Pre-Eclampsia and the Impact on Chiropractic Management of the Pregnant Patient
SOURCE: J Clinical Chiropractic Pediatrics 2012 (Dec)
Sharon Gordon, BAppSc(Chiro), DICCP and Sherryn Silverthorne, M Clinical Chiro, RN, RM
Sharon Gordon, BAppSc(Chiro), DICCP
Private Practice, Gippsland, Victoria, Australia
Sherryn Silverthorne, M Clinical Chiro, RN, RM
Private Practice, Melbourne, Victoria, Australia
Up to 10% of women develop pre-eclampsia during pregnancy. It is a significant cause of mortality, responsible for 10-15% of maternal deaths. Its diagnosis is based on the presence of hypertension, with or without proteinuria and edema. As primary contact health care providers, chiropractors must be aware of the risk factors, clinical signs of pre-eclampsia, and the need to modify their management appropriately. An open internet search was conducted for current guidelines in scientific journal databases, in the diagnosis and management of pre-eclampsia. Although there is little literature outlining the role of the chiropractor in patient management, it is clear that specific history and examination procedures must be performed for appropriate co-management and referral.
Key Words: pre-eclampsia, eclampsia, toxemia, hypertension, pregnancy, chiropractic
From the Full-Text Article:
Introduction
Pre-eclampsia (also known as toxemia of pregnancy) is one of the major causes of maternal mortality and morbidity. 10%-15% of maternal deaths are directly associated with pre-eclampsia and eclampsia. [1] Up to 10% of pregnant women develop pre-eclampsia. [2] The incidence of pre-eclampsia in the nulliparous woman is cited as being between 3%-7% and for the multiparous woman 1%-3%. [1, 3] This diagnosis is based on the presence of hypertension, proteinuria, with or without edema. As primary contact health care providers, chiropractors must be aware of the risk factors, clinical signs of pre-eclampsia, and the need to modify their management appropriately.
Objective
To review the diagnostic criteria, risk factors and complications of pre-eclampsia, and discuss how this may affect chiropractic management of the pregnant patient.
Methods
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An open literature search of ‘pre-eclampsia’,‘preeclampsia’, ‘eclampsia’, and ‘toxemia of pregnancy’, was conducted. In addition, these terms were combined with ‘chiropractic’. Other terms entered in combination with ‘chiropractic’ were ‘pregnancy’ and ‘hypertension’. The search was performed with Google, and journal databases PubMed, Medline, Proquest, Cochrane, CINAHL, Medscape, and Index to Chiropractic Literature. Collectively, more than 20,000 articles have been published in scientific journals on ‘pre-eclampsia’, ‘preeclampsia’, ‘eclampsia’ and ‘toxemia of pregnancy’. There were no articles found on chiropractic management of these conditions. In this paper, 29 articles were cited. Six of these were RCTs, 17 were reviews of literature, and 5 were surveys, commentary, cross-sectional studies, case studies and media publications. Inclusion was based on year of publication (2000-2012), research design (RCT and Review of literature prioritized), publication in a peer-reviewed journal, the number of citations of the given article (higher rate of citation given priority), other publications by author, and articles with unique insight into the topic.
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