Discussion: Pregnancy Induced Hypertension & Maternal Outcomes

This assignment is a discussion board post analyzing a research article on pregnancy complications, specifically focusing on pregnancy-induced hypertension and its impact on maternal outcomes. The student provides a two-paragraph overview of the topic, introducing the chosen article by U. Vivian Ukah et al. (2018) and critiquing it using ten specific questions, incorporating APA format. The article, "Prediction of adverse maternal outcomes from pre-eclampsia and other hypertensive disorders of pregnancy: A systematic review," is examined for its purpose, literature review, research gaps, methods, findings, and implications for future research and advanced nursing practice. The post highlights the importance of the study, particularly its use of multivariable models to predict adverse maternal outcomes and the need for further research to refine these models for improved patient care. The student emphasizes the article's value in understanding potential predictors of maternal complications in women with hypertensive disorders of pregnancy.

Running head: COMPLICATIONS OF PREGNANCY
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CHAPTER:22- COMPLICATIONS OF PREGNANCY

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Introduction
During pregnancy a women’s body goes through a lot of changes due to high level of
estrogen and progesterone. Mild nausea, abdominal pain, augmented blood volume etc are
some common discomforts felt by a pregnant woman. But in some cases, the symptoms may
be amplified and cause maternal disorders leading to complications in the pregnancy.
Complications of pregnancy are health related problems occurred during and after the
childbirth. There are two phases in the complication, the first phase which is termed as the
Obstetric labour Complication that occurs during the pregnancy. While the second phase are
the problems which arises after the pregnancy is called Puerperal Disorders (J.M.Alexander,
2013). According to Global Burden of Disease Study (GBD), 2017 there has been around 2.5
lakh deaths due to pregnancy globally. some major disorders are Hypertension, Gestational
diabetes mellitus, blood clotting disorder, placental disorder and many more which may
jeopardise foetus’s life and expose it to various diseases
To understand the complication of the pregnancy in a more efficient manner a report has been
chosen that focuses on the Pregnancy Induced Hypertension and its effect on the mother. It is
one of the major causes of maternal and foetal death and ill-health conditions.

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Discussion
U. Vivian Ukah, Dane A. De Silva, Beth Payne, Laura A. Magee et.al (2018). Prediction of
adverse maternal outcomes from pre-eclampsia and other hypertensive disorders of
pregnancy: A systematic review. Pregnancy Hypertension, 11, 115-123
Purpose of the article
The Hypertension Disorder of pregnancy (HDP) results in various maternal complications
such as eclampsia, stroke and impairment to the hepatic and renal organs. If these symptoms
are addressed using simple procedures it could aid in managing and overcoming these
complications. Thus, this research report focuses on accessibility of probable univariable
predictors (L.A. Magee, 2015). It also aims to review reports and predict the symptoms of the
Hypertension Disorder and state the worst maternal outcomes.
Literature Review
A literature review was conducted on Thangaratinam et.al report that focused on “Estimation
of proteinuria as a predictor of problems of pre-eclampsia”. This report stated that Proteinuria
was a faulty analyst of maternal complications. In his review uric acid level also was of
clinical usefulness and HELLP (haemolysis, elevated liver enzymes, low platelet count)
syndrome was an opposing outcome and was a common consequence. His review also reports
that the liver enzyme tests like AST, ALT and LDH were ordinary predictors of maternal and
foetal complications with preeclampsia. These tests did not possess any solid clinical utility
but their AUROCs shows a great level of distinction and can be investigated further for better
analysis.
Research Gap
There are many research’s done by numerous authors to identify various probable predictors
of maternal complications of pregnancies. This particular report is the first to identify the

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predictors of HDPs complication in a woman. All types of HDPs expands the clinical
applicability as it includes a larger population of women at risk and not every woman is
originally admitted with high blood pressure. This review solely includes the usage of
multivariable models which was absent in all the previous reviews. The result of this study
might not be applicable in dissimilar setting as the review includes some low quality and
underpowered study. It also includes multivariable models which were not validated
externally, thus making the results not plausible in different scenario. All the tests are taken
into account in this review as they were interested in studying any test which will show a
possible maternal analytical value for HDPs. Due to very little literature in this study area the
author includes even the mediocre test in his report.
The problems in this study is the methodological issues and the diversification in population
that effects the ability of the review to draw any specific conclusion. The inadequate numbers
of research assessing similar tests and consequences also made it difficult to incorporate most
of the analysts using meta-analyses.
Methods used-
The methodology is divided into various sections. Firstly, the protocol is followed by doing
the registration of the report. A strategical planning is done to select and search various
literatures.
To study various maternal complications a search in MEDLINE (Ovid), Embase (Ovid),
CINAHL (EBSCO) was conducted. A thorough search in Google Scholar was done to see
any potential articles related to this topic. Every article was screened individually, firstly by
title and abstract and then by going over the whole article one by one. They extracted
information on study and test(s) features and outcomes. Accuracy was measured using
sensitivity, precision, probable ratios and area under the receiver operating curve (AUROC).

