A
Comparative Study to Assess Relationship of Placental Weight in Normal Pregnant
Women and in Anemic Pregnant Women in Selected Hospital of Pune
City
Ms
Supriya Chinchpure
Lecturer, Sadhu Vaswani college of Nursing, 10/10-1, Koregaon
Road, Pune 411001
*Corresponding Author Email: supriyachinchpure@gmail.com
ABSTRACT:
Background: Nearly 600,000 women die each
year as a result of complications of pregnancy and childbirth; most of these
deaths could be prevented with attainable resources and skills (WHO 1996). In
India, anemia affects an estimated 50 percent of the population. A key
component of Safe Motherhood is the eradication of anemia during
pregnancy. Over the course of a
pregnancy, maternal blood volume increases by approximately 50%, from 4 to 6 L,
the plasma volume increases somewhat more than the total RBC volume, leading to
a fall in the hemoglobin concentration and hematocrit
values. This decrease is smaller in women who take supplemental iron, whereas
the fall may be dramatic in women who do not take supplemental iron and have
limited iron stores or are anemic upon becoming pregnant. The placenta is the
physiological link between the mother and her unborn infant. Abnormal placental
growth is associated with adverse pregnancy outcomes disproportionately heavy
placenta, suggestive of placental hypertrophy, may indicate an adaptive
response to an adverse intrauterine environment. Placental hypertrophy may
occur in the presence of conditions such as maternal anemia, cigarette smoking
and lower socio-economic status. Conversely, a disproportionately small
placenta may indicate poor nutrient supply to the placenta, or hypoxia resulting
in placental growth restriction and subsequently fetal growth restriction. When
there is a limitation imposed on fetal growth velocity due to nutritional
deficiencies, the placenta may undergo hypertrophy in an attempt to compensate.
As well, placental hypertrophy may occur in response to fetal /placental
hypoxemia. It is also possible that using the placental ratio as a marker,
infants with possible in-utero growth disturbance can
be identified so that their postnatal growth and future health status can be
monitored. Thus there may be effect of maternal anemic condition on the
placental growth in turn may affect the newborns growth and development Thus
there may be effect of maternal anemic condition on the placental growth in
turn may affect the newborns growth and development. .
Objectives:
• To
compare the placental weight among normal & anemic pregnant women
• To
correlate the placental weight with the baby’s weight
Design: A Correlational
design was adopted for the study.
Setting: Government hospital of Pune city was selected.
Participants: 100 expectant mothers
fulfilling the inclusion criteria were selected by non probability convenient
sampling technique. Two groups: Group A consisted of 50 pregnant mother with Hb level above 10gm%. & Group B consisted of 50
pregnant women with Hb level below 10 gm %.
Methodology: The tool consisted of Semi
structured interview and observation of placental parameters. The Tool was
divided into Section I- Demographic data, Section II- Examination of placenta
& Section III- Birth weight. All participants fulfilling the criteria were
approached, consent was taken & data was collected over 24 hours according
to the patients delivery timing. The average time
taken to fill the questionnaire after delivery of the baby and placenta was
almost 15-20 minutes.
Results: The findings revealed that, in
comparison of placental weight between Group A (Normal cases) and Group B
(Anemic cases) shows highly significant difference (P<0.001), similarly in
comparison of birth weight in normal and anemic cases shows highly significant
difference between Group A (Normal cases) and Group B (Anemic cases)
(P<0.001).
In Correlation between placental weight and
birth weight Group A (Normal cases) does not show significant difference (P
>0.05) but shows a positive correlation in the scatter diagram. This means
as the placental weight increases the birth weight also increases and
vice-versa. Group B (Anemic cases) shows highly significant difference with a
positive correlation (p >0.001) and in the scatter diagram also it shows
positive correlation. This means as the placental weight increases the birth
weight also increases and vice-versa
Conclusion: To conclude with the help of
above findings this study provides us with evidence that increase or decrease
in maternal Hb levels leads to changes in the
placental weight. And due to alteration in placental weight it affects the
birth weight.
KEY
WORDS: Relationship,
Placental weight, Normal pregnant women & anemic pregnant women.
INTRODUCTION:
As soon the news of pregnancy is splashed,
the environment is completely changed, whatever the pains, sorrows all come to
an end. The whole family is experiencing joy and is planning for welcome of the
coming angel. Whenever a seed is sown it starts going through different stages
like germination, development of various parts i.e. roots, stem, leaves etc.
for this whole process adequate food, nutrients, water, sunlight and care is
required. Similarly when a life starts growing inside the womb, it also goes
through various developmental stages of life for this whole process it requires
nutrients, care, identification of problems at earlier stage and providing
prompt intervention to ensure safety of the mother and the baby. All
pregnancies and deliveries are at risk. However, there are certain categories
of pregnancies where the mother, the fetus or the neonate are in a state of
increased jeopardy. About 20 to 30 percent pregnancies belong to this category.
If we desire to improve obstetric results, this group must be identified and
given extra care.
