Pre-eclampsia is characterised as pregnancy-induced hypertension and is associated with proteinuria after week 20 of pregnancy (El-Sayed, 2017; Nirupama et al, 2020). It can trigger a woman's anxiety about themselves or their baby during pregnancy (Toker and Kömürcü, 2017). Pre-eclampsia is a major cause of maternal mortality and morbidity, neonatal and fetal mortality and preterm birth (Nirupama et al, 2020). Globally, the incidence of pre-eclampsia was 5.90% in 2019 (Macedo et al, 2020). In Indonesia, pre-eclampsia and eclampsia prevalence is 3.30% (Kementerian Kesehatan Republik Indonesia, 2018), and pre-eclampsia and eclampsia are the second leading cause of mortality during pregnancy (Wardhana et al, 2021).
Blood pressure is regulated mainly by the autonomic nervous system; in pre-existing and gestational forms of hypertension during pregnancy, the sympathetic nervous system is activated (Braunthal and Brateanu, 2019; Agrawal and Wenger, 2020). Systolic blood pressure is created when the heart muscle contracts, pushing the contents of the ventricles into the artery. During diastole, arteries expand because of peripheral resistance in the arterioles, which prevents all blood from reaching the tissues. As a result, blood pressure is influenced in part by the strength and volume of the arteriole wall. In general, higher blood pressure is detrimental to maternal vasculature, and can result in endothelial dysfunction and decreased vasoconstriction-buffering mechanisms in the blood vessel wall, which contribute to the development of hypertension (Spradley, 2019).
Proteinuria has been linked with the severity of pre-eclampsia, particularly in early-onset pre-eclampsia. A study by Dong et al (2017) found that proteinuria level has a significant positive relationship with time of onset of pre-eclampsia. Adverse fetal outcomes appear to result from prematurity rather than proteinuria itself (Dong et al, 2017). A cross-sectional study reported that blood pressure was significantly associated with proteinuria in patients with hypertension (Rudiansyah et al, 2020). Quantitative examination of protein content of urine collected over a 24-hour period is the gold standard for determining proteinuria, and pregnant women with severe proteinuria have been found to be significantly more likely to experience eclampsia (Özkara et al, 2018).
Clinical symptoms have been researched to provide health professionals with a way to recognise underlying biological processes and assess the need for precision interventions (Starkweather et al, 2019; Rias et al, 2020). Detecting clinical symptoms of pre-eclampsia, such as blood pressure and protein urine, is important so that such interventions can be put into place in a timely manner.
Guided imagery has been found to effectively treat hypertension in pregnancy as it aids in maintaining a stable blood pressure (Moffatt et al, 2010). Guided imagery is a mind-body therapy that encourages a woman to visualise images to promote relaxation and lower blood pressure. This can be done independently, one-on-one or in groups with an instructor, using audio or scripted material (Haruna et al, 2019). The mechanisms proposed to explain the relaxation response and decline in blood pressure and heart rate include direct inhibition of sympathetic nervous system activity through neural responses, an increase in parasympathetic nervous system stimulation, or a combination of the two (Moffatt et al, 2010). These alterations may decrease heart rate and contractility, increase blood vessel relaxation or combine the two, thereby reducing maternal blood pressure (Moffatt et al, 2010).
Proteinuria is also commonly increased by treatment for concerns during pregnancy, such as the use of aspirin, and pregnancy-induced hyperfiltration (Attini et al, 2017). Despite increasing evidence linking proteinuria to pregnancy outcomes, therapeutic strategies to handle proteinuria are not yet fully understood (Phipps et al, 2019). Similarly, few studies have been conducted that explore the effectiveness of guided imagery on blood pressure and protein urine (Moffatt et al, 2010; Soliman et al, 2017; Haruna et al, 2019), and this therapy has not been explored in Indonesia.
Progressive muscle relaxation is a relaxation technique that involves individuals actively contracting muscles to create tension and progressively releasing this tension (Akmeşe and Oran, 2014) Several studies have found that progressive muscle relaxation may help control blood pressure (Arisjulyanto, 2018; Rosdiana and Cahyati, 2019; Ermayani et al, 2020). Aalami et al (2016) found that progressive muscle relaxation treatment for pregnant women with hypertension decreased systolic and diastolic blood pressure. Blood pressure varies somewhat in response to physiological changes in motion, such as those associated with progressive muscle relaxation (Arisjulyanto, 2018; Shahoud et al, 2019). Individuals with pre-eclampsia who performed stretching exercises and relaxation training have been found to have lower levels of proteinuria and lower diastolic blood pressure (Awad et al, 2019). Similarly, an experimental study was conducted in Egypt, assessing the effectiveness of complementary and alternative medical interventions such as a combination of progressive muscle relaxation and guided imagery. It found that this combination treatment was effective in reducing blood pressure among pregnant women with mild hypertension, although it did not explore the effect on proteinuria (Soliman et al, 2017).