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The data is taken and then extracted in a very precise manner to avoid any wrong analysis.
Then the data which has been extracted is assessed accordingly to bring it to a study quality.
The assessed data is then synthesised in according to various models and likelihood ratios.
All the statistical analysis was performed using R versions 3.1.3. Studies that stated none of
these projected measures were added only if adequate data were there to calculate these
measures. The studies which reported both maternal and foetal as a collective outcome were
excluded.
Sample, Size, and Setting
The sample size includes thirty-two women, as a study sample and only twenty-eight of
which presented model development and the other four scrutinized external validation. The
study was chosen as it deals with the ability to predict the complication using easy tests. The
report also justifies to present a report on potential predictors of adverse maternal problems
among the women.
Findings and Conclusions
This research included a specific number of women who have HDPs and that explored the
capacity of various test to foresee adverse outcomes in the mothers. This heterogeneity
contributed to the unpredictable results found for the consistent performance of the estimated
tests. The reasonable performances as a rule in test included “nonspecific viral symptoms”
and 24hour urinary protein. The rule-out tests included headaches, pictorial symptoms,
hyperreflexia, and serum uric acid.
Moreover, the test was assessed in only one study or was estimated in multiple studies but
was performed imperfectly. In this research the oxygen saturation presented as most potential
prognostic test for the hypertensive mother in univariable and mostly in multivariable
models. Supplementary tests reflected headaches, visual symptoms, AST, chest pain in a

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multivariable model which was also validated internally. Some of the tests need further
investigations as a potential predictor for adverse maternal problems of HDPs. The best
accomplished multivariable model includes gestational age, chest pain or dyspnoea, oxygen
saturation, platelet count, creatinine and AST as a predictor of complex maternal problem in
women with high blood pressure and overlaid pre-eclampsia.
This univariable and multivariable model was superficially assessed in four works that were
involved in the review. Though three of them justified a decent discriminatory performance,
the other two of these studies were lacking sufficient data. In addition, the case-mix
differentiation between the studies and the progress study could have affected the model
performance.
The prediction of unfavoured maternal problems from the HDPs is vital to optimise
management, inclusive of time of delivery and planning the best place for the health care. In
general, the multivariable models achieved better results than the univariable tests.
Nevertheless, a sufficiently powered exterior authentication in studies using a similar
population as an expansion studies are still essential for most of these models. The review
highlights the need for improved quality studies in estimation and support. It also needs a
better amalgamation of predictors for improved chances of prediction of adverse maternal
outcomes.
What are the implications for future research?
The following review on the complications of pregnancy among women with all types of
HDPs has been provided for the first time. The strength of the article lies in the quality of the
review which majority of studies on this topic usually lack. In order to conduct future
research, this review can be a steppingstone for researchers with respect to understanding
complications women face during pregnancy. In comparison with other literature and

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guidelines, the article provided by Thangaratinam, et.al systematically reviews the maternal
symptoms as predictors of adverse outcomes. Some suggest that proteinuria predictor of
maternal complications while some have concluded that proteinuria as a prognostic test to
identify maternal outcomes is still insufficient. However, the research is still ongoing to
determine the best methods of measurement for predicting adverse outcomes of maternal
complications. The major strength of this review is the inclusion of HELLP syndrome as an
important criterion for HDP as it is an important part of spectrum of Pre-eclampsia rather
than outcome.
How could the information in this article be applied to advanced nursing practice?
The topic of complications during pregnancy is important to study for people opting for
advanced nursing. This article would be beneficial in terms of understanding the potential
predictors of maternal complications with all types of HDPs. The definitions for HDPs have
been revised and the use of multivariable models have also been included. These models
were previously not included as there were no sufficient data available. The information
related to HDPs can be utilised for future research. The review has reported that the liver
enzyme tests good moderately become the predictors of combine maternal and foetal
complications in women with pre-eclampsia. Since the review has been given in in alignment
with the NICE guidelines, there is an improved need for more studies for kidney and liver
function too to predict adverse outcomes.
Would you recommend this article to others as an example to add to the understanding of
this information?
The following article deals with identifying the hypertensive disorders of pregnancy that
become the lead cause of maternal and prenatal mortality and morbidity. A meticulous study
on identification of predictors of severe maternal complications among women was
conducted by looking at previous researches on the following topic. The article is

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recommended to others as an example because there have been not many researches
conducted. The research has provided strong evidence of prediction and provided
multivariable models rather than single predictors. The credibility of this review will be valid
in future as it has systematically reviewed adverse maternal outcomes in women with HDPs.
The following research will be a strong evidence of pregnancy characteristics, its symptoms
and symptoms of pre-eclampsia for the prediction of composite maternal outcomes.
Conclusion
As mentioned above, the following research can be a steppingstone for researchers to predict
the adverse maternal outcomes. The helping taken from MEDLINE, Embase and CINAHL
for studies made it easier to gain insights on predictors of severe maternal complications
among women with a hypertensive disorder of pregnancy. The predictions made in the study
is likely to be positive due to the use of multivariable models and therefore the results were
not dependent on a single test. The strength of the review was utilising combinations of test
in multivariable models rather than using a single predictor to reach the desired outcome. The
multivariable models performed better and the need of similar studies for these models are
still required.

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Reference List
Shaheen, S. O., Macdonald-Wallis, C., Lawlor, D. A., & Henderson, A. J. (2016).
Hypertensive disorders of pregnancy, respiratory outcomes and atopy in
childhood. European Respiratory Journal, 47(1), 156-165.
Sutan, R., Hassan, H., & Shamsuddin, K. (2016). Health Information Seeking Behaviour
among Hypertensive Disorder In Pregnancy (HDP) High Risks Antenatal Mothers. of, 6, 2.
U. Vivian Ukah, Dane A. De Silva, Beth Payne, Laura A. Magee et.al (2018). Prediction of
adverse maternal outcomes from pre-eclampsia and other hypertensive disorders of
pregnancy: A systematic review. Pregnancy Hypertension, 11, 115-123