Acog guidelines for preeclampsia 2013

Preeclampsia is the main cause of maternal mortality and prematurity.

Pregnancy-induced hypertensive disorders affect about 10% of all pregnant women worldwide. According to the Centers for Disease Control and Prevention (CDC), one in twenty pregnant women develops preeclampsia - a potentially life-threatening condition. Studies suggest that preeclampsia is among the most preventable causes of maternal death, and yet it remains the primary cause of maternal mortality, severe maternal morbidity, and preterm delivery in the United States. Current strategies for preeclampsia prevention focus on prenatal care, changes in lifestyle, nutritional supplements, and medications. Screening for signs and symptoms of preeclampsia is important to identify, diagnose, and manage the condition in its early stages to prevent maternal and fetus harm.

Importance of early detection and prevention of preeclampsia

Preeclampsia may go undiagnosed because of its "silent" symptoms and is particularly dangerous if it remains untreated. Untreated preeclampsia may progress towards a severe preeclampsia condition known as Hemolysis, Elevated Liver enzymes, Low Platelet (HELLP) Syndrome. HELLP syndrome can quickly become life-burning for both mother and fetus and is usually associated with severe morbidity. Furthermore, HELP syndrome may result in liver dysfunction and cause disseminated intravascular coagulopathy, acute renal and liver failure, cardiopulmonary arrest, and coma. Preeclampsia poses significant risks to the fetus or neonate, including premature birth, placental abruption, and stillbirth. Additionally, undiagnosed and untreated preeclampsia is associated with significant risks with cerebral complications - eclampsia.

Epidemiological Scope of Preeclampsia

Based on data from the World Health Organization (WHO), pregnancy-related hypertensive disorders responsible for 26% of maternal deaths in Latin America and the Caribbean, contrary, 9% of maternal deaths in Africa and Asia. 16% of all maternal deaths in developed countries, Where maternal mortality is high, 9 percent of deaths are directly connected to preeclampsia and its complications. The epidemiological scope of preeclampsia reflects a wide range of possible risk factors associated with the condition. In the United States, socioeconomic disparities are associated with higher rates of preeclampsia-associated deaths among non-Hispanic black women due to the reduced access to health care facilities, the opportunity for screening, and early detection of the condition.

Furthermore, according to the data from different studies, undesirable psychosocial circumstances can be regarded as preexisting or precipitating factors of the disease from an epidemiological perspective, depending on the scheduling of exposure to psychosocial anxiety (Sharma, 2019). It is reasonable to recommend that pregnant women are "handicapped" by the unfavorable cultural, social background. Medically this is conveyed as a "disability," which lies anatomically in the axis Hypothalamic Pituitary Adrenal (HPA), and causes chronic physiological stress in women with individual risk factors, especially the crash of the homeostasis. In reviewing the data on the social-cultural disadvantages of preeclampsia and their connection, the results of the pregnancy process from the early stages of pregnancy to almost all expressions of the disorder are evidenced(Sharma, 2019). However, data from several studies show that unfavorable conditions of psychosocial stress or sociocultural circumstances precede pregnancy. The recognition of timely demographic risk factors in different empirical studies has shown consistency in epidemiological evidence, mainly during the subclinical duration of preeclampsia.

A scientific Explanation of preeclampsia

Preeclampsia is a multisystem disorder categorized by the development of new-onset abnormal hypertension that usually occurs after 20 weeks of gestation or the first week after pregnancy (Kell, 2019). American Congress of Obstetrics and Gynecology (ACOG) suggests that hypertension can be accompanied by nonspecific clinical signs like irritability, headaches, dizziness, abdominal pain, and blurred vision. Previously, preeclampsia was diagnosed on the basis of hypertension and the presence of protein in the urine. However, ACOG suggested that proteinuria is no longer a diagnostic criteria required for preeclampsia condition.

A blood pressure reading of 140/90 mm Hg is abnormally high in pregnancy. However, a second abnormal blood pressure reading four hours after the first is required to confirm suspected preeclampsia diagnosis.

Preeclampsia and eclampsia etiology remains unclear, and the initial diagnostic characteristic of high blood pressure can be ascribed to deformed blood vessels that feed into the uterine placenta (Kell, 2019). Unusual or destroyed vessels may cause inflammation or restriction in the vessel to release inflammatory substances and other molecules. Delay in child-bearing, genetic defects, inflammatory diseases, and obesity are other potential causes for preeclampsia.

