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Should Patient Education Be Optional?

Last Updated on Wednesday, October 30, 2013

Last Thursday, the American College of Obstetricians & Gynecologists Task Force on Hypertension in Pregnancy released the electronic version of its Executive Summary of evidence-based recommendations for treatment of women with hypertensive disorders in pregnancy. One recommendation was for healthcare providers to provide clear information to all expectant mothers about the signs and symptoms of preeclampsia and what to do if they occur. In this same month, October 2013, the Journal of Maternal Fetal Neonatal Medicine published the results of the Preeclampsia Foundation’s 2008 survey assessing the state of preeclampsia awareness among pregnant women. The survey results are included in the evidence presented by the College’s recommendations.

The Journal of Maternal Fetal Neonatal Medicine article is titled “Prenatal education is an opportunity for improved outcomes in hypertensive disorders of pregnancy: results from an Internet-based survey.” It was authored by Dr. Anne B. Wallis (Assistant Professor, Department of Epidemiology, University of Iowa), Eleni Z. Tsigas (Executive Director of the Preeclampsia Foundation), Dr. Audrey Saftlas (title?), and Dr. Baha M. Sibai (Visiting Professor, Depart. of Obstetrics, Gynecology & Reproductive Sciences, University of Texas). 

Because little was known about how many prenatal care providers discuss preeclampsia with their patients or if women understand what is communicated to them when such discussions occur, the Preeclampsia Foundation conducted an internet-based survey in March and April of 2008 to determine what women learned about preeclampsia in the context of prenatal care during their first pregnancy (2000-2008). 

Only 40% of the women indicated that their prenatal care provider "definitely" described preeclampsia; 35% said they were "definitely not" given information about preeclampsia, and the remaining 16% did not remember. Of those who definitely had preeclampsia described to them, slightly more than half said they "fully understood the explanation," 37% "understood most of the explanation," while 15% either "understood some of the explanation," or did not remember. Here is the really interesting bit: a full 75% of women who said they "definitely" received information on the signs and symptoms of preeclampsia and understood "fully" or "most" of the explanation, indicated that because of this information, they took one or more of the following actions: 

  • Reported symptoms to their provider,
  • Went to the hospital,
  • Monitored their own blood pressure,
  • Complied with an order of bed rest, or
  • Responded in some other way (e.g., made dietary changes or did their own research on preeclampsia).However, of those who received information, but did not understand the explanations provided, only 6% took any action based on the presence of symptoms. 

Survey participants tended to be well educated and middle class, making the importance of what we learned from this online survey clear: 

  • Most women were not told about preeclampsia or did not fully understand their providers' explanations about the signs and symptoms of preeclampsia. 
  • With knowledge and comprehension, women are much more likely to respond appropriately.
  • Women with fewer resources and less education may receive and retain even less information, and thus be even less likely to respond appropriately to concerning symptoms.

Education about preeclampsia and related hypertensive disorders must continue into the post-partum period so that women can recognize and respond to symptoms even after delivery.  Most cases of eclampsia that develop after a woman has been discharged from a health facility are first seen in an emergency department. A woman with legitimate complaints who presents at an emergency department may leave untreated if the staff is all emergency or trauma providers, without Ob/Gyn specialists. Thus, women not only need basic education in preeclampsia, but they require repeated education to ensure they understand the risks and can be empowered with knowledge that will allow them to advocate strongly for their own care.



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