Preeclampsia: pathophysiology and implications for care

CE: Gestational Hypertension, Preeclampsia, and Peripartum Cardiomyopathy: A Clinical Review

Gestational hypertension, preeclampsia, and peripartum cardiomyopathy are among the most common and often severe pregnancy-specific cardiovascular diseases (CVDs) and causes of complications in pregnancy. This clinical review provides nurses with an overview of pregnancy-specific CVDs, outlines their pathophysiology, and discusses risk factors and assessment. It describes management interventions according to timing: the antepartum, intrapartum, and postpartum phases are each addressed.

Assessment, Management, and Health Implications of Early-Onset Preeclampsia

Early-onset preeclampsia is a serious condition of pregnancy with the potential for adverse maternal and fetal health outcomes. A strong body of evidence supports the need for postpartum follow-up and health counseling, because these women and their offspring are at risk for future cardiovascular disease; nurses play a key role in this education. An understanding of the diagnosis, risk screening for, pathogenesis, and management of severe preeclampsia and its sequelae, such as intrauterine growth restriction and pulmonary edema, enables nurses to develop a comprehensive plan of care that will support women and their families through this challenging and dynamic complication of pregnancy.

Nursing care for women with pre-eclampsia and/or eclampsia: integrative review

OBJECTIVE

To analyze the available evidence in the literature on nursing care for women with pre-eclampsia and/or eclampsia.

METHODS

Integrative review searching for primary studies in the databases PubMed, CINAHL, LILACS and SciELO.

RESULTS

The sample size consisted of 17 primary studies published between January 2000 and December 2014, grouped into four categories: standardizing blood pressure measurement technique; training with simulation; instruments for standardization of care and quality of care The main nursing actions were: physical examination, early detection of signs of pre-eclampsia/eclampsia, monitoring of laboratory tests, fetal assessment, qualification and training of professionals. We identified the need for standardization of care from instruments, protocols and blood pressure measurement technique, early identification and treatment of hypertensive crisis through institutional protocols and review of cases and work processes.

CONCLUSION

Women with pre-eclampsia and/or eclampsia require specific nursing care, which must be guided by care protocols based on scientific evidence.

OBJETIVO

Analisar as evidências disponíveis na literatura sobre assistência de enfermagem às mulheres com pré-eclâmpsia e/ou eclâmpsia.

MÉTODO

Revisão integrativa cuja busca dos estudos primários foi realizada nas bases de dados PubMed, CINAHL, LILACS e SciELO.

RESULTADOS

Amostra foi composta por 17 estudos primários, publicados entre janeiro de 2000 e dezembro de 2014, agrupados em quatro categorias: padronização da técnica de mensuração da pressão arterial; treinamentos com simulação; instrumentos para padronização da assistência e qualidade da assistência As principais ações de enfermagem foram: exame físico, identificação precoce de sinais de pré-eclâmpsia/eclâmpsia, acompanhamento de exames laboratoriais, avaliação fetal, capacitação e treinamento dos profissionais. Identificou-se a necessidade de padronização do atendimento a partir de instrumentos e protocolos e da técnica de aferição da pressão arterial, identificação e tratamento precoces da crise hipertensiva mediante protocolos institucionais e revisão de casos e processos de trabalho.

CONCLUSÃO

Mulheres com pré-eclâmpsia e/ou eclâmpsia exigem cuidados de enfermagem específicos, os quais devem ser pautados em protocolos de cuidados baseados em evidências científicas.

Development and Testing of the Preeclampsia Prenatal Symptom-Monitoring Checklist (PPSMC)

Background and Purpose: Preeclampsia, a common disorder of unknown origin, presents with signs and symptoms that can be subtle, making assessment and intervention challenging. The purpose of this study was to refine the psychometric properties of an instrument designed to assess a comprehensive range of preeclampsia symptoms. Methods: Testing of the Preeclampsia Prenatal Symptom-Monitoring Scale (PPSMC) was accomplished through a retrospective, correlational, and comparative study of 100 postpartum women with preeclampsia and gestational hypertension. Results: The initial 17-item Cronbach’s alpha was .73; reliability of the current 11-item PPSMC increased to .77. Content validity index for the PPSMC (17 items) was .88; for the PPSMC (11 items), .93. Exploratory factor analysis, known group comparisons, and predictive validity lend beginning support of the instrument’s construct validity. Conclusion: This instrument may be useful in examining in greater detail the symptomatology of women with preeclampsia in practice and research settings.

Occupation as a risk factor for hypertensive disorders of pregnancy

BACKGROUND

Hypertensive disorders of pregnancy (HDP) are leading causes of morbidity and mortality and have been rising in incidence. Little is known about the effects of worker classifications on HDP. This large-scale study examines associations between occupational classifications and HDP.

METHODS

We examined 385,537 Texas Electronic Registrar Birth Registration 2005 birth certificates. Maternal occupations were coded using the Standard Occupational Classification (SOC). Crude and adjusted risks for HDP among working women within occupational groupings were analyzed and compared with risks of nonemployed women.

RESULTS

The risk of developing HDP varies across SOC occupational classifications. After controlling for known confounders, women employed in business, management, and the legal and social services, teaching, counseling, and healthcare professions are at higher risk for developing HDP than women employed in support industries, such as food preparation, housekeeping, cosmetic and personal care services, or nonemployed women. Women employed in computer, engineering, architectural, and scientific occupations also carry greater risks, although these increased risks do not affect women of normal weight.

CONCLUSIONS

Worker classification is an independent risk factor for HDP. Additional work must be done to examine the complex interactions among individual maternal genetics, biology, and physical and mental abilities and how they affect adverse health outcomes. Examining job stressors may shed light on these occupational variations and their potential HDP associations. Strategies to mitigate job stressors in the workplace should be considered.