Women's experiences of preeclampsia: Australian action on preeclampsia survey of women and their confidants

Patients and health care workers perceived challenges in managing preeclampsia, in Malawi

OBJECTIVES

This study investigated perceptions of the challenges for patients and health care workers (HCW) in dealing with preeclampsia in Blantyre, Malawi.

METHODS

A descriptive cross-sectional formative study using semi-structured In-Depth Interviews (IDI) was conducted at Queen Elizabeth Central Hospital (QECH), Malawi. Data was analyzed using NVIVO™ software. Thematic content analysis was used to analyze and interpret the findings. Emerging themes were then developed inductively and deductively. Patients were interviewed who recently had preeclampsia.

RESULTS

Stress, lack of information, physical symptoms, delay in receiving care were identified challenges to better care among patients as well as the impact of poor pregnancy outcomes. Late diagnosis, staff burn out, inadequate skills and lack of resources were expressed as challenge to provide better management by the interviewed HCWs.

CONCLUSION

Our study showed that a diagnosis of preeclampsia is challenging to both patients and HCWs. These challenges need to be addressed carefully at all levels for optimal management of preeclampsia in Malawi, Africa and in order to improve outcomes.

Awareness and Knowledge of Pre-eclampsia Among Saudi Women of Reproductive Age

BACKGROUND

Pre-eclampsia has emerged as a significant concern in maternal healthcare worldwide, impacting the health and well-being of expectant mothers and their unborn children. This study examines the extent of pre-eclampsia knowledge and awareness among Saudi women aged 18 to 49. Recognising informed and proactive healthcare decisions is pivotal in managing and preventing pre-eclampsia.

METHODS

It is a prospective cross-sectional community-based study design. We calculated a minimum sample size of 385 participants using the Raosoft online calculator, aiming for a 5% margin of error and a 95% confidence interval. The structured questionnaire was distributed via various social media platforms to collect the data. The questionnaire consisted of two sections, namely demographics and medical history. Additionally, the questionnaire explored pre-eclampsia risk factors, symptoms, and complications. We analysed data using the Statistical Package for the Social Sciences (SPSS) version 26 (IBM Corp., Armonk, NY). We applied statistical tests, including the Chi-squared test (χ2) and the Mann-Whitney test for non-parametric variables.

RESULTS

Most of our participants were young, with a mean age of 25.94 and single (69.5%). Moreover, many (68.8%) had a bachelor's degree. A notable portion of participants stated they had no family history (86.1%) of pre-eclampsia and (98.1%) no previous experience with pre-eclampsia. Approximately 50% recognised hypertension as a symptom, while 44.1% identified persistent headaches. However, complications such as fetal and maternal death were better-known consequences of pre-eclampsia. 11.3% of participants had adequate knowledge about pre-eclampsia, 39.3% had moderate knowledge, and 49.4% had inadequate knowledge. It is a fact that higher levels of knowledge are positively correlated with advanced age, prior pregnancy experience, and a family history of pre-eclampsia.

CONCLUSION

This study highlights the limited knowledge and awareness of pre-eclampsia among Saudi women of reproductive age. Addressing this knowledge gap is crucial for preventing pre-eclampsia-related maternal and fetal complications. Policymakers and healthcare providers should consider implementing educational programs to raise awareness and improve outcomes for pregnant women in Saudi Arabia and similar regions.

Women´s experiences of preeclampsia as a condition of uncertainty: a qualitative study

Background

Preeclampsia is a severe condition that annually affects about 3–8% of pregnancies worldwide. Preeclampsia is thereby one of the most common pregnancy complications for both mother and child. Despite that, there is limited research exploring the women´s perspective of experiencing preeclampsia.

Aim

The aim of this study was to describe women´s experiences of preeclampsia to improve the support and care given during and after pregnancy.

Methods

A qualitative descriptive interview study was undertaken. Nine women, diagnosed with preeclampsia, were recruited from a maternity unit in southern Sweden. The descriptive phenomenological method according to Amadeo Giorgi was used to analyse the data.

