Pre-eclampsia is a condition that affects a significant percentage of mothers, and accounts for mother death during childbirth anywhere from fifteen to twenty percent of the time—pre-eclampsia is one of the most significant and important causes of maternal death during childbirth to this day (Sibai, Dekker & Kupferminc, 2005; Ghulmiyyah & Sibai, 2012). As such, it is immensely important to develop strategies to deal with the problem of pre-eclampsia, but it is also essentially important to develop strategies for dealing with education and prevention of the condition (Villar et al., 2003). There are a number of common conditions that are associated with the development of pre-eclampsia, but the mechanisms of the disease—and even appropriate preventative measures—are still relatively unknown and unclear (Villar et al., 2003; Lisonkova & Jospeh, 2013). The PICOT question that has been identified is as follows: In patients with preeclampsia, should education and medication therapy be considered versus early delivery of the fetus as the best approach to prevent maternal mortality? Five variables for discussion?
The disease affects between two percent and 8 percent of global pregnancies, which means that it is an uncommon condition, but certainly not a rare one (Lisonkova & Jospeh, 2013 Ghulmiyyah & Sibai, 2012; Li et al., 2014). Pre-eclampsia and the related disease, eclampsia, seems to affect certain populations more than others (Lisonkova & Jospeh, 2013 Ghulmiyyah & Sibai, 2012; Li et al., 2014). Asian and African women tend to be the least affected by the disorder, while women from South America seem to be much more readily affected (Sibai, Dekker & Kupfeminc, 2005). There also seems to be a class-related component to the development of the disease, as women in poorer countries tend to develop the disease much more readily than their wealthier peers in more developed nations (Lisonkova & Jospeh, 2013 Ghulmiyyah & Sibai, 2012; Li et al., 2014). The research seems to suggest this is a combination of reduced access to adequate health care, lack of access to education, and dearth of treatment options (Lisonkova & Jospeh, 2013 Ghulmiyyah & Sibai, 2012; Li et al., 2014).
Medical professionals who work with pregnant women of all ages and body types must be aware of this particular disorder. Pre-eclampsia is difficult because the mechanism for development is still largely unknown—although there is information about the compounding factors for the disorder, the how and why of development are still being researched (Villar et al., 2003; Lisonkova & Jospeh, 2013). Nurses, who by their nature work very closely with patients and have a much better understanding of an individual patient’s trends in blood pressure and other vital signs, must be able to recognize the warning signs of this deadly disorder before it becomes too severe (Villa et al., 2013; Sibai, Dekker & Kupferminc, 2005; Ghulmiyyah & Sibai, 2012; Li et al., 2014). It is especially important to note that many of the pre-existing conditions that worsen the expectant mother’s chances of developing pre-eclampsia are common conditions in today’s world, making diligent nursing even more important insofar as treatment and prevention are concerned (Sibai, Dekker & Kupferminc, 2005; Ghulmiyyah & Sibai, 2012; Li et al., 2014).
Some of the most common risk factors for pre-eclampsia include obesity, diabetes mellitus, and a previous history of hypertension, or high blood pressure (Sibai, Dekker & Kupferminc, 2005). Unfortunately, all of these conditions are relatively common in most populations in places like the United States and other westernized nations; obesity and diabetes mellitus are occurring in much higher rates in women than ever before (Sibai, Dekker & Kupferminc, 2005). When a nurse has a patient presenting with pregnancy and any one of these symptoms, it is important for the nurse to recognize the potential issues involved for the patient and take appropriate educational and medication-based preventative measures (Sibai, Dekker & Kupferminc, 2005; Ghulmiyyah & Sibai, 2012; Li et al., 2014). Although this discussion will focus primarily on the United States and the developed world, cultural issues will play a major part in the discussion, as low-income areas even within the developed world have a higher prevalence of this disorder (Li et al., 2014).
Some of the risk factors for pre-eclampsia seem to be contradictory: for instance, one group that is particularly at risk is first-time mothers—however, women who have a history of pre-eclampsia or a family history of pre-eclampsia are also at risk (Li et al., 2014). Finally, women who have children with different men have a higher and higher likelihood of developing the disorder with the number of partners that she has (Li et al., 2014). Unfortunately, it is a condition that becomes a problem rather quickly, and there are no real tests available to establish likelihood of pre-eclampsia before the disorder develops.
Diagnosing pre-eclampsia can be difficult, even for experienced medical professionals, and it is not the role of the nurse to diagnose pre-eclampsia. All the signs and symptoms commonly associated with pre-eclampsia are also symptoms that might generally occur during a normal pregnancy; swelling, pitting edema, extreme headaches, impaired liver or kidney function, changes in vision, shortness of breath, and upper abdominal pain are all symptoms associated with the condition. However, they are also all symptoms that can be related to other parts of pregnancy, and are not necessarily specific to pre-eclampsia (Lisonkova & Jospeh, 2013; Sibai, Dekker & Kupferminc, 2005; Ghulmiyyah & Sibai, 2012; Li et al., 2014).