These approaches are simple to learn and implement, making them an excellent supplemental therapy, which are cost-effective as they do not require specialist equipment (Smith et al, 2020). Nonetheless, no research has been carried out to explore the synergistic effect of progressive muscle relaxation and guided imagery on blood pressure and protein urine among women with pre-eclampsia, especially in the conservative ward. Conservative management of severe pre-eclampsia before 34 weeks gestation has been shown to benefit the neonate without injuring the mother (Vigil-De Gracia and Ludmir, 2020) when staying in a hospital for 6–12 days (Wijayanti and Ernawati, 2019).
However, a previous study with a larger sample size published findings that conservative management had no perinatal benefit when compared to aggressive therapy (Vigil-De Gracia et al, 2013). Conservative management has also been found to be related to higher fetal growth restriction and placental abruption (Vigil-De Gracia and Ludmir, 2020).
Progressive muscle relaxation together with guided imagery may positively reduce clinical symptoms in individuals with pre-eclampsia. However, these relationships require clarification. Therefore, the aim of the present study was to investigate the synergistic effects of progressive muscle relaxation and guided imagery on blood pressure and protein urine among pregnant women with pre-eclampsia in the conservative ward.
Methods
Study design and setting
From February to August 2021, this quasi-experimental clinical trial was conducted in a regional teaching hospital in East Java. The hospital has two conservative wards managed by the same physician and nursing team.
Participants
Convenience sampling was used to recruit respondents receiving conservative management for pre-eclampsia at the hospital. Inclusion criteria were Indonesian pregnant women with a single living fetus, who were aged 20–45 years and who had received a diagnosis of pre-eclampsia confirmed by the physician with blood pressure test results ≥140/90–160/90 mmHg and proteinuria between +1 and +3, as seen in the routine urine assessment, or 0.3 g/L or more. Participants' gestational age was limited to 30–32 weeks with a planned ≥7 day length of stay in the conservative ward. The cut off points for age and gestation were selected based on the mean age and gestation of patients. Participants needed to be capable of making the decision to participate, verbally communicate, and were asked to sign a consent form.
Participants who had mini-mental state exam scores ≤24, had auditory deficiencies, were not pregnant, used antidepressants, or had limb amputation or could not walk were excluded from the study. Women diagnosed with eclampsia, headache, epigastric pain, increased reflexes, visual impairment or liver dysfunction, those who were experiencing severe pre-eclampsia symptoms, those who had been diagnosed with hemolysis, elevated liver enzymes, low platelet count and women who had been diagnosed with other chronic diseases were also excluded.
Sample size calculation
A power analysis for the repeated-measures analysis of variance test was conducted, using G*Power Version 3.1.2 to determine the sample size, setting the power at 0.95, the effect size at 0.5 (Faul et al, 2007), and the significance level at 5%. A group allocation ratio of 1:1 was used. Based on these calculations, it was determined that the sample size should be 54 patients (27 in each group). The assumed attrition rate for the study was 10%, meaning 30 respondents were recruited for each group. (control and study group). All 60 participants participated in the entire study, and none withdrew at any stage.
Intervention
Participants were assigned to the study or control groups based on their medical record number, with patients with even numbers assigned to the study group and those with odd numbers assigned to the control group. This process was carried out by the investigator and a certified psychologist. To minimise selection bias, the investigator and psychologist were not aware of participants' names, only their medical record number. The study group received both progressive muscle relaxation and guided imagery, as well as routine care. Each pregnant woman in the study group was given a handbook and audio recording and was asked to listen to and perform both the progressive muscle relaxation exercises and guided imagery by following the instructions on the audio recording twice per day (morning and evening) for 7 days, based on the approximate length of stay in the hospital.
