INTRODUCTION AND LETERATURE REVIEW

1.1 INTRODUCTION

Preeclampsia is a serious complication of pregnancy characterized by high blood pressure and

signs of damage to other organ systems, most commonly the liver and kidneys. If not diagnosed

and treated promptly, it can have adverse effects on both mother and baby. Recent studies have

shown that bicarbonate and potassium levels in the blood can serve as biomarkers for pre-

eclampsia, providing valuable information for early detection and monitoring of the condition

(Lassey & Wilson, Citation1998). Theories of the pathophysiology of preeclampsia involve both

maternal and fetal factors. Although the cause of preeclampsia remains unclear, many theories

suggest that abnormal placental implantation and abnormal trophoblast invasion may be the cause

(Smith & Kenny, 2006). It has been hypothesized that fluctuations in maternal serum bicarbonate

are responsible for the elevated blood pressure seen in patients with preeclampsia (cited in

Sidahmed & Abubaker, 2017; cited in Tabassum, Al-Jameil, Ali, Khan, & Al-Rahed, 2015).

1.2.1: DEFINITION OF PREECLAMPSIA

Formerly known as toxemia, preeclampsia is a hypertensive syndrome that usually occurs during

pregnancy after 20 weeks gestation and is one of the hypertensive disorders of pregnancy

responsible for maternal as well as perinatal mortalities worldwide (Sukonpan & Phupong, 2005).

The syndrome consists of persistent hypertension accompanied by one or more of the following:

proteinuria, evidence of systemic involvement, liver involvement, neurologic complications, fetal

growth restriction, and hematologic complications (Felman & Liberto, 2017).

1.2.2: PATHOGENESIS OF PREECLAMPSIA

Preeclampsia is a serious complication that can occur during pregnancy and is characterized by

high blood pressure and damage to organs such as the kidneys and liver. The pathogenesis of

preeclampsia is not fully understood, but it is believed to involve abnormalities in the placenta
 (Smith & Kenny, 2006). The placenta plays a crucial role in supplying the fetus with nutrients and

oxygen, and in preeclampsia, there is thought to be inadequate blood flow to the placenta, leading

to placental hypoxia and release of factors that trigger the maternal symptoms of preeclampsia.

The pathogenesis of preeclampsia and its subsequent effects on the mother and fetus (Sukonpan

& Phupong, 2005). The failure of trophoblast uterine interactions in the first trimester leads to a

stress response in the placenta. This may affect the growth and development of the velvet tree and

the delivery of oxygen and nutrients to the fetus. The stress to the syncytiotrophoblast leads to the

shedding of a range of factors into the systemic circulation. These factors disrupt the homeostatic

functions of the maternal endothelium, including regulation of coagulation, fluid shifts, and blood

pressure, thereby inducing a systemic inflammatory response ( Ahmed A.2021).

1.3: CAUSES OF PREECLAMPSIA

Preeclampsia is a serious medical condition that can occur during pregnancy, typically after 20

weeks gestation. It is characterized by high blood pressure and damage to the liver and kidneys.

While the exact cause of preeclampsia is not fully understood, there are several risk factors and

possible causes that have been identified through research.

One of the main risk factors for developing preeclampsia is a history of high blood pressure or

preeclampsia in a previous pregnancy. Other risk factors include being pregnant for the first time,

being over the age of 40, carrying multiple babies, having a family history of preeclampsia, and

certain medical conditions such as obesity, diabetes, and kidney disease. These risk factors can

increase a woman's chances of developing preeclampsia, although the exact cause of the

condition is still unknown (Chesley, Annitto, & Cosgrove,1976).

Researchers believe that preeclampsia may be caused by problems with the placenta, the organ

that nourishes the growing fetus during pregnancy. In a normal pregnancy, blood vessels in the
 placenta widen to allow for increased blood flow to the fetus. However, in women who develop

preeclampsia, these blood vessels may not widen as they should, leading to restricted blood flow

and high blood pressure. This can result in damage to the mother's organs and potentially harm

the developing baby. Further research is needed to fully understand the causes of preeclampsia

and develop effective treatments to prevent and manage the condition.