Insufficient current treatments of preeclampsia

Current treatment measures for preeclampsia are limited despite the scale of the issue. Most countries surveyed have few components in place to address preeclampsia, but significant policy and practice gaps remain in place. ACOG recommended the use of self-monitoring for signs and symptoms along with increased surveillance in the form clinic visits, lab test, and sonogram for women with a diagnosis of risk for preeclampsia. Some medications are recommended to reduce your blood pressure. Calcium injections during pregnancy are advised for mitigation of preeclampsia for all females but, in particular, those who are at high risk for preeclampsia in areas where dietary calcium is low (at doses of 1.5-2.0g elemental calcium/day). In order to prevent preeclampsia in women who are at high risk of developing the conditions, a low-dose of acetylsalicylic acid (aspirin, 75mg) being advised. The mitigation of preeclampsia and its associated complications should start with low doses of acetylsalicylic acid (aspirin, 75 mg) before 20 weeks of pregnancy.

Currently, delivery of the baby is the ultimate treatment for preeclampsia; therefore, effective preventions and early recognition of signs and symptoms are essential elements in eliminating preeclampsia-associated complications.

Legislative Background

The priority of the Preeclampsia Foundation is to promote initiatives to minimize preeclampsia and HELLP syndrome and other hypertensive pregnancy disorders by maternal and child disease and death. Patient assistance and schooling, public awareness, increased investment in research, and improved health systems and quality are the main objectives of advocacy efforts. The Preeclampsia Foundation encourages States to use training materials to help women, families, and health workers to understand preeclampsia symptoms and respond appropriately. For instance, the Preeclampsia Foundation has distributed resources to hundreds of health facilities across their country to improve patient's and providers' understanding and responsiveness for preeclampsia symptoms. May received a formal designation in 2013 as a Preeclampsia awareness month by the federal government.

Every year, members of Congress, governors, state legislators, and the mayor across the country call for better awareness of preeclampsia, increased research funding, and access to the care they need for pregnant women. The Preeclampsia Foundation continues to promote the supporting federal clinical investment in preeclampsia and other hypertensive pregnancy dysfunction at the National Institutes of Health. The Preeclampsia Registry, a living database, was launched in 2013 and included valuable data from preeclampsia, its family members, and researchers to improve knowledge and find prevention or therapies for preeclampsia and other hypertensive pregnancy abnormalities. The Preeclampsia Foundation works with its partners on a State by State basis to improve the process of maternal mortality and morbidity assessments and to guarantee that patients and families can participate. The collection of data can lead to improvements in the quality of the delivery of maternal healthcare. It encourages the development of new biomarkers and medications to handle preeclampsia and other hyperglycemic pregnancy dysfunction.

My Own Legislative/Regulatory proposal

Studies showed preeclampsia could manifest itself before women experience any notable symptoms and may develop between recommended prenatal visits. Self-monitoring of blood pressure in pregnant women might be a determining factor in the early detection of gestational hypertensive disorders and should be incorporated into the care for patients with hypertension and is recommended by major guidelines. Governmental funding and legislative measures are needed to ensure sufficient national supply and equitable access to suitable blood pressure devices across the United States. cas a pregnant women with free of charge blood pressure devices suitable for pregnancy and preeclampsia. Adequate education on the use of the device should be conducted during the first maternity appointment.

Anticipated Impact if Implemented.

Much evidence supports the benefits of patient self-monitoring compared with office-based screening, including the more substantial predictive value in terms of preeclampsia risk. If applied, the guidance covers financial ….. all pregnant women with adequate education and devices supply to monitor signs and symptoms of preeclampsia.

Furthermore, remote technology may assess patient's findings automatically transferred to the health care provider. Abnormal results of suspected preeclampsia may be recognized immediately by the system, reviewed by a healthcare professional remotely, and appropriately responded to.

Conclusion

Preeclampsia is a familial condition, although the pathogenesis remains unknown. Multiple factors like maternal genetic predisposition, diet, socioeconomic factors, and behavior might independently contribute to the development of preeclampsia. Clinical and pathological subsets need to be defined with multi-center efforts, and further research on preeclampsia health and economic consequences is essential to inform policy and resource allocation decisions in health care. There are positive and most promising relationships between self-screening for blood pressure, knowledge about the importance of blood pressure measurement, and prevention of preeclampsia. solutions to the problem of preeclampsia are self-screening strategies