Results

The women´s experiences of PE were expressed as A condition of uncertainty, meaning that it was an unexpected and unknown situation. This main result consisted of 1) incomprehensible diagnosis message, 2) ambivalent feeling when the unexpected happens, 3) confusing contradictory messages, 4) appreciated support from the midwife, 5) need for continuous information. The nature of preeclampsia can sometimes deteriorate rapidly both for the mother and/or the child, often resulting in conversion from a planned vaginal spontaneous delivery to an emergency Caesarean section. The women narrated diffuse symptoms, and they experienced that they got contradictory information from different health care professionals regarding the severity of their disease. Detailed and continuous information is requested throughout the course of the disease, and the postpartum period.

Conclusion

This qualitative study reveal a need for improved clinical management. Health care professionals must be aware that women and their partners need detailed, consistent and repeated information about severity and prognosis to diminish the condition of uncertainty, confusion and fearful experience. The clinical implication would be a standardized preeclampsia education for pregnant women early on in the pregnancy, to raise awareness of preeclamptic symptoms. Furthermore, there is a need for harmonized guidelines and individualized support to the woman and her partner both at the antenatal care and the maternity ward and inpatient care at the hospital.

Pregnant women's experiences with the management of hypertensive disorders of pregnancy: a qualitative study

Background

Hypertensive disorders are a leading cause of mortality and morbidity during pregnancy. Despite multiple national and international clinical guidelines and a plethora of research in the field of optimising management, there has been limited research describing the perspectives and experiences of pregnant women with the management of hypertensive disorders of pregnancy (HDP). Understanding these perceptions and experiences is imperative to the optimisation of HDP management.

Methods

A qualitative study involving face-to-face, in-depth interviews were undertaken with 27 pregnant women diagnosed with and being treated for HDP to explore their perspectives of and experiences with clinical management. Written consent was obtained individually from each participant, and the interviews ranged from 16 to 54 min. Inductive codes were generated systematically for the entire data set. Line-by-line analysis was then performed and nodes were created within NVivo, a qualitative data management software. Data collection was continued until thematic saturation was reached. Thematic analysis was employed to interpret the data.

Results

Three major descriptive themes were discerned regarding the women’s perspectives on and experiences with the management of HDP: attitudes towards monitoring of HDP, attitudes and perceptions towards development and management of complications, and perceptions of pregnant women with chronic hypertension. Trust in the hospital system, positive attitudes towards close blood pressure monitoring as well as self-monitoring of blood pressure, and a realistic approach to emergency antenatal hospital admissions contributed to a positive attitude towards monitoring of HDP. Women with prior experiences of HDP complications, including pre-eclampsia, were more confident in their clinical management and knew what to expect. Those without prior experience were often in shock when they developed pre-eclampsia. Some women with chronic hypertension displayed limited understanding of the potential risks that they may experience during pregnancy and thus lacked comprehension of the seriousness of the condition.

Conclusions

The clinical management experiences of pregnant women with HDP were varied. Many women did not feel that they were well informed of management decisions and had a desire to be more informed and involved in decision-making. Clear, concise information about various facets of HDP management including blood pressure monitoring, prescription of the appropriate antihypertensive agent, and planning for potential early delivery are required.

Women's attitudes, beliefs and values about tests, and management for hypertensive disorders of pregnancy

BACKGROUND

Advances in research suggest the possibility of improving routine clinical care for preeclampsia using screening (predictive) and diagnostic tests. The views of women should be incorporated into the way in which such tests are used. Therefore, we explored the views of women with experience of preeclampsia and other hypertensive disorders in pregnancy (HDPs) about predictive and diagnostic tests, treatment risks, and expectant management.