1.3.1: DEFINITION OF BICARBONATE

Bicarbonate is a base, that the body needs to help keep a normal acid-base (pH) balance. This

balance prevents your body from becoming too acidic, which can cause many health problems.

The lungs and kidneys keep a normal blood pH by removing excess acid. Serum bicarbonate

mostly travels throughout the body as carbon dioxide (CO2), a gas dissolved in the blood

(Manjareeka, M., & Nanda, S. 2012). That's why the amount of CO2 in your blood is used to

measure serum bicarbonate (base) and to therefore check your acid-base balance. If CO2 is too

low in your blood, then that means serum bicarbonate (base) is low, and your body has too much

acid. Too much acid in the body is called metabolic acidosis (Manjareeka, M., & Nanda, S. 2012).

1.3.2: USE OF BICARBONATE AS BIOMAKER IN PREECLAMPSIA

Bicarbonate is an important component of the body’s buffering system, helping to maintain the

pH balance in the blood. Abnormal levels of bicarbonate have been found in women with the

preeclampsia, suggesting a disruption in the body’s ability to regulate acid-base balance

(Manjareeka, M., & Nanda, S. 2012). Low levels of bicarbonate may indicate metabolic acidosis,

a condition often seen in patients with preeclampsia due to decreased kidney function and

compromised blood flow to vital organs. Monitoring bicarbonate levels in pregnant women with

the suspected preeclampsia can aid in early diagnosis and management of the condition.

Bicarbonate levels have been identified as a potential biomarker for preeclampsia. Preeclampsia

is characterized by abnormal placental function and systemic endothelial dysfunction (Smith &
 Kenny, 2006). This can lead to disturbances in acid-base balance, including alterations in

bicarbonate levels. Monitoring bicarbonate levels can provide valuable clinical information for

the diagnosis and treatment of preeclampsia. However, it's important to note that the use of

bicarbonate levels as a biomarker for preeclampsia may require further validation through clinical

studies and research.

1.4: POTASSIUM

Potassium is important in body functions such as the regulation of blood pressure and of water

content in cells, transmission of nerve impulses, digestion, muscle contraction, and heartbeat.

Low levels of potassium can affect these important functions in your body. Over time, low

potassium levels in the body can lead to effects such as heart arrhythmias, muscle weakness, and

even paralysis. Low potassium levels can also affect your kidneys, causing excessive urination

(polyuria) and excessive thirst (polydipsia) (Lassey & Wilson,1998). This is because potassium

helps kidneys balance body's fluid and electrolyte levels. However, bicarbonate and potassium

levels may serve as biomarkers for preeclampsia. In preeclampsia, there is a disruption in the

maternal endothelium's homeostatic functions, which can lead to imbalances in various

electrolytes and biomolecules. Monitoring bicarbonate and potassium levels may provide

valuable insights into the physiological changes that occur in pre-eclampsia and may aid in the

diagnosis and treatment of the condition (Manjareeka, M., & Nanda, S. 2012).

1.4.1: EFFECT OF POTASSIUM IN PREECLAMPSIA

Potassium, on the other hand, plays a crucial role in muscle and nerve function, including the

contraction of the heart and maintenance of blood pressure. Studies have shown that women with

preeclampsia often have lower levels of potassium in the blood, which may be attributed to

increased kidney dysfunction and reduced blood flow to the placenta (Smith & Kenny, 2006).

Monitoring potassium levels in pregnant women with preeclampsia can help healthcare providers
 assess the severity of the condition and make timely interventions to prevent complications for

both the mother and the baby. Overall, the identification of bicarbonate and potassium as potential

biomarkers for preeclampsia provides promising opportunities for early diagnosis and improved

management of this dangerous condition.

