Literature Review On Pregnancy Induced Hypertension And Preeclampsia

Literature review on pregnancy induced hypertension

Pregnancy Induced Hypertension may be defined as systolic blood pressure greater than 140 mmHg and diastolic blood pressure greater than >90 mmHg (Americanpregnancy, 2018). This further can be mild, moderate and severe basis SBP and DBP. It usually causes when the mother reaches 20^th week pregnancy. The paper further addresses the high risk factors of hypertension, which is preeclampsia, which can lead to death of the mother or infant and or both, a care needs to be taken as and when the symptoms arises, and when it is diagnosed, the role of medical practitioners and midwifery goes beyond the routine checkup. The paper also explains the legal and ethical practices of Australia for midwives.

The main purpose of this review is to compare and contrast the pathophysiological aspects that contributes to the health condition, the medical and pharmacological treatments that can be beneficial to reduce the abovementioned issues, and to identify the role of the midwives and necessary intervention or strategies to deal with the hypertension and preeclampsia problems that are caused during pregnancy.

At the end of this study the most favorable treatment of this health condition will be identified, it will also be concluded that what type of process or physical elements of the body takes place in the process of hypertension and preeclampsia at the time of pregnancy. The scopes of this study is wide and also include identifying the role of the midwives and what strategy or interventions should be used by them in pregnancy associated issues.

The criteria foranalyzing and comparing literature review is; the journal articles of last ten years (from 2009 to 2018) will be reviewed and searched for related information. The comparison will be done on the basis of conclusion made by the authors in their study.

Pregnancy induced hypertension is also known as toxemia, and preeclampsia of pregnancy as it is a pregnancy complication described by swelling due to fluid retention, high blood pressure and protein in the urine. According to Clevelandclinic (2018) Approximately 1 out of every 14 pregnant women are affected by pregnancy induced hyptertension. This issue occurs during first pregnancy, sometimes it also occurs in succeeding pregnancies.  Another study conducted by James, Steer, Weiner, &Gonik (2010), reported that placenta has been marked as a major culprit in the hypertension associated with preeclampsia, which usually develops during pregnancy and passes on only after delivery.Kovo, Schreiber, Ben-Haroush, Wand, Golan & Bar (2010) described PIH as a condition during pregnancy where blood pressure rises beyond a certain limit, which can further lead to a serious condition called preeclampsia that is mainly called as Toxemia.There are various causes of developing hypertension during pregnancy that have been discussed below.

1. The first time pregnant women are at higher risk than others.
2. It is considered to be genetic; therefore, those women whose mothers or sisters have had such disease in the past can be at higher risk. It can be a biggest reason of developing hypertension among the women during pregnancy.
3. Women, who are carrying more than one child thus they can also suffer from such condition (Twins or triplets or more).
4. According to literature given by Basaran (2009), pregnancy before 20 or in late 40s can also be a major reason of hypertension during pregnancy of women.
5. Women already suffering from high blood pressure or kidney diseases, pregnancy can further induce blood pressure.

According to literature given by Basaran (2009), medical practitioners explain a variety of anti-hypertensive medications during pregnancy. Nice (2018) stated that there are enormous hemodynamic changes occur due to pregnancy that have been discussed below.

1. Atenolol and Metoprolol
2. Labetalol
3. Clonidine and methyldopa
4. Nifedipine
5. Hydralazine
6. Furosemide
7. Atenolol
8. Labetalol
9. Clonidine

According to Bollini, Pampallona, Wanner&Kupelnick (2009), the risk of preeclampsia is not reduced even after antihypertensive agent treatment. Osborne & Monk (2013) analyzed that the pharmacological treatment and management of PIH is still unclear and controversial. A complex process such as pregnancy is directly associated with any sort of changes in the clearance of antihypertensive agents, which may further impact the choice of agents.There has to be a balance which shall benefit both the mother and the fetus (Yoder, Thornburg &Bisognano, 2009).

Pharmacological management of PIH

The pathophysiology of preeclampsia is a complex process. According to Uzan, Carbonnel, Piconne, Asmar and Ayoubi (2011), the primary observed cause is due to the abnormalities occurs in placenta. This health problem can also be perceived as the impairment in the immunity system of mother that stops it from identifying the fetoplacental unit. A defective invasion of single or more spiral artery by the cytotrophoblast cells is identified during this health issue. Various studies have been reported that the invasion of these cells in uterus is the unique differentiation pathway in which the cells of fetus adopt some attributes of endothelium of their mother. In preeclampsia this pathway is impaired. The endothelium dysfunction can cause the clinical sign identified in the mother such as impairment of HELLP (Hemolysis, Elevated Liver enzyme and Low Platelet count) syndrome and even eclampsia.