METHOD

Eight hundred and seven women with experience of preeclampsia or other HDPs completed an online questionnaire. These women were participants in the Preeclampsia Registry (USA). The questionnaire contained 22 items to elicit women's views about predictive tests (n = 8); diagnostic tests (n = 5); treatment risks (n = 7), and expectant management (n = 2). An optional text box allowed participants to add qualitative open-ended comments. Levels of agreement with the statements were reported descriptively for the sample as a whole, and a preliminary investigation of the role of lived experience in shaping women's views was conducted by comparing subgroups within the sample based on time of HDP delivery (preterm/term). The qualitative data provided in the optional text box was analysed using inductive thematic analysis to examine participants' responses.

RESULTS

Women generally favored predictive and diagnostic testing, although not because they would opt for termination of pregnancy. Participants generally disagreed that taking daily low-dose aspirin (LDA) would make them nervous, with disagreement significantly higher in the preterm delivery subgroup. A high proportion of participants, especially in the preterm delivery subgroup, would take LDA throughout pregnancy. The majority of participants would be more worried about the possibility of preeclampsia than about the risks of treatments to their health (60%), and that proportion was significantly higher in the preterm delivery subgroup. There were no differences between subgroups in the views expressed about expectant management, although opinion was divided in both groups. Overall, most participants opted to put the baby's interests first.

CONCLUSION

Women with experience of hypertensive disorders were enthusiastic about improved predictive and diagnostic tests. However, varied views about treatment options and expectant management suggest the need for a shared decision-making tool to enable healthcare professionals to support pregnant women's decision-making to maximize the utility of these tests and interventions.

The experience of provided information and care during pregnancy and postpartum when diagnosed with preeclampsia: A qualitative study

INTRODUCTION

Despite preeclampsia being one of the most severe obstetrical complications there is only scant research describing women's experiences of preeclampsia. The aim of this study was to explore women's experience during pregnancy and the postpartum period regarding the provided information and care concerning preeclampsia.

METHODS

A qualitative study was designed. Semi-structured face-to-face interviews were performed with fifteen women who were diagnosed with preeclampsia and included at two maternity units located in southern Sweden. The material was analyzed using content analysis.

RESULTS

Suffering from preeclampsia was understood as being stressful, illustrated in four themes: fragmented information, lack of care planning, separation postpartum, and overall stress and worry.

CONCLUSIONS

The women experienced fragmented obstetrical care and information deficits when diagnosed with preeclampsia. Our findings indicate a need for additional support and professional guidance due to increased stress, worry, and despair of being separated from the newborn. Future research investigating specific care-planning and postpartum follow-up are suggested as steps to improve care for women with a pregnancy complicated by preeclampsia.

Knowledge and attitude of pregnant women towards preeclampsia and its associated factors in South Gondar Zone, Northwest Ethiopia: a multi-center facility-based cross-sectional study

BACKGROUND

Preeclampsia has the greatest impact on maternal mortality which complicates nearly a tenth of pregnancies worldwide. It is one of the top five maternal mortality causes and responsible for 16 % of direct maternal death in Ethiopia. Little is known about the level of knowledge and attitude towards preeclampsia in Ethiopia. This study was designed to assess the knowledge and attitude towards preeclampsia and its associated factors in South Gondar, Northwest Ethiopia.

METHODS

A multicenter facility-based cross-sectional study was implemented in four selected hospitals of South Gondar Zone among 423 pregnant women. Multistage random sampling and systematic random sampling techniques were used to select the study sites and the study participants respectively. Data were entered in EpiData version 3.1 while cleaned and analyzed by Statistical Package for Social Sciences (SPSS) version 23. Descriptive and inferential statistics were performed. Adjusted odds ratio with 95 % confidence interval were used to identify the significance of the association between the level of knowledge on preeclampsia and its predictors.

