

•        Participants: The study will include pregnant women attending antenatal clinics at the selected healthcare facilities in Kwara State, Nigeria.

•        Variables: The primary variable of interest is the PCV level, which will be measured using standardized laboratory techniques. Secondary variables will include demographic characteristics, medical history, obstetric profile, and potential risk factors associated with lower PCV levels during pregnancy.

•        Timeframe: The study will be conducted over a specific period, with data collection occurring within that timeframe.

•        Geographical Location: The study will be conducted specifically in Kwara State, Nigeria, focusing on the Kwara State Specialist Hospital, Sobi and Cottage Hospital Adewole,

Ilorin.

The Limitations of the Study is as follows:

•        Generalizability: The findings of this study may not be generalizable to pregnant women outside the selected healthcare facilities or to other regions in Nigeria or different countries. The study is limited to the specific population and setting under investigation.

•        Sample Selection Bias: The study will use a convenient sampling method, which may introduce selection bias. The sample may not fully represent the entire population of pregnant women attending antenatal clinics in Kwara State, affecting the external validity of the study.

•        Cross-Sectional Design: The study design is cross-sectional, which limits the establishment of causal relationships. Longitudinal studies would provide more robust evidence of the effect of pregnancy on PCV levels over time.

•        Potential Confounding Factors: While efforts will be made to control for potential confounding factors, there may still be unaccounted variables that influence PCV levels during pregnancy, such as dietary factors, socioeconomic status, and other comorbidities.

•        Limited Assessment of PCV: The study will focus on PCV levels as a measure of Anaemia, but other parameters, such as haemoglobin levels and red blood cell indices, will not be assessed. These additional measurements could provide a more comprehensive understanding of the haematological status of pregnant women.

•        Self-Reporting Bias: Some data collected, such as medical history and obstetric profile, may rely on self-reporting by participants, which can be subject to recall bias or misinterpretation.

Despite these limitations, the study will provide valuable insights into the effect of pregnancy on PCV levels among pregnant women attending antenatal clinics in Kwara State, Nigeria. The findings can guide future research and interventions to address Anaemia and improve maternal and foetal health outcomes in the study area.

1.8     DEFINITION OF TERMS

The following are some of the terminologies used in the course of writing this project;

•        Antenatal Clinic: An antenatal clinic is a healthcare facility or department that provides medical care and support to pregnant women during their pregnancy. Antenatal clinics typically offer a range of services, including prenatal check-ups, prenatal education, screening for health conditions, and monitoring of the mother and baby's well-being.

•        Foetal Health Outcomes: Foetal health outcomes refer to the health and well-being of the developing foetus during pregnancy. This includes factors such as foetal growth, development, birth weight, gestational age at delivery, and the occurrence of any foetal complications or abnormalities.

•        Haemodilution: Haemodilution refers to a condition characterized by a decrease in the concentration of red blood cells (RBCs) and other blood components, leading to a dilution of the blood. This occurs when there is an increase in plasma volume relative to the number of RBCs in the blood. It can be a physiological response or a consequence of medical interventions.

•        Iron Supplementation: Iron supplementation refers to the administration of iron supplements, typically in the form of oral iron tablets or syrups, to pregnant women to prevent or treat iron deficiency anaemia. Iron supplementation plays a crucial role in maintaining adequate iron levels and supporting healthy red blood cell production during pregnancy.

•        Maternal Health Outcomes: Maternal health outcomes refer to the health outcomes and experiences of pregnant women during pregnancy, childbirth, and the postpartum period.

This can include factors such as maternal morbidity, mortality, gestational complications, and overall well-being.

•        Nutritional Status: Nutritional status refers to an individual's overall health and wellbeing in relation to their diet and nutrient intake. In the context of this study, nutritional status may include factors such as dietary intake, micronutrient deficiencies (such as iron deficiency), and body mass index (BMI) as indicators of nutritional adequacy.

•        Packed Cell Volume (PCV): Also known as haematocrit, PCV is a measurement that represents the proportion of red blood cells in the total volume of blood. It is expressed as a percentage and is obtained by centrifuging a blood sample to separate the red blood cells from the plasma.

•        Plasma Expansion: Plasma expansion refers to an increase in the volume of plasma, the liquid component of blood, within the circulatory system. It occurs when there is an expansion of the plasma volume relative to the number of red blood cells (RBCs) in the blood, leading to changes in blood composition. Plasma expansion is a normal physiological response that can occur in various situations, including during pregnancy, as well as in certain medical conditions or as a result of medical interventions.

•        Prevalence: Prevalence refers to the proportion or percentage of individuals in a specific population who have a particular condition or characteristic at a given point in time. In the context of this study, prevalence would refer to the proportion of pregnant women attending antenatal clinics who have anaemia or specific PCV levels.

•        Platelet (PLT): Platelets, also known as thrombocytes, are small, irregularly shaped cell fragments found in the blood. They play a crucial role in haemostasis, which is the process of blood clotting to prevent excessive bleeding.

•        Red Blood Cell (RBC): Red blood cells (RBCs), also known as erythrocytes, are the most abundant type of blood cells in the human body. They are specialized cells that play a crucial role in transporting oxygen from the lungs to the body's tissues and carrying carbon dioxide back to the lungs for elimination.

•        White Blood Cell (WBC): White blood cells (WBCs), also known as leukocytes, are a crucial component of the immune system. They are a diverse group of cells that help defend the body against infections, foreign substances, and abnormal cells. Unlike red blood cells, white blood cells have a nucleus and are larger in size.