Introduction

HDPs, which afflict 5–10% of women worldwide, are a primary cause of maternal morbidity and

mortality (Janani, 2017). Pre-eclampsia, eclampsia, prenatal hypertension, and chronic

hypertension are included. Pre-eclampsia, characterized by high blood pressure and proteinuria

after the 20th week of pregnancy, affects 5% of pregnancies and is a major health issue,

especially in LMICs (Hutcheon, 2022). These illnesses are important because pre-eclampsia kills

70,000 to 80,000 mothers and 500,000 perinatal each year (Duley, 2006). A 2014 survey in

Kenya identified HDPs as the third greatest cause of maternal mortality, accounting for 20%

(Duley, 2009).

A pre-eclampsia research publication will be critiqued using a standard approach. The selected

paper, "Clinical presentation and outcomes of Pre-eclampsia and Eclampsia at a national hospital

in Kenya: Retrospective cohort study" by Ndwiga et al. (2020), sheds light on the condition's

clinical symptoms and The analysis will assess the study's merits and limitations, methodology,

and clinical relevance.

Article Selection and Search Strategy

The paper was chosen following a thorough PubMed and PLOS search using the phrases "pre-

eclampsia," "eclampsia," "maternal outcomes," and "low-resource settings." I chose the research

because of its focus on a varied population and its implications for managing pre-eclampsia in

resource-limited settings, which are relevant to many LMICs' healthcare systems.

Framework for Analysis

The critique will use Parahoo's framework, which evaluates research publications' clarity of

goals, methodology, and findings. This approach will demonstrate the study's impact and offer
future research and clinical practice improvements.

Objective

This review aims to explain how the study's findings can improve pre-eclampsia management

and global health outcomes. The critique will conclude with a review of major themes and

recommendations for future research and clinical practice improvements.

2 Article

The article selected article is (Ndwiga, 2020)"Clinical presentation and outcomes of Pre-

eclampsia and Eclampsia at a national hospital in Kenya: Retrospective cohort study," after a

wide and deep search. The search terms used in this exercise were "pre-eclampsia," "eclampsia,"

"maternal outcomes," and "low-resource settings." The search sources included the database of

PubMed and PLOS. The rationale for such a study was chosen because of its emphasis on the

diverse population within the area down to investigating the clinical symptoms and acute

problems brought into focus in a resource-poor environment, all of direct relevance to my

workplace. Among the important criteria that these include are thorough data collection and up-

to-date research methodologies used for the study.

3 Critical analysis:

Effective and dependable analysis of research papers, therefore, needs an incisive approach that

seriously scrutinizes the methodology used and the results concluded. The present paper is aimed

at critically appraising a well-conducted study, using the Parahoo framework, which

systematically validates and elicits the relevance of findings from research. This is one of the

best designs that can critically analyze so many types of research, like cohort studies. It assessed

"the clinical characteristics and outcomes associated with pre-eclampsia at different times and
stages of pregnancy" from a national hospital in Kenya through a retrospective cohort study

(Ndwiga, 2020).

Title: "The Effect of Early Intervention on Long-Term Outcomes in Pre-Eclampsia: A

Retrospective Analysis" is clear. A good title will be short and at the same time explicative. The

titles should be long enough to explain the topic and scope yet not too long to become

cumbersome. A clear title directly tells the reader what the scope of the study is. It may include

key terms relevant to the purpose, methodology, and/or outcomes of the study. For example,

Author: There are several authors who have contributed to the article, majority of health

practitioners come across are professional journals that publish results of research relevant to

clinical practice of a profession—nursing, medicine, or multidisciplinary healthcare.

Abstract: An abstract is a very brief, compact summary in this article. This gives the reader an

extremely quick view of the study's purpose, methodology, results, and main conclusions in

order for the reader to decide promptly whether he or she should read the full article.

Date: The date of publication is current it was published in 2020, this relevance may be affected

by the credibility of publication in fast-growing fields.

Journal: The release of the research article in PLOS ONE highlights its significant contribution

to the scientific comprehension of pre-eclampsia and eclampsia, specifically in the setting of

Kenya. By choosing to publish their work in PLOS ONE, the authors have assured that their

findings are easily accessible to a wide audience and have the ability to impact clinical practice,

policy-making, and future research efforts in the field of maternal and newborn health.