RESULTS

In this study, 118 (28.8 %), 120 (29.3 %) of the study participants had good knowledge and a positive attitude towards preeclampsia respectively. The likelihood of having good knowledge on preeclampsia was found to be low among women with no education (AOR = 0.22, 95 % CI (0.06, 0.85)), one antenatal care visit (ANC) (AOR = 0.13, 95 % CI (0.03, 0.59)). Whereas, those who booked for ANC in the first trimester (AOR = 6.59, 95 % CI (1.43, 30.33)), gave the last birth at a health facility (AOR = 2.61, 955 CI (1.03, 6.61)), and experienced a complication during previous births (AOR = 3.67, 95 % CI (1.78, 7.57)) were more likely to be knowledgeable on preeclampsia.

CONCLUSIONS

No formal education and not attending four ANC visits were associated with poor knowledge of preeclampsia. While participants who visited health facilities during the first trimester, who gave birth at health facilities, and those who experienced a complication in previous births were more likely to be knowledgeable on preeclampsia. Improving the numbers of ANC visits and encouraging facility delivery are important measures to improve women's knowledge on preeclampsia. Health education regarding preeclampsia risk factors, symptoms, and complications shall be emphasized.

The lived experience of women with a high-risk pregnancy: A phenomenology investigation

BACKGROUND

Pregnancy is a time of transformation, hope, expectation, and worry for women and their families - none more so than when the pregnancy is at-risk. The objective of this study was to describe the lived experience of women during high-risk pregnancy.

METHODS

This qualitative investigation utilized a hermeneutic phenomenology study. The study was conducted in a public health center in a large urban area in southeast Iran. Purposive sampling of 20 women with a high-risk pregnancy. Participants included both nulligravid and multigravid women in the second and third trimesters of pregnancy with varied medical conditions. Data collection used face-to-face interview with transcribed data analyzed using Braun and Clarke's six stage thematic analysis approach.

RESULTS

Four themes were extracted and included challenge of family in high-risk pregnancy, challenge of anticipation for motherhood, and challenges for future pregnancies, and challenge of adaptation.

CONCLUSIONS

Findings demonstrate that women with a high-risk pregnancy struggle to adapt with burdens related to successful maternal role attainment and family functioning. Fears about pregnancy outcome and future pregnancies are dominant.

Placental growth factor (alone or in combination with soluble fms-like tyrosine kinase 1) as an aid to the assessment of women with suspected pre-eclampsia: systematic review and economic analysis

BACKGROUND

Pre-eclampsia (PE) prediction based on blood pressure, presence of protein in the urine, symptoms and laboratory test abnormalities can result in false-positive diagnoses. This may lead to unnecessary antenatal admissions and preterm delivery. Blood tests that measure placental growth factor (PlGF) or the ratio of soluble fms-like tyrosine kinase 1 (sFlt-1) to PlGF could aid prediction of PE if either were added to routine clinical assessment or used as a replacement for proteinuria testing.

OBJECTIVES

To evaluate the diagnostic accuracy and cost-effectiveness of PlGF-based tests for patients referred to secondary care with suspected PE in weeks 20-37 of pregnancy.

DESIGN

Systematic reviews and an economic analysis.

DATA SOURCES

Bibliographic databases including MEDLINE, EMBASE, Web of Science and The Cochrane Library and Database of Abstracts of Reviews of Effects were searched up to July 2015 for English-language references. Conferences, websites, systematic reviews and confidential company submissions were also accessed.

REVIEW METHODS

Systematic reviews of test accuracy and economic studies were conducted to inform an economic analysis. Test accuracy studies were required to include women with suspected PE and report quantitatively the accuracy of PlGF-based tests; their risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) criteria. The economic studies review had broad eligibility criteria to capture any types of economic analysis; critical appraisal employed standard checklists consistent with National Institute for Health and Care Excellence criteria. Study selection, critical appraisal and data extraction in both reviews were performed by two reviewers.

ECONOMIC ANALYSIS

An independent economic analysis was conducted based on a decision tree model, using the best evidence available. The model evaluates costs (2014, GBP) from a NHS and Personal Social Services perspective. Given the short analysis time horizon, no discounting was undertaken.