McPhee, Papadakis&Rabow (2010) stated that with hypertension a lot of other diseases come along, there is a high risk of abruption placentae, intravascular coagulation dispersal, it also affects the major organs of the body, cerebral hemorrhage, kidney failure and liver failure.

The current NHBPEP (National high blood pressure education program) Proposes the hypertension classification with the following aspects:

1. Preeclampsia–Eclampsia
2. Chronic Hypertension (Primary or Secondary)
3. Preeclampsia–Eclampsia Superimposed on Chronic Hypertension
4. Gestational Hypertension

According to Healthline (2018)Preeclampsia is when women have high blood pressure and possibly protein in urine after or during the delivery or pregnancy. Usually, Preeclampsia happens after the 20^th week of pregnancy. In other words, Preeclampsia is a disease completely marked during pregnancy which is said to be a risky pregnancy complication due to hypertension. It may also become a result of low cutting elements in kidney, liver and blood (Ncbi, 2014). There are various etiology of Preeclampsia which have been elaborated below.

1. It has Genetics involved
2. Preexisting high blood pressure
3. Collagen Vascular disease causing inflammation
4. When plasma concentration is raised  
5. Diabetes
6. Multiple pregnancy

Seely, Tsigas& Rich-Edwards (2015) explains the Diagnosis of PE which is generally occurred on the basis of symptoms and recorded high Blood pressure, where systolic is marked greater than 140 mm Hg, and Diastolic is marked greater than 90 mm Hg. It shall be measured in every 4 hours to record it and further urine is measured in the 24 hour collection (Healthline, 2018).

1. Hospitalization is considered the initiate step from where the necessary treatment could start immediately, sometimes antihypertensive treatment is also given to the pregnant women at home and hospital as well.
2. In this stage,  doctors are forced to perform pre-mature delivery after considering the gestational age of women.
3. Delivery of the baby and placenta must handle and resolve the situation.
4. Fetal heart rate shall be changed of the patient because it indictes distress and frustration.
5. Once the baby is delivered, preeclampsia signs must handle and resolve.

Outpatients need to visit for medical checkup every 2 to 3 days for a general checkup pertaining to seizures, preeclampsia symptom visibility, any vaginal bleeding, measurement of blood pressure, any other sort of reflexes, to check the heart status of the fetus, at every 3^rd day or weekly tests are done to keep a regular track on platelet count, serum liver enzyme and serum creatinine (Redman, Sargent & Staff, 2014).

Inpatientsare allotted a maternal medicine specialist for evaluating the above mentioned conditions more frequently, keeping the emergency in mind, in cases where severe preeclampsia is diagnosed and or where the gestational age is less than 34 weeks and premature delivery is also not possible (Redman, Sargent & Staff, 2014).

Safe and effective Midwifery care is much needed and must be promoted for the maternal and fetal health during pregnancy (Noseworthy, Phibbs& Benn, 2013).The following assessments must be recorded every 4 hours or as prescribes:

1. Headache
2. visual disturbance
3. epigastric pain
4. significant oedema
5. hyper-reflexia
6. Intrauterine growth restriction
7. Blood pressure and its average
8. Blood sample for prescribed duration and interval
9. In case of gestation is greater than 30 weeks carry out a CTG and ultrasound

According to Familymidwiferycare,(2018), 100% government funded is needed in midwifery care. Midwifery is paid and handled by the ministryof health cand long term care to provide care for women thoroughly pregnancy during rhe birth. It is stated that midwives are registered specially health care providers. The people also provode fully clinincal care and facilies. It includes ample of information such as advice, support and excellent choices for dynamic and unique care. The health care providers work to build and enhance relationship of trust and loyalty with women and their families because they understand and known that, this will help to improve and enhance the satisfaction and safety with the experince of birth, pregnancy and early parenting (Familymidwiferycare,2018). There are two registration standards for the board for midwifery practice for mother and infant including:

1. Pregnancy
2. Labor
3. Delivery and post natal care

Pathophysiology and Medical Management of PIH

The standards are include

1. Registration Standard for Eligible Midwives
2. Registration Standard for Scheduled Medicines for Eligible Midwives.

There are mandatory six requirements to be accomplished for becoming a recognize and eligible midwife in Australia . There has to be no restriction on practice in Australia as a midwife with current registration.

1. There has to be an experience of 3 years, specifically as a midwife post initial registration.
2. People have to be competent enough to provide any care including Pregnancy, birth, labor, post natal to women and infants..
3. For a midwife it is needed to provide an additional 20 hour per year of continuing profession for a continual midwifery care.
4. NMBA(Nursing and midwifery board of Australia) approved program for midwifery is conducted every 3 years therefore it shall be successfully completetd.
5. Also, a program within 18 months of recognition needs to be attended and completed, which is determined and identified by the board and it is further for the development and enhancement of midwives’ knowledge and skills

Midwifery is responsible to provide the medications and perform checkups for which they understand their limitations and must not compromise with mother and infant safety under any circumstance and further they must be able to justify the decisions took, which include the following.