Education is, the research suggests, one of the most important ways that doctors and nurses can reach women at risk for pre-eclampsia. However, if doctors and nurses are unaware of the exact signs, symptoms, and risks of pre-eclampsia, it is unlikely that they will be able to appropriately assist their patients with the disorder (Lisonkova & Jospeh, 2013; Sibai, Dekker & Kupferminc, 2005; Ghulmiyyah & Sibai, 2012; Li et al., 2014). Because there are so many variables associated with pregnancy, and because two lives are at stake rather than only one, it is essential that medical personnel establish good educational foundations on the condition of pre-eclampsia (Lisonkova & Jospeh, 2013; Sibai, Dekker & Kupferminc, 2005).
A number of important methods were used to search for information on pre-eclampsia and the current literature related to the condition. Specific and targeted searches were used on a number of journal search engines, including Springer, Elsevier, The New England Journal of Medicine, and Google Scholar. Only relatively recent information was used for the literature review; the goal was to be certain that only the most up-to-date information was utilized for the discussion. First and foremost, “pre-eclampsia” was used as a search term, with other indicating keywords like “culture,” “education,” “prevention,” “medication,” and “mortality” were used to complete the search.
Very specific care was taken when choosing the literature for this discussion. There is a plethora of research available about pre-eclampsia, but the purpose of this discussion was not to look into the purported mechanisms of the disease. Instead, the discussion takes an approach much more centered on epidemiology and the prevalence of the disorder in certain communities. In addition, the purpose is to discuss the role of education in the prevention of pre-eclampsia, which necessitated searches through social work and educational databases, rather than merely focusing on the medical databases. Overall, however, Springer, Elsevier and Google Scholar were all essential tools in the development of the literature review list, and the development of the overall discussion thread for this research.
Once the search was begun, a number of pieces were considered and then abandoned based on old or inaccurate research. Once the sheer magnitude of the available literature was revealed, the researchers developed a new criterion that demanded the article be no older than 2005. This effectively narrowed the topic, and presented researchers with the appropriate information without the excess or older information. The search continued, and one of the most difficult areas to find appropriate research was the area regarding the intersection of education, culture, and rates of pre-eclampsia. However, there were a few studies, like the von Dadelszen et al. (2013) study, that did discuss the role of education and educational development in the prevention and treatment of pre-eclampsia. These studies were difficult to find, but essential for the development of the research overall.
References
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Ghulmiyyah, L., & Sibai, B. (2012, February). Maternal mortality from preeclampsia/eclampsia. In Seminars in perinatology (Vol. 36, No. 1, pp. 56-59). WB Saunders.
Li, X. L., Chen, T. T., Dong, X., Gou, W. L., Lau, S., Stone, P., & Chen, Q. (2014). Early onset preeclampsia in subsequent pregnancies correlates with early onset preeclampsia in first pregnancy. European Journal of Obstetrics & Gynecology and Reproductive Biology, 177, 94-99.
Lisonkova, S., & Joseph, K. S. (2013). Incidence of preeclampsia: risk factors and outcomes associated with early-versus late-onset disease. American journal of obstetrics and gynecology, 209(6), 544-e1.
Sibai, B., Dekker, G., & Kupferminc, M. (2005). Pre-eclampsia. The Lancet, 365(9461), 785-799.
Villa, P. M., Kajantie, E., Räikkönen, K., Pesonen, A. K., Hämäläinen, E., Vainio, M., & Laivuori, H. (2013). Aspirin in the prevention of pre‐eclampsia in high‐risk women: a randomised placebo‐controlled PREDO Trial and a meta‐analysis of randomised trials. BJOG: An International Journal of Obstetrics & Gynaecology, 120(1), 64-74.
Villar, K., Say, L., Gulmezoglu, A. M., Meraldi, M., Lindheimer, M. D., Betran, A. P., & Piaggio, G. (2003). Eclampsia and pre-eclampsia: a health problem for 2000 years. In Pre-eclampsia (pp. 189-207). RCOG Press, London.
von Dadelszen, P., Sawchuck, D., Hofmeyr, G. J., Magee, L. A., Bracken, H., Mathai, M., & Roberts, J. M. (2013). PRE-EMPT (PRE-eclampsia-Eclampsia Monitoring, Prevention and Treatment): A low and middle income country initiative to reduce the global burden of maternal, fetal and infant death and disease related to pre-eclampsia. Pregnancy Hypertension: An International Journal of Women's Cardiovascular Health, 3(4), 199-202.
