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286 From Preconception to Postpartum

↑↑↑MCV ↑↑↑MCH ↑NRBC ↑Reticulocytes ↑RPI ↑↑↑MBH

**Placental dysfunction** ↓↓↓PlGF ↑↑sVEGFR-1 ↓VEGF

index; MBH, membrane-bound hemoglobin ↑↑↑ - P<0.001; ↑↑ - P<0.01; ↑ - P<0.05

**Lipid profile** ↑TG ↓↓↓HDLc ↓↓Apo A-I ↑↑↑LDLc/HDLc

PlGF, placental growth factor; sVEGFR-1, soluble vascular endothelial growth factor receptor type 1; VEGF, vascular endothelial growth factor; tPA, tissue plasminogen activator; PAI-1, plasminogen activator inhibitor; TG, triglycerides; HDLc, HDL cholesterol; LDLc, LDL cholesterol; Apo,

apolipoprotein; CRP, c-reactive protein; sVCAM, soluble vascular cell adhesion molecule; MCV, mean cell volume; MCH, mean cell hemoglobin; NRBC, nucleated red blood cell; RPI, reticulocyte production

Table 3. Main changes observed in biochemical and hematological umbilical cord blood of newborns from PEc pregnancy when compared with the newborn in normal pregnancy.

Fig. 7. Schematic of some modifications observed in maternal and cord blood. IUGR,

In summary, most of the changes observed in the maternal circulation in PE women are also present in the cord blood of their newborns, although these changes are less pronounced.

PE shares several similarities with atherosclerosis, such as modifications in the lipid profile, amplification of the inflammatory process and increased oxidative stress. These changes may contribute to disturbe cell activation with subsequent endothelial dysfunction. Some studies have suggested that pregnant women who developed PE have a predisposition to

intrauterine growth restriction; SGA, small for gestational age.

**Endothelial dysfunction** ↑tPA ↓↓PAI-1/tPA

**Inflammation** ↑α1- antitrypsin ↑CRP **Leukocyte activation** ↑sVCAM ↓↓sL-Selectin

**Oxidative stress** ↑↑↑Uric acid

**(damage/remove/production)**

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**18** 

*Nigeria* 

**Bioethics in Obstetrics** 

*University and Teaching Hospital, Nnewi,* 

*Department of Obstetrics and Gynaecology Nnamdi Azikiwe* 

Obstetrics has been defined as the branch of medicine concerned with child birth. This simplistic definition may not entirely represent the plethora of events, many challenging, others contentious that are usually associated with the developmental processes that culminate in the birth of the child. They can therefore be only but a few aspect of clinical practice that are likely to elicit as much bioethical considerations as obstetrics practice. Bioethical questions arise in virtually all aspects of pregnancy and child birth starting from ethical issues involved in genetics and embryo research through the process of assisted reproduction, surrogacy, abortion, the process of normal and abnormal pregnancies, safe motherhood and neonatal care. Cook et al have observed the emerging significant of bio-ethics over the last half a century, at both professional and scholarly levels, and have further highlighted the input of multiple discipline – biology, philosophy, healthcare service, medicine, law, nursing and religious studies in the structuring of modern bioethics. This perhaps has been most profoundly expressed in obstetrics care, and indeed reproductive health as a whole. The medical profession in several cultures has an inherent responsibility to conduct its activities guided by the highest ethical standard. Reproductive healthcare practitioners in particular inevitably face ethical and bioethical challenges, some of which constitute a conflict between the old and new, requiring resolution, for example, the process of super-ovulation with higher multiple pregnancies, associated with assisted reproduction may require the ethicallyquestionable process of selective reduction foeticide in order to ensure the survival of one or two foetuses and facilitate the success of the procedure. Health professionals looking after woman are more compelled to observe strict ethical principles because they work in areas of women's body that are private and of particular psycho-sexual sensitivity (Ezeani, 2003). The decision to oblige to treatment request, obstetrics care inclusive requires that the reproductive healthcare practitioner appraises and appreciates his or her personal ethical stand-point which is then related to his duty to address the well being of his patients and also the overall character and conscience of the community. The need to include bioethics in the training curriculum of residents in obstetrics and gynaecology has become compelling and over the past two decades been increasingly highlighted (Elkins et al, 1986; Royal College of Physicians and Surgeons of Canada, 1997). As clearly stated by Mckneally and Singer (2001) "Enhancing Clinicians" knowledge and skills in resolving ethical quandaries can increase their ability to deal with issues that cause moral distress

that

**1. Introduction** 

Joseph Ifeanyi Brian-D. Adinma