1. They do and they must understand the limits they have according to their knowledge and skill sets in comparison to the medical professional and therefore, they should work within prescribed limits (Walker, 2011).
2. Medication is dependent upon the situation and patient condition, healthcare providers must know and be able to interpret when and how to refer or seek guidance as and when necessary from a specialist or the prescriber of the medications.
3. Prescribing and explaining  is a medicine is not the only job, but needs to understand and know the right dosage, indications, interaction with the other medicines and food items, caution to be taken, side effects of medicine and dose with having an up to date knowledge is the real task.
4. Each medicine comes with its own errors and side effects therefore, the midwifery must know the common errors and their prevention.
5. To build up confidence and to enhance midwife competence it is important to make prescribing decisions.
6. When it comes to prescribing medicine or any specific treatment, care is taken, and must be updated with any advances in the related practices, to ensure safety of the patient.
7. Accurate and timely records are must in order to alter the dosage and shift from one treatment to another to prevent any further ailment, issues  and the need for the same shall be understood (Walker, 2011).
8. Legal requirements need to be followed strictly and therefore, entire prescription must be written clearly and complete and shall be readable.
9. Dosage of every treatment and medicine needs to be checked and calculated to ensure patient safety and accuracy of treatment being given.

The hypertension caused during pregnancy required better nursing or midwifery interventions such as having a good sound knowledge of the issue occurs in pregnancy, meeting the needs of the pregnant women, checking blood pressure regularly. The midwise should assess and communicate accurately when detect any initial sign of hypertension. They are expected to play a major role including liaison with the team members and educating the pregnant lady her family. Advocacy is another important part of midwifery intervention for making link between the women, her family members and the obstetric team.The midwifery’s work is completely professional, and they work within the regulations complying to the laws and legislations also, the organizational standards, which include the following:

1. Every midwifery when discussing and analyzing the treatment understands the accountability and responsibility of doing so, they share a management plan and work accordingly, also, they understand that with complete responsibility comes the legal and ethical propositions/implications (McFarland &Wehbe-Alamah, 2014).
2. They should use their own judgmental and the need of the patient as per their condition and test results while discussing medicines, rather than using any personal consideration regarding medications (Filby, McConville&Portela, 2016).
3. They must be well aware of the current legislation and legal and ethical compliances that may directly or indirectly affect their prescribing practices.
4. Ever organization has certain standard and practice codes, which needs to be followed while prescribing.
5. These prescriptions must be kept safely and securely in case they are lost or stolen by any party unknown, midwives must be aware what needs to be done next (McFarland &Wehbe-Alamah, 2014).

Within the own area of expertise the skills and knowledge needs to be updated time to time, with regards to clinical and pharmaceutical knowledge, to comply the legal and organizational policies and for patient safety.

1. It is stated by Fenwick, Butt, Dhaliwal, Hauck &Schmied (2010) that the midwives are responsible to assess and know the symptoms of the disease and its severity on the basis of signs and symptoms and further performing medical tests, they need to understand the conditions before prescribing medicines.
2. Not only pharmaceutical, but non pharmaceutical approaches also need to be understood to simply and modify disease and conditions, to promote health and safety, any sort of desirable or undesirable outcomes that may arise due to the prescription, they must be able to identify them and assess them in order to alter the prescription.
3. The medicine and their doage depends upon the age of the patient, their gestational age and condition of the infant and the renal impairment, every detail needs to be taken care  by the doctors and their mode must be understood clearly and how it may affect the dosage (Ncbi, 2014).
4. There are numerous unwanted effects of the prescription and treatment the patient is undergoing, they may be any sort of allergy, any adverse drug side effect or reactions, contraindications which needs to be known before the start of medication and they must be able to identify the cause to be able to recognize, manage and minimize the effect timely.
5. Inventory management is also important and crucial in the healthcare industry that should be take care by healthcare providers and doctors.
6. Any medicine, which has adverse drug reactions in the patients must be reported and analyzed, it shall be understood how each medicine is licensed and monitored, and how they are being supplied.
7. The understanding of the public health issues pertaining to the medical use must be taken care by the health care providers.
8. Quality midwifery care for new boorns babies and mother shall be considered while expanding the business.
9. The people should eat healthy diet, food and specially limit sodium intake and they shall keep prenatal appointments,
10. The healthcare providers need to provide and develop bed rest if women are needed during pregnancy. In this way, women can take ample of opportunities during pregnancy.