However, in preeclampsia, there may be alterations in potassium levels due to the condition's

impact on the renal and cardiovascular systems. Preeclampsia can cause high blood pressure

affect kidney function, and may even cause abnormal potassium levels (Delgado,2004).

Monitoring potassium levels in patients with preeclampsia is important because it can help assess

the severity of the condition and guide treatment decisions. There is a significant change in serum

potassium levels in preeclampsia because a low potassium level combined with a normal sodium

level can cause sodium retention and therefore development, of hypertension that causes

preeclampsia (Schrier & Briner,1991). Hypokalemia in preeclampsia patients can alter

homeostasis in serum, which may act as a predisposing factor in the pathogenesis of preeclampsia

(Sullivan & Martin, 1994). However, healthcare providers must interpret potassium levels in the

context of each patient's clinical presentation and medical history. Therefore, routine monitoring

and proper management of potassium levels are essential in the care of women with

preeclampsia.

1.5: AIM AND OBJECTIVES

This project aims to discuss the current understanding of how bicarbonate and potassium can be

used as biomarkers to identify pre-eclampsia, and the adverse health consequences faced by

patients affected by this disease. Recent studies suggest that serum electrolytes may play a role in

preeclampsia because preeclampsia is a disease of the vascular endothelium. Objective: To

compare serum sodium and potassium levels between preeclamptic and normotensive pregnant

women at a tertiary hospital in Ghana.

1.5.1: CLINICAL MANIFESTIONS OF PREECLAMPSIA

Patients with preeclampsia present with some degree of blood pressure elevation. They may have

an unrelenting headache, right upper quadrant pain, or vision changes. Occasionally, patients may

complain of increased lower extremity edema, which, while not diagnostic of preeclampsia,

should certainly raise concern for disease development (Poorolajal, & Jenabi, 2016). In the

absence of symptoms, laboratories drawn for any indication that could be indicative of

developing preeclampsia should alert the clinician’s suspicion. Patients generally have their blood

pressure checked at every appointment, and the blood pressure trend is important as patients who

are diagnosed with preeclampsia often have increased blood pressure during their pregnancy

(Villar, Betran, & Gulmezoglu, Citation2001).

1.5.2: DIAGNOSIS OF PREECLAMPSIA

Preeclampsia is a serious blood pressure condition that can occur during pregnancy. It's diagnosed

when a pregnant woman has high blood pressure (140/90 mm Hg or higher) after 20 weeks of

pregnancy, along with at least one other finding: Protein in the urine (Sullivan & Martin,1994).

Also called proteinuria, this indicates kidney impairment. A 24-hour urine collection can be used

to diagnose preeclampsia if it contains more than 300 mg of protein. A single urine sample can

also be tested for a protein/creatinine ratio of 0.3 or higher, or a dipstick reading of 2+

(Manjareeka, M., & Nanda, S. 2012).

One of the primary methods of diagnosing preeclampsia is through regular blood pressure

monitoring. High blood pressure is a hallmark sign of the condition, and if a pregnant woman

consistently shows elevated blood pressure readings, it may indicate the presence of

preeclampsia. Even more than that, urine tests can be conducted to detect the presence of protein,
which is another key indicator of preeclampsia. These two simple tests are often the first step in

diagnosing the condition and determining the best course of treatment (Searcy,1969).

In some cases, other symptoms may accompany high blood pressure and proteinuria, such as

headaches, blurred vision, and swelling in the hands and face (Manjareeka, M., & Nanda, S.

2012). These additional symptoms can further support the diagnosis of preeclampsia. It is

important for pregnant women to attend all prenatal appointments and communicate any

concerning symptoms to their healthcare providers to ensure early detection and proper

management of preeclampsia. With prompt diagnosis and appropriate treatment, the risks

associated with preeclampsia can be minimized, leading to better outcomes for both the mother

and the baby.