Literature search: The literature of this study indicate that it is crucial to prevent, detect early,

and manage pre-eclampsia and eclampsia at every stage of care (WHO, 2011). Efficient
preconception care and timely and consistent antenatal care (ANC) offer opportunities to detect

pre-existing problems such as hypertension. Provide education to women who are about to

become pregnant or are currently pregnant regarding the risk factors for pre-eclampsia. Aside

from self-referrals made by knowledgeable women, there is a need for improved diagnostic and

surveillance capabilities. ANC also includes specialised monitoring and management of chronic

and gestational hypertension, ensuring the availability and proper use of medications, prompt

delivery with optimal care for newborns, and critical and intensive care for mothers (Lisonkova,

2009). Strict adherence to treatment protocols for managing hypertension during pregnancy and

the judicious utilisation of approved drug regimens for women with a blood pressure reading of

150/100 have been proven to decrease pregnancy risks, particularly in cases of early-onset

preeclampsia (Joris, 2017).

A higher proportion of women with EO-PE developed maternal problems such as HELLP

syndrome and antepartum haemorrhage compared to women with LO-PE. Inadequate care,

especially during the initial stages of pregnancy, might result in mortality. Furthermore, the act

of seeking medical care from home and the delay in referring patients from lower level facilities

to tertiary level institutions also play a role in the negative outcomes experienced by mothers

(Townsend, 2016).

Methodological Appraisal

Methodological Nature of the Study: Ndwiga et al. (2020) conducted a retrospective cohort

study to examine the clinical presentation and outcomes of pre-eclampsia and eclampsia at a

national hospital in Kenya. This methodology falls within a quantitative research paradigm,

where data is numerically oriented, outcomes are statistically analyzed, and results are

interpreted in terms of significance levels and association strengths (Polit & Hungler, 1997).
Sampling: The sampling technique utilized in the study capitalizes on a large dataset of 620

records from a single institution. "However, while this has served as a very sound base against

which to subject to statistical analysis, it is of the utmost importance to bear in mind the

possibility of selection bias due to the lack of inclusion and exclusion criteria mentioned (Hamer

& Collinson, 1999). From such a sample, the robustness of the conclusions is dependent on the

representativeness of the wider population. Thereby, if it is a national referral hospital, that could

be different from the general community (Kiondo et al., 2014).

Data Collection and Integrity: The data collection approach from the patient records may thus

be subjected to potential pitfalls of retrospective analyses, including introduction of information

bias. The methods of ensuring data accuracy, such as double data entry or validation checks,

were not explicitly mentioned in the methodology. As a result, the methods of ensuring data

accuracy and validation checks raised questions on the reliability of the data (Ramesh et al.,

2018).

Statistical analysis: The study in this research has strong effectiveness with the statistical data

analysis, considering it uses the chi-square test, t-test, and odds ratio in the telling of how the

variables relate. However, their associations' strength might be weakened by the failure to

perform a multivariate analysis to adjust for the strength of their associations. However, the

strength of their associations might be weakened with the failure to adjust for confounders

through multivariate analysis. The results can, therefore, be interpreted with the risk of a type I

or type II error in mind, which is something the present study does not refer to properly.

Relevance in Clinical Practice: The results of this research in translating it to clinical practice

are undeniably overwhelming, more so in a resource-limited setting. Its findings suggest an early

detection and management of pre-eclampsia. There is a need for a recommendation from the
findings for early detection and management of pre-eclampsia, and particularly no detailed

recommendations to translate these into practice from the settings that are dissimilar to that of

the study."

Conclusions: The conclusion is, drawn upon a change in practice with the highlight of the need

for multi-centred, prospective studies, as in this conclusion, retrospective designs are less robust

in establishing the causal relationship and guiding change in practice.

Reflection on Knowledge Acquisition: Reading this paper contributes significantly to my

understanding in the area of study, especially on the clinical presentations and outcomes of pre-

eclampsia and eclampsia in this resource-constrained setting. The work of Ndwiga et al. (2020)

actually somewhat makes one see clearly the details of managing pre-eclampsia and brings out

the contribution of early detection and intervention to help improve outcomes. Now, after an in-

depth critical analysis of the methods used in such research and the findings thereof, I have been

exposed to a lot more about the challenges and opportunities provided by this critical health

problem.

Consideration for Practice Change: While most of the ideas presented herein find support

from the research literature, the robustness of the findings and their applicability to changes in

clinical practice do indicate that caution is warranted. Therefore, the absence of multivariate

analysis and the retrospective nature of the study both have issues with respect to the biases that

could be present and limitations on generalizability (Xiong et al., 2002). It, therefore, would

mean that it is prudent for the implementation of practice changes based on these findings alone

to take cautious steps until further research is done.

Need for Further Research

Undoubtedly, the contribution of this study to knowledge is valuable; however, it obviously

would require many more research studies that aim to fill some very crucial gaps in our

understanding of how to manage pre-eclampsia. Some future research could conduct prospective

studies among populations of patients with a rigorous methodology to validate the findings of

existing research (Bilano 2014). Other study designs fully explored in review papers may include

alternates, like using randomized control trials