RESULTS

Four studies were included in the systematic review of test accuracy: two on Alere's Triage^® PlGF test (Alere, Inc., San Diego, CA, USA) for predicting PE requiring delivery within a specified time and two on Roche Diagnostics' Elecsys^® sFlt-1 to PlGF ratio test (Roche Diagnostics GmbH, Mannheim, Germany) for predicting PE within a specified time. Three studies were included in the systematic review of economic studies, and two confidential company economic analyses were assessed separately. Study heterogeneity precluded meta-analyses of test accuracy or cost-analysis outcomes, so narrative syntheses were conducted to inform the independent economic model. The model predicts that, when supplementing routine clinical assessment for rule-out and rule-in of PE, the two tests would be cost-saving in weeks 20-35 of gestation, and marginally cost-saving in weeks 35-37, but with minuscule impact on quality of life. Length of neonatal intensive care unit stay was the most influential parameter in sensitivity analyses. All other sensitivity analyses had negligible effects on results.

LIMITATIONS

No head-to-head comparisons of the tests were identified. No studies investigated accuracy of PlGF-based tests when used as a replacement for proteinuria testing. Test accuracy studies were found to be at high risk of clinical review bias.

CONCLUSIONS

The Triage and Elecsys tests would save money if added to routine clinical assessment for PE. The magnitude of savings is uncertain, but the tests remain cost-saving under worst-case assumptions. Further research is required to clarify how the test results would be interpreted and applied in clinical practice.

STUDY REGISTRATION

This study is registered as PROSPERO CRD42015017670.

FUNDING

The National Institute for Health Research Health Technology Assessment programme.

Experience of Preeclampsia and Bed Rest: Mental Health Implications

Preeclampsia is a major cause of maternal and fetal morbidity and mortality affecting 5-10% of pregnancies. Mental health issues are often exhibited in this vulnerable population partly due to the rigid management of this condition including prolonged bed rest. The purpose of this qualitative study is to describe women's experience with preeclampsia and being placed on bed rest. Six themes emerged including: negative feelings and thoughts, lack of guidelines about their diagnosis, family stressors, lack of social support, not being heard, loss of normal pregnancy, and physical symptoms. The identified categories provide insight into improving care for these women.

Knowledge of pre-eclampsia in women living in Makole Ward, Dodoma, Tanzania

BACKGROUND

Pre-eclampsia is a hypertensive disorder specific to pregnancy responsible for significant maternal morbidity and mortality in Africa. The majority of deaths related to pre-eclampsia could be avoided with timely and effective care. "Phase one delays" arise because of lack of knowledge.

OBJECTIVES

This study aimed to assess the knowledge levels of women living in Makole ward, comparing respondent subgroups with different demographic characteristics. It also aimed to compare knowledge levels in respect to six subtopics of pre-eclampsia. This was to allow for planning of appropriate activities to reduce delays in seeking health care.

METHODS

This study surveyed 200 adult women randomly identified in the community. They were asked 36 questions on pre-eclampsia requiring yes / no answers. The data was analysed quantitatively.

RESULTS

Overall knowledge levels were low with an average of 41% of correct answers. Minor differences in the knowledge levels of demographic subgroups were found. Statistically significant differences were identified between sub-topics of pre-eclampsia; signs and symptoms were the least well known.

CONCLUSION

Educational systems (formal and informal) are failing to provide communities with potentially life-saving information. Health centre, community and school based education programmes are recommended.

