Opening Statements:
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—aare 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?
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.
Literature Review: Medication
Some literature seems to suggest that aspirin can and should be used to prevent pre-eclampsia in women who have high risk of the disorder (Sibai, Dekker & Kupferminc, 2005; Ghulmiyyah & Sibai, 2012; Li et al., 2014).
However, there is also significant research that suggests that aspirin has no effect on pre-eclampsia or pre-eclampsia onset (Villa et al., 2013; Sibai, Dekker & Kupferminc, 2005; Ghulmiyyah & Sibai, 2012; Li et al., 2014).
However, controlling the blood pressure and lowering high blood pressure is very important in the treatment of pre-eclampsia.
Patients with pre-eclampsia often show signs before developing the condition, and the high risk factors for the disease can be controlled with medication (von Dadelszen et al., 2013; Sibai, Dekker & Kupferminc, 2005; Ghulmiyyah & Sibai, 2012; Li et al., 2014).
Medication alone does not seem to be able to prevent women from developing this condition.
Literature Review: Culture and Community Education
Prevention and education are significant when treating communities more likely to develop pre-eclampsia (von Dadelszen et al., 2013).
Education, or Knowledge Transmission, is essential in the development of communities with low rates of pre-eclampsia (von Dadelszen et al., 2013).
Knowledge transmission programs can have an immensely positive effect on the community, and they can reduce rates of pre-eclampsia cases in a population by up to seventy-five percent (von Dadelszen et al., 2013).
Treating communities without educating them is to put a small bandage over a gaping wound: these communities must be educated thoroughly to see any positive impacts or reductions in the number of cases of pre-eclampsia (von Dadelszen et al., 2013).
Because women who are first-time mothers or who had pre-eclampsia in their first pregnancy are mpre likely to face issues, communities can become havens for cases of pre-eclampsia (Li et al., 2014; von Dadelszen et al., 2013).
Communities can sometimes be under-educated overall in health-related issues and prevention of disease (Li et al., 2014).
Communities with high levels of the diseases closely associated with pre-eclampsia should be targeted for educational programs (Sibai, Dekker & Kupferminc, 2005; Ghulmiyyah & Sibai, 2012; von Dadelszen et al., 2013).
Literature Review: First-Time Mother Education
First-time mothers are much more likely to experience problems leading to pre-eclampsia than mothers who have successfully given birth without the condition in the past (Li et al., 2014).
First time mothers do not know the risks well (Li et al., 2014).
Most mothers go to the doctor, which is an excellent time to provide mothers with information about potential pregnancy complications and issues associated with the condition (Li et al., 2014; Bodnar et al., 2013).
Educating mothers on signs and symptoms is a good method of knowledge transmission, especially early in the pregnancy (von Dadelszen et al., 2013).
This is applicable to women of all different ethnic groups and cultures.
Literature Review: Rates of mortality in the fetus and the mother
Mothers tend to experience higher rates of mortality if pre-eclampsia goes untreated until childbirth (Sibai, Dekker & Kupferminc, 2005; Ghulmiyyah & Sibai, 2012).
Rates of mortality for both the mother and the infant or fetus are dependent upon the interventions that doctors use (Sibai, Dekker & Kupferminc, 2005; Ghulmiyyah & Sibai, 2012)
The earlier the intervention, the greater the likelihood for success during childbirth (Villar et al., 2003).
Women who develop eclampsia have significant health risks and a significantly higher likelihood for mortality (Sibai, Dekker & Kupferminc, 2005; Ghulmiyyah & Sibai, 2012)
Literature Review: Differences in Outcomes for Mothers Presenting with Severe Symptoms of Pre-eclampsia
Like many disorders, pre-eclampsia is judged based on severity (Villar et al., 2003; Lisonkova & Jospeh, 2013)
Women with extreme symptoms of pre-eclampsia are more likely to experience significant consequences as a result of the disorder, including death during childbirth (Villar et al., 2003; Lisonkova & Jospeh, 2013).
Severity of symptoms can worsen if the underlying conditions are not cared for properly (Sibai, Dekker & Kupferminc, 2005; Ghulmiyyah & Sibai, 2012).
Diabetes and hypertension have a significant effect on the development of the disease and the severity of it.
Theoretical Framework
This research operates under the assumption that prevention is a highly effective way to reduce the negative consequences associated with diseases and conditions like pre-eclampsia. Although the mechanism of the disorder is not known entirely, there are a number of symptoms that are so closely related to the development of the condition that preventative care based on these conditions is of paramount importance to the prognosis of the patient and the community in the long run. Preventative care in pregnant women is something that is already encouraged: for instance, women who are likely to be come pregnant are encouraged to take prenatal vitamins as a way to prevent problems with pregnancy. Education in the community and for first-time mothers is likewise another form of preventative care: women must be educated about the disorder, and given information about how best to lower their likelihood of developing complications. The philosophies of patient education and preventative care, then, are the underlying philosophical tenets upon which this discussion will be built.
References
Bodnar, L. M., Simhan, H. N., Catov, J. M., Roberts, J. M., Platt, R. W., Diesel, J. C., & Klebanoff, M. A. (2014). Maternal vitamin D status and the risk of mild and severe preeclampsia. Epidemiology (Cambridge, Mass.), 25(2), 207.
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.