Maternal mortality continues to be a major health problem in
the developing world. Nearly 600,000 women die each year as a
result of complications of pregnancy and childbirth; most of these
deaths could be prevented with attainable resources and skills (WHO
1996). In India, anemia affects an estimated 50 percent of the population. A
key component of Safe Motherhood is the eradication of anemia during
pregnancy. (1)
Over the course of a pregnancy, maternal blood volume
increases by approximately 50%, from 4 to 6 L, the plasma volume increases
somewhat more than the total RBC volume, leading to a fall in the hemoglobin
concentration and hematocrit values.
This decrease is smaller in women who take supplemental
iron, whereas the fall may be dramatic in women who do not take supplemental iron
and have limited iron stores or are anemic upon becoming pregnant which can
effect on the placental growth in turn may affect the newborns growth and
development.(2)
A cohort study on effect of maternal anemia
on placental ratio was conducted by Farrukh Robina et al (2006) on one hundred pregnant women,
50 anemic and 50 having normal range of Hb. After
delivery, weight of the new born and weight of placenta was recorded. The mean
weight of the Newborn (±SD) in anemic group was 3.12 ± 0.45Kg and 3.18 + 0.35Kg
in control group. The difference was statistically non-significant (P=0.445).
The mean placental weight of anemic group was 0.58 ± 0.13Kg and that of control
group was 0.52 ± 0.088Kg showing a significant increase (P<0.009). Feto-placental ratio was 0.193 + 0.035 (Mean ± SD) in
anemic patients and 0.166 + 0.024 in control group. FP ratio of anemic patients
was significantly higher than control group (P<0.001). The study shows a
significantly large placental weight and a high fetoplacental
ratio (3).
Another cross sectional study was done by Kidanto Hussein L, Ingrid Mogren,
Gunilla Lindmark, Siriel Massawe, Lennarth Nystrom (2009) to
assess risks of maternal anemic condition on preterm delivery and low birth
weight (n= 174 anemic and 547 non-anemic women). The risk of preterm delivery
increased significantly with the severity of anemia, with odds ratios of 1.4,
1.4 and 4.1 respectively for mild, moderate and severe anemia. The
corresponding risks for LBW and VLBW were 1.2 and 1.7, 3.8 and 1.5, and 1.9 and
4.2 respectively. The risks of preterm delivery and LBW increased in proportion
to the severity of maternal anemia. (4)
The placenta is the physiological link
between the mother and her unborn infant. Through the placenta nutrients
(and possible the contaminants) are transferred from the mother to the infant,
including life-sustaining oxygen. There is exchange of waste products
from the infant back to the mother for excretion also. The placenta is a fetal
organ consisting of an umbilical cord, membranes (chorion
and amnion), and parenchyma. Maternal or fetal disorders may have placental sequelae since the mother and fetus interface at this site.
Conversely, primary placental abnormalities can affect both maternal and fetal
health. Thus, examination of the placenta may yield information on the impact
of maternal disorders on the fetus or the cause of preterm delivery, fetal
growth restriction, or neuro developmental
impairment. Placental examination is an essential component of the autopsy in
cases of fetal or neonatal death and even has clinical significance. (Roberts J Drucilla).
Many studies have shown relationship of
placental weight to birth weight, a longitudinal cross-sectional study was conducted by Asgharnia. M, Esmailpour. N, Poorghorban. M and Atrkar-Roshan.
Z (2008) to determine placental weight and factors associated
with low weight placentas (n=1088). The subjects were categorized in high (>
750 g), normal (330-750 g), and low placental weights (< 330 g). The mean
and standard deviation of neonates' weights at birth and placental weights were
3214.28 ± 529 and 529.72 ± 113 g, respectively and showed statistically
significant relationships between placental weight and birth weight, fetal
distress, Apgar score, maternal diabetes, pre-eclampsia and approaches of deliveries (α = 0.05). (5)
Another study was conducted by Sanin Luz Helena et al (2001) to
assess Relation between Birth Weight and Placenta Weight. The mean of birth
weight was 3,369 g with a standard deviation (SD) of 445 g. Placenta weight had
a mean of 537 g (SD: 96 g). The relation between the weight of the placenta and
the birth weight was significant, and we found that for each gram increase in
placenta weight, birth weight is increased by 1.98 g (SE = 0.25, p < 0.01)
and this relation is not linear, since the quadratic term was significant.
Placenta weight has a nonlinear relation to the birth weight and is an
important predictor of birth weight. Together with the gestational age and the
maternal age and size, it explains 32% of the variability of birth weight.
Placenta weight can be a 'sentinel' indicator of nutritional and/or
environmental problems (6)
Several studies show that abnormal
placental growth is associated with adverse pregnancy outcomes disproportionately
heavy placenta, suggestive of placental hypertrophy, may indicate an adaptive
response to an adverse intrauterine environment. Placental hypertrophy may
occur in the presence of conditions such as maternal anemia,
cigarette smoking and lower socio-economic status. Conversely, a disproportionately small placenta may
indicate poor nutrient supply to the placenta, or hypoxia resulting in
placental growth restriction and subsequently fetal growth restriction. When
there is a limitation imposed on fetal growth velocity due to nutritional
deficiencies, the placenta may undergo hypertrophy in an attempt to compensate.
