Karen S. Reed

Date of Award

5-1999

Document Type

Thesis

Degree Name

Master of Science (MS)

Department

Nursing

Abstract

Preeclampsia and pregnancy-induced hypertension complicate 6 to 7% of all pregnancies in the United States with the incidence varying among different regions, counties, and states. For improved perinatal outcomes in high-risk pregnancies there must be adequate care given in a timely and appropriate manner. Very little has been written on the incidence and trends in rural America and even less is known about incidence and trends in the rural Native American population. It is unknown how effective small rural hospitals are in the nursing care of the hypertensive pregnant women they encounter.

This project was an epidemiological retrospective cohort study of pregnancy- related hypertension (PRH) which also included a descriptive analysis of nursing care practices for hypertensive pregnant women in North Dakota hospitals. It encompassed all births to North Dakota residents from 1989 through 1997 who were Caucasian and Native American. The epidemiological data was extracted from the North Dakota Health Department birth records. A survey was sent to all North Dakota hospitals offering delivery services to obtain data on nursing care practices.

Of the 87,737 births analyzed, the overall incidence of PRH was 3.8%, lower than the national average. The Caucasian population with an overall incidence of 3.8% is slightly more at risk than the Native American population, with overall incidence of 3.6%. Plurality of births posed the greatest relative risk with 1995 showing a high of 3.34, with a 95% confidence interval of (2.40, 4.64). The relative risk for infants of hypertensive pregnancies to be of low birth weight ranged from 2.51 to 4.13, and prematurity of gestation was also a great risk at 3.09. Consistently throughout the nine years smoking was a protective factor against preeclampsia. The risk of having PRH and a low birth weight infant were higher in the nonsmoking groups than the smoking groups. Maternal outcomes include an increased risk of being transferred to a referral hospital and delivery by cesarean section.

The survey of nursing care practices revealed that the hypertensive pregnant woman is being effectively cared for, overall, and appropriately transferred when necessary. The greatest concerns expressed by nursing staff in caring for mothers with PRH are lack of experience and fears of inability to handle seizures and other emergency situations.

There is a great need for providing education to nurses in these small rural communities. Astute nursing surveillance is essential during the antepartum and intrapartum periods to mitigate the effects of PRH and decrease perinatal morbidity and mortality. Future studies need to focus on the paradoxical effects of smoking and pregnancy, and what makes it protective for preeclampsia. Nursing research is needed on the effectiveness of activity restriction with preeclampsia, and whether controlling the environment actually makes a difference in illness experiences and the outcomes for mothers and infants.

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