Conclusion

On the above mentioned study, it is concluded pregnancy induced hypertension is effective and dynamic women during pregnancy. It would be clearified to call the disease having multifactorial etiology, and therefore, the hindrance can be done by a combination of various therapies and with the midwifery help. Hypertension in itself is the cause of line of diseases, during pregnancy the complications increase manifold and require considerable medical and pathological management. However, midwife plays an important role in detecting the signs and symptoms of the disease, further performing tests to confirm the severity of the situation, they act as an important link between practitioners and the patient within the organization. Further, it can be concluded that the underlying disease, symptoms, causes and complications must not be underestimated by either the patient, family or the midwives, they have bitter consequences, which may lead to the death of the patient and infant. In this way, the serive providers will help to stand against the rivalries in the international market.

References

Americanpregnancy., (2018). Gestational hypertension:Pregnancy induced hypertension(PIH)[Online], Available from https://americanpregnancy.org/pregnancy-complications/pregnancy-induced-hypertension/ [Accessed as on 25^th September 2018].

Basaran, A. (2009). Pregnancy-induced hyperlipoproteinemia: review of the literature. Reproductive sciences, 16(5), 431-437.

Bollini, P., Pampallona, S., Wanner, P., &Kupelnick, B. (2009). Pregnancy outcome of migrant women and integration policy: a systematic review of the international literature. Social science & medicine, 68(3), 452-461.

Clevelandclinic.,(2018). Pregnancy induced hypertension [Online],  Available from https://my.clevelandclinic.org/health/diseases/4497-pregnancy-induced-hypertension [Accessed as on 25th September 2018].

Familymidwiferycare.,(2018). About us[Online], Retreived from https://familymidwiferycare.ca/about-us/

Fenwick, J., Butt, J., Dhaliwal, S., Hauck, Y., &Schmied, V. (2010). Western Australian women’s perceptions of the style and quality of midwifery postnatal care in hospital and at home. Women and Birth, 23(1), 10-21.

Filby, A., McConville, F., &Portela, A. (2016). What prevents quality midwifery care? A systematic mapping of barriers in low and middle income countries from the provider perspective. PloS one, 11(5), e0153391.

Healthline.,(2018). Preeclampsia [Online], Retrieved from https://www.google.co.in/search?q=preeclampsia+causes&oq=Preeclampsia+Causes&aqs=chrome.0.0l6.2273j0j4&sourceid=chrome&ie=UTF-8

James, D. K., Steer, P. J., Weiner, C. P., &Gonik, B. (2010). High Risk Pregnancy E-Book: Management Options-Expert Consult. Elsevier Health Sciences.

Kovo, M., Schreiber, L., Ben-Haroush, A., Wand, S., Golan, A., & Bar, J. (2010).Placental vascular lesion differences in pregnancy-induced hypertension and normotensive fetal growth restriction. American journal of obstetrics and gynecology, 202(6), 561-e1.

McFarland, M. R., &Wehbe-Alamah, H. B. (2014). Leininger’s culture care diversity and universality. Jones & Bartlett Publishers.

McPhee, S. J., Papadakis, M. A., &Rabow, M. W. (Eds.).(2010). Current medical diagnosis & treatment 2010. New York:: McGraw-Hill Medical.

Ncbi.,(2014). The management of hypertension in pregnancy [Online], Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3925675/

Nice., (2018). Hypertension in pregnancy: diagnosis and management [Online], Retreived from https://www.nice.org.uk/guidance/cg107/resources/guidance-hypertension-in-pregnancy-pdf

Noseworthy, D. A., Phibbs, S. R., & Benn, C. A. (2013).Towards a relational model of decision-making in midwifery care. Midwifery, 29(7), e42-e48.

Osborne, L. M., & Monk, C. (2013). Perinatal depression—the fourth inflammatory morbidity of pregnancy?: theory and literature review. Psychoneuroendocrinology, 38(10), 1929-1952.

Redman, C. W., Sargent, I. L., & Staff, A. C. (2014). IFPA Senior Award Lecture: making sense of pre-eclampsia–two placental causes of preeclampsia?. Placenta, 35, S20-S25.

Seely, E. W., Tsigas, E., & Rich-Edwards, J. W. (2015, June). Preeclampsia and future cardiovascular disease in women: how good are the data and how can we manage our patients?.In Seminars in perinatology (Vol. 39, No. 4, pp. 276-283). WB Saunders.

Walker, R. (2011). Clinical Pharmacy and Therapeutics E-Book.Elsevier Health Sciences.

Yoder, S. R., Thornburg, L. L., &Bisognano, J. D. (2009).Hypertension in pregnancy and women of childbearing age. The American journal of medicine, 122(10), 890-895.

Uzan, J., Carbonnel, M., Piconne, O., Asmar, R., &Ayoubi, J. M. (2011). Pre-eclampsia: pathophysiology, diagnosis, and management. Vascular health and risk management, 7, 467.

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