Prevalence and Risk Factors of Maternal Anxiety in Late Pregnancy in China

Objective: A large number of studies have shown the adverse neonatal outcomes of maternal psychological ill health. Given the potentially high prevalence of antenatal anxiety and few studies performed among Chinese people, the authors wanted to investigate the prevalence of antenatal anxiety and associated factors among pregnant women and to provide scientific basis to reduce prenatal anxiety effectively. Methods: A cross-sectional study was carried out at the Changchun Gynecology and Obstetrics Hospital from January 2015 to march 2015, with 467 participants of at least 38 weeks’ gestation enrolled. Antenatal anxiety was measured using the Self-Rating Anxiety Scale (SAS). χ² test and logistic regression analysis were performed to evaluate the association of related factors of antenatal anxiety. Results: Among the 467 participants, the prevalence of antenatal anxiety was 20.6% (96 of 467). After adjustment for women’s socio-demographic characteristics (e.g., area, age, household income), multivariate logistical regression analysis revealed that antenatal anxiety showed significant relationship with education level lower than middle school (years ≤ 9), expected natural delivery, anemia during pregnancy, pregnancy-induced hypertension syndrome, disharmony in family relationship and life satisfaction. Conclusions: It is important to prevent or reduce antenatal anxiety from occurring by improving the health status of pregnant women and strengthening prenatal-related education and mental intervention.

An Integrative Review of Mothers' Experiences of Preeclampsia

OBJECTIVE

To describe and synthesize the extant research on women's experiences with preeclampsia into the postpartum period, when birth is necessary to save the mother's or infant's life.

DATA SOURCES

The PubMed, PsycINFO, CINAHL, and ISI Web of Science databases were searched for relevant articles published between 2004 and 2014.

STUDY SELECTION

Although a comprehensive search was performed, only eight studies were found that answered the research question and were included in the review.

DATA EXTRACTION

Data were extracted and analyzed from each article that addressed women's experiences of pre-eclampsia: authors, year, country, study purpose, design, sample size, setting, main focus, data collection method, study findings, and limitations.

DATA SYNTHESIS

The following themes emerged from the synthesis of how women experience severe preeclampsia: (a) From Feeling Fear and Closeness to Death to Feeling Hope, (b) Relationship With the Infant, (c) Separation From Loved Ones, and (d) Communication With Health Professionals.

CONCLUSION

Fear and feeling close to death characterized the experience of childbirth for many of these women, and the premature birth was a shock for many. Having a newborn in the NICU was experienced as a transition from fear to hope as the newborn's life was sustained outside the womb. Separation of the mother from the newborn when one or both need special care remains a problem. Health care professionals must ensure that women in this situation receive the information and support they need and that the information is understood. This review revealed that more research is necessary regarding this specific mother-infant dyad and their families in the context of Western countries and developing countries.

Preeclampsia screening from the patient's perspective

Preeclampsia represents an important cause of maternal and fetal morbidity and mortality. The early identification of pregnant women at risk represents a priority in reducing preeclampsia complications. For a better evaluation of the importance of preeclampsia screening, a questionnaire was developed. Methods. The questionnaire based on 14 items was distributed online. The form was anonymously completed. All forms consisted of simple questions. Results. Data from 151 completed forms were collected and analyzed. The analysis revealed the importance of arterial pressure control. 15% of the responders needed hypertensive treatment in pregnancy. They were interested in completing the preeclampsia risk test (88%). Conclusions. The results suggested that preeclampsia screening and measurement of the atrial pressure may become a valuable tool for evaluating and for determining the diagnosis in question, but the possibility of emotional distress for the subjects at risk of developing the condition should be taken in consideration.

Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy

OBJECTIVE

This guideline summarizes the quality of the evidence to date and provides a reasonable approach to the diagnosis, evaluation and treatment of the hypertensive disorders of pregnancy (HDP).

EVIDENCE

The literature reviewed included the previous Society of Obstetricians and Gynaecologists of Canada (SOGC) HDP guidelines from 2008 and their reference lists, and an update from 2006. Medline, Cochrane Database of Systematic Reviews (CDSR), Cochrane Central Registry of Controlled Trials (CCRCT) and Database of Abstracts and Reviews of Effects (DARE) were searched for literature published between January 2006 and March 2012. Articles were restricted to those published in French or English. Recommendations were evaluated using the criteria of the Canadian Task Force on Preventive Health Care and GRADE.