The guided imagery intervention involved asking participants to rest comfortably and close their eyes while the audio recording played, which included:
- A standardised 5–10 minute introduction to guided imagery delivered by either the principal investigator or certified psychologist
- A variety of natural sounds, including cascading water, sea waves, chattering jungle birds, and rain falling
- An introductory guided imagery session with audio scripted specifically for the study
- Instructions for the respondents to visualise themselves in a location described in the audio recording (eg the jungle or at the seaside). They were asked to attempt hearing and smelling these locations in order to immerse themselves in the setting represented in the audio recording.
The individuals wore headphones connected to a device playing the sounds to block out external noise and maintain concentration on the audio recording. Participants used the technique for at least 15–20 minutes twice daily before going to sleep at night and in the afternoon for the duration of the trial. Positive affirmations and emotions such as ‘I am relaxed’, ‘I am calm’ and ‘nurturing energy fills me’ were incorporated throughout the sound play with quiet harp music (Moffatt et al, 2010; Jallo et al, 2013).
The progressive muscle relaxation technique included instructions on how to execute progressive relaxation exercises and breathing techniques. Participants were taught to take deep abdominal and diaphragmatic breaths and relax their muscles while visualising a picturesque landscape and with low-level music (eg a harp) in the background. The participants were advised to lie in a comfy bed, according to the audio instructions. They were then instructed to contract and release certain muscle groups. They practiced tensing a muscle group until a minor contraction was felt and then releasing it while simultaneously relaxing other muscle units. The practice began with the feet, followed by the calves, thighs, gluteal muscles, belly, chest, hands, forearms, shoulders, neck and face. The duration of a typical intervention session was approximately 20 minutes (Akmeşe and Oran, 2014).
The control group received routine care only. Research assistants encouraged them to continue their habitual activities and follow routine care for safety management. Routine care included regular blood pressure checks and testing to identify high-risk pregnancies. Urine protein tests were also performed regularly to identify abnormalities, and all participants (including those in the study group) received a pharmaceutical antihypertensive. Measurements for blood pressure and proteinuria were collected before patients were administered their medication.
Overall, 60 individuals with pre-eclampsia were divided between the intervention (n=30), and control (n=30) groups.
Data collection
Demographic characteristics including age, education level, income, employment status, miscarriage history, number of pregnancy, history of pregnancy complication, pregnancy interval period, body mass index and history of preeclampsia were collected from the participants (Table 1). These data were gathered from participants' medical files and in 5–10 minute interviews with participants conducted on the conservative ward before the intervention began.
Table 1. Comparison of participants' sociodemographic data according to group (n=60)
| Characteristic | Study group, n=30 (%) | Control group, n=30 (%) | Total, n=60 (%) | Chi squared | P value |
|---|---|---|---|---|---|
| Age (years) (Fisher's exact test used) | |||||
| 20–35 | 15 (50.0) | 13 (43.3) | 28 (46.7) | 0.389 | 0.796 |
| ≥35 | 15 (50.0) | 17 (56.7) | 32 (53.3) | ||
| Level of education | |||||
| Primary school | 8 (26.7) | 12 (40.0) | 20 (33.3) | 2.116 | 0.347 |
| Secondary school | 17 (56.7) | 16 (53.3) | 33 (55.0) | ||
| University | 5 (16.7) | 2 (6.7) | 7 (11.7) | ||
| Employment status | |||||
| Unemployed | 22 (73.3) | 24 (80.0) | 46 (76.7) | 0.373 | 0.542 |
| Employed | 8 (26.7) | 6 (20.0) | 14 (23.3) |
Data on blood pressure and proteinuria were collected at baseline, post-intervention at 3 days and post-intervention at 7 days. Systolic and diastolic blood pressures were measured by Omron SEM-1 Tensimeter Digital, an automated, non-invasive blood pressure monitor that is routinely checked and calibrated. For proteinuria, each respondent in the study group and control group was requested to collect a 24-hour clean midstream urine test in sterilised bottles after cleansing the vulva with current water. Protein levels in urine before and after treatment were sampled. Urine specimens for protein analysis were kept refrigerated at 20°C until analysis. The protein concentration (g/L) was measured using an automatic analyser in a private laboratory (ISO 14001: 2015 and 9001:2015 certified).
Adverse events
The safety of the method in the intervention group was investigated by the incidence of adverse events during the trial research period. The potential adverse events included fatigue. This was self-recorded by respondents on a scale of 0–10 (not at all fatigued to extremely fatigued) and monitored by physicians once a day, as well as being well-documented by clinical nurses. In the event of a side-effect, the physician and principal investigators were to immediately discontinue the intervention and intervene. However, no adverse events occurred during the study.