As well, placental hypertrophy may occur in response to fetal /placental
hypoxemia. (7)
It is also possible that using the
placental ratio as a marker, infants with possible in-utero
growth disturbance can be identified so that their postnatal growth and future
health status can be monitored. Thus there may be effect of maternal anemic
condition on the placental growth in turn may affect the newborns growth and
development. Thus there is a felt need to assess any effect of the maternal
anemic condition on the placenta through placental examination. And further
correlate the changes of placental weight with the birth weight of the baby.
STATEMENT OF PROBLEM:
“A comparative study to assess relationship
of placental weight in normal pregnant women & in anemic pregnant women in
selected hospital of Pune”
OBJECTIVES:
·
To
assess placental weight in normal pregnant women.
·
To
assess placental weight in anemic pregnant women
·
To
compare the placental weight among normal & anemic pregnant women
·
To
correlate the placental weight with the baby’s weight
HYPOTHESIS: There is no significant effect of maternal
anemic condition on placental weight and baby weight.
ASSUMPTIONS:
The study assumes that-
Ø Anemia during pregnancy has an effect on
the placental weight.
Ø Anemia during pregnancy has an effect on
the baby’s weight.
Ø Any change in the placental weight has an
effect on the baby’s weight.
Variables:
Research
Setting:
The study was conducted in a corporation
hospital of Pune city
Population:
Sample:
Findings of section II:
Section II is examination of placenta which
consists of general examination, examination of maternal surface, examination
of fetal surface and umbilical cord and the major findings revealed for the
same are as follows:
Majorities (97%) of placenta were discoid
shape from which 49% belong to Group A (Normal
subjects) and 48% belong to Group B (anemic subjects). And 3% of placentas were
oval shapes from which 1% belongs to Group A (Normal
subjects) and 2% belong to Group B (anemic subjects).
The findings of the placental diameter,
thickness & lobes showed that there was no significant difference between
Group A (Normal subjects and Group B (Anemic subjects)
In maternal surface abnormalities majority
(34%) infarcts were seen as in cases of Group B (Anemic subjects). Similarly in
fetal surface abnormalities 10% of cases in Group B (Anemic subjects) were circumvallate placenta and 4% of cases with other
abnormalities i.e. were present in group B (Anemic subjects)
.
In umbilical cord insertion majority (35%)
of cases were with central cord insertion from which 21% of cases belong to
Group A (Normal subjects) and 14% of cases belong to Group B (Anemic subjects).
And 35% of cases were with Marginal cord insertion from which 15% of subjects
belong to Group A (Normal subjects) and 20% of subjects belong to Group B
(Anemic subjects). And 2% of cases were with Velamentous
cord insertion from Group B (Anemic subjects). Umbilical cord length &
diameter did not show any significant difference between Group A (Normal
subjects) and Group B (Anemic subjects).
The comparison of placental weight shows
highly significant difference between Group A (Normal cases) and Group B
(Anemic cases). In group A the mean was 485.5 and standard deviation was 41.41,
similarly in Group B the mean was 544.8 and standard deviation was 122.01. It
showed highly significant difference (P value is <0.001). Thus it explains
that as the hemoglobin levels altered changes in the placental weight was seen.
In comparison of birth weight in normal and
anemic cases, highly significant difference between Group
A (Normal cases) and Group B (Anemic cases) was seen. In Group A the mean was
2694.5 and standard deviation was 387.93, similarly in Group B the mean was
2035.5 and standard deviation was 150.18. It is evident by calculating the p
value. The p value is 11.20. It showed highly
significant difference (P <0.0001) which explains that as the hemoglobin
levels altered changes in the birth weight was seen.
Findings
of Section III:
In Correlation
between placental weight and birth weight Group A (Normal cases) does
not show significant difference (P >0.05) but showed a positive correlation
in the scatter diagram. This means as the placental weight increases the birth
weight also increases and vice-versa.
Group B (Anemic cases) shows highly
significant difference (P >0.001) with a positive correlation. It is evident
by calculating the R value. The R value is 0.63. Here so it showed highly
significant difference and in the scatter diagram also it shows positive
correlation. This means as the placental weight increases the birth weight also
increases and vice-versa.
Ø In Correlation
between placental weight and birth weight Group A (Normal cases) does
not show significant difference (P >0.05) but shows a positive correlation
in the scatter diagram which means as the placental weight increases the birth
weight also increases and vice-versa.
Ø In Correlation
between placental weight and birth weight Group B (Anemic cases) shows highly significant difference (P
>0.001) with a positive correlation which means as the placental weight
increases the birth weight also increases and vice-versa.
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Received on 08.04.2014 Modified on 25.06.2014
Accepted on 10.07.2014 ©
A&V Publication all right reserved
Asian J. Nur. Edu. & Research 4(3): July- Sept., 2014; Page 307-313