Study fidelity
The fidelity of the study was maintained through meetings with investigators, clinical nurses, psychologists, research assistants, research fellows, and physicians to review protocols, check proficiency measurement, and equalise perceptions during the study.
Data analysis
Allocations of demographic information and predictors variables between groups were analysed. The chi-squared or Fisher's exact tests were used to compare sociodemographic charactertistics between groups and baseline findings. The generalised estimating equation models with acceptable link function and distribution assumptions were used to compare changes in the blood pressure and proteinuria data across time among the two groups. Overall, the models were adjusted for potential confounding factors. Statistical analyses were calculated using the Statistical Package for Social Sciences 25.0, with a P<0.05 used for significance.
Validity and reliability
The study design was created by the research team and verified for validity and reliability. To ensure consistency, the intervention was provided to all individuals in the study group by the same researcher. All instruments used were validated and found to be reliable. A statistician was part of the study team, who verified the data's accuracy, watched the reports and contributed to the analysis. All data were analysed immediately after collection, and baseline data were analysed for normality and variance homogeneity.
Ethical considerations
The study protocol was approved by the Hospital Review Board of Dr Soetomo Hospital Ethics Committee (IRB: 032/KEPK/I/2021) and conformed to the provisions of the Declaration of Helsinki. Informed written consent was obtained from each participant after they were provided with both verbal and written information about the study.
Results
Participants' baseline sociodemographic characteristics are presented in Table 1 and clinical data are shown in Table 2. Participants' mean ages were 56.95 years for the study group and 59.18 years for the control group. A third of participants in the study group (33.3%) had a history of pre-eclampsia, as did 26.7% of participants in the control group. There were no significant differences in the baseline characteristics between the two groups (P>0.05).
Table 2. Comparison of participants' clinical data according to group (n=60)
| Characteristic | Study group, n=30 (%) | Control group, n=30 (%) | Total, n=60 (%) | Chi squared | P value |
|---|---|---|---|---|---|
| Miscarriage history | |||||
| No | 21 (70.0) | 24 (80.0) | 45 (75.0) | 0.800 | 0.371 |
| Yes | 9 (30.0) | 6 (20.0) | 15 (25.0) | ||
| Number of pregnancies | |||||
| Primipara | 6 (20.0) | 9 (30.0) | 15 (25.0) | 1.314 | 0.518 |
| Multipara | 23 (76.7) | 19 (63.3) | 42 (70.0) | ||
| Grande multipara | 1 (3.3) | 2 (6.7) | 3 (5.0) | ||
| History of twin pregnancy | |||||
| No | 26 (86.7) | 27 (90.0) | 53 (88.3) | 0.162 | 0.688 |
| Yes | 4 (13.3) | 3 (10.0) | 7 (11.7) | ||
| History of pregnancy complication | |||||
| No | 22 (73.3) | 23 (76.7) | 45 (75.0) | 0.089 | 0.766 |
| Yes | 8 (26.7) | 7 (23.3) | 15 (25.0) | ||
| History of pre-eclampsia | |||||
| No | 20 (66.7) | 22 (73.3) | 42 (70.0) | 0.317 | 0.573 |
| Yes | 10 (33.3) | 8 (26.7) | 18 (30.0) | ||
| Pregnancy interval | |||||
| ≤3 | 3 (10.0) | 4 (13.3) | 7 (11.7) | 0.636 | 0.728 |
| 3–5 | 20 (66.7) | 17 (56.7) | 37 (61.7) | ||
| ≥5 | 7 (23.3) | 9 (30.0) | 16 (26.7) | ||
| Mother's body mass index during pregnancy | |||||
| Underweight | 2 (6.7) | 4 (13.3) | 6 (10.0) | 2.710 | 0.258 |
| Normal | 5 (16.7) | 9 (30.0) | 14 (23.3) | ||
| Overweight or obese | 23 (76.7) | 17 (56.7) | 40 (66.7) | ||
No statistically significant differences (P>0.05) between the two groups were noted in sociodemographic or clinical characteristics, including age, level of education, employment status, miscarriage history, number of pregnancies, history of twin pregnancy, pregnancy complications or pre-eclampsia, pregnancy interval and body mass index during pregnancy.
The blood pressure and proteinuria measurements in both groups at baseline, after 3 days and after 7 days are shown in Table 3. A comparison of the measured outcomes, systolic and diastolic blood pressure and proteinuria, between the two groups is shown in Table 4.
Table 3. Blood pressure and proteinuria measurements
| Variable | Baseline mean (standard deviation) | Mean after 3 days (standard deviation) | Mean after 7 days (standard deviation) |
|---|---|---|---|
| Systolic blood pressure (mmHg) | |||
| Study group | 161.30 (10.53) | 150.57 (10.86) | 136.53 (10.05) |
| Control group | 161.63 (8.63) | 157.93 (9.02) | 155.77 (9.02) |
| Diastolic blood pressure (mmHg) | |||
| Study group | 104.87 (8.91) | 101.93 (8.11) | 91.63 (6.44) |
| Control group | 107.43 (8.93) | 106.13 (8.83) | 101.57 (5.96) |
| Proteinuria (g/L) | |||
| Study group | 2.84 (0.14) | 2.47 (0.19) | 2.08 (0.21) |
| Control group | 2.82 (0.15) | 2.72 (0.16) | 2.58 (0.16) |
Table 4. The effect of progressive muscle relaxation-guide imagery combination on blood pressure and urine protein
| Outcome measure | Regression coefficient | Standard error | 95% confidence interval | P value |
|---|---|---|---|---|
| Systolic blood pressure (mmHg) | ||||
| Difference between groups at baseline | 0.333 | 2.444 | -4.457 to 5.123 | 0.892 |
| Time effect on control group on day 3 | -10.733 | 2.715 | -16.054 to -5.412 | <0.001 |
| Time effect on control group on day 7 | -24.767 | 2.612 | -29.887 to -19.647 | <0.001 |
| Difference between groups on day 3 | 7.033 | 3.520 | 0.134 to 13.933 | 0.046 |
| Difference between groups on day 7 | 18.900 | 3.442 | 12.155 to 25.645 | <0.001 |
| Diastolic blood pressure (mmHg) | ||||
| Difference between groups at baseline | 2.567 | 2.265 | -1.872 to 7.001 | 0.257 |
| Time effect on control group on day 3 | -2.933 | 2.163 | -7.172 to 1.305 | 0.175 |
| Time effect on control group on day 7 | -13.233 | 1.974 | -17.102 to -9.365 | <0.001 |
| Difference between groups on day 3 | 1.633 | 3.124 | -4.490 to 7.757 | 0.601 |
| Difference between groups on day 7 | 7.367 | 2.759 | 1.959 to 12.774 | 0.008 |
| Proteinuria (g/L) | ||||
| Difference between groups at baseline | -0.019 | 0.038 | -0.093 to 0.056 | 0.624 |
| Time effect on control group on day 3 | -0.370 | 0.043 | -0.455 to -0.286 | <0.001 |
| Time effect on control group on day 7 | -0.763 | 0.045 | -0.852 to -0.674 | <0.001 |
| Difference between groups on day 3 | 0.266 | 0.058 | 0.152 to 0.381 | <0.001 |
| Difference between groups on day 7 | 0.524 | 0.060 | 0.405 to 0.642 | <0.001 |
Note: Time effects and differences between groups on days 3 and 7 are compared with baseline
The differences in systolic (P=0.892) and diastolic (P=0.257) pressure between groups at baseline were not statistically significant. There was a significant difference in the decline in systolic blood pressure after 3 days (P<0.001) and 7 days (P<0.001) between the two groups. Participants showed no significant reduction in diastolic blood pressure after 3 days (P=0.175), but a significant decline after 7 days (P<0.001). The effect of the intervention was significant in reducing diastolic blood pressure compared to the control group (P=0.008).
No significant difference was found in proteinuria between groups at baseline (P=0.624). Proteinuria decreased significantly after 3 days and 7 days (P<0.001 for both) in both the control group and the intervention group. There was a significant difference between groups after both 3 and 7 days (P<0.001 for both).
Discussion
To the best of the authors' knowledge, this is the first study to investigate the synergistic effect of progressive muscle relaxation and guided imagery on clinical symptoms among patients with pre-eclampsia in an Indonesian population. The study's findings were that after 7 days of treatment, both the control group (who underwent normal conservative management for pre-eclampsia) and the study group (who underwent progressive muscle relaxation and guided imagery treatments in addition to normal care) showed a significant declined in systolic blood pressure, diastolic blood pressure and proteinuria. The differences in systolic blood pressure, diastolic blood pressure and proteinuria were significantly different between the two groups following treatment.
It has been reported in Switzerland and Iran that while both guided imagery and progressive muscle relaxation can help reduce heart rate, guided imagery alone is considerably more successful at increasing a pregnant woman's comfort (Urech et al, 2010; Nasiri et al, 2018). The present study's findings are in line with a previous study conducted among 60 pregnant women with mild hypertension at a maternal and child health centre in Egypt (Soliman et al, 2017). After an intervention that included progressive muscle relaxation and guided imagery, Soliman et al (2017) found that there was a statistically significant difference in mean blood pressure score between the control and study groups (P<0.001).
Pregnancy-related hypertension can be caused by a multitude of factors, including pre-eclampsia, anxiety and stress (Smith et al, 2020). A systematic review of eight trials found that mind-body therapies such as progressive muscle relaxation and guided imagery significantly lower systolic and diastolic blood pressure in women with pregnancy-induced hypertension and/or pre-eclampsia (Smith et al, 2020). Another study reported that progressive muscle relaxation and guided imagery significantly decrease systolic and diastolic blood pressure among those with gestational hypertension (Azimian et al, 2017). In general, there is a direct correlation between blood pressure and proteinuria in pre-eclampsia, and a noticeable decline in proteinuria during relaxation and stretching exercises could be related to the significant decline in systolic and diastolic blood pressures (Awad et al, 2019).
The synergistic effect between progressive muscle relaxation and guided imagery in reducing blood pressure and proteinuria might be the result of both biological and psychological effects. The combined beneficial effects of these methods have been shown to enhance comfort in pregnant women and reduce physiological problems in pregnant women (Nasiri et al, 2018). There is evidence of reduced hypothalamic-pituitary–adrenal and sympathetic-adrenal-medullary reactivity in pregnant women after interventions for relaxation (Urech et al, 2010). Cortisol and catecholamine lower after induced relaxation and may be assessed by measuring blood pressure and heart rate changes (Urech et al, 2010). Relaxation exercises including both progressive muscle relaxation and guided imagery have been shown to decrease heart rate and blood pressure (Urech et al, 2010). Therefore, the use of progressive muscle relaxation and guided imagery, and the resultant reduction in physiological problems, are potentially essential strategies for reducing blood pressure and proteinuria, and thereby improving mortality rates in patients with pre-eclampsia.
Limitations
This study was conducted in women with a gestational age of 30–32 weeks only. Pregnant women are susceptible to increased anxiety and stress during labour, and so it is recommended that future studies investigating the effect of these therapies on pre-eclampsia are conducted over a more extended period to fully analyse their impact.
Depression, anxiety and stress can have an effect on blood pressure and increased protein urine, and their impact were not investigated in this study. However, the researchers attempted to control for any differences in depression, anxiety and stress between participants by allocating participants to groups at random.
Another limitation was the quasi-experimental design of the investigation, which meant it was not possible to establish causality; instead it was only possible to establish a connection between blood pressure and proteinuria. A randomised controlled trial comparing groups with and without positive intervention, thus minimising selection bias, would have offered more conclusive data on pre-versus post-outcomes.
Conclusions
This study found that progressive muscle relaxation and guided imagery had a positive effect on proteinuria and blood pressure among patients with pre-eclampsia in Indonesia. These results suggest that nursing educators and health professionals could play a prominent role in improving treatment for pre-eclampsia by promoting treatment strategies that can maintain or reduce blood pressure, such as progressive muscle relaxation and guided imagery.
Key points
- A combination of progressive muscle relaxation and guided imagery can be used to manage blood pressure and proteinuria during conservative treatment for pre-eclampsia.
- This study investigated the effect of a dual intervention of progressive muscle relaxation and guided imagery on women receiving conservative care for pre-eclampsia at a regional teaching hospital in East Java.
- Respondents showed significant declines in systolic pressure and proteinuria after 3 and 7 days, and significant declines in diastolic pressure after 7 days. The differences between groups for all three measures after 7 days was statistically significant.
- The authors strongly recommend a combination of progressive muscle relaxation and guided imagery for women with pre-eclampsia during conservative treatment.
CPD reflective questions
- What supportive care can you provide to a woman with pre-eclampsia who is experiencing proteinuria?
- How might progressive muscle relaxation-guided imagery for pregnant women with pre-eclampsia affect women at your practice?
- What additional learning have you identified regarding the care of pregnant women with pre-eclampsia requiring monitoring of blood pressure and urine protein, and how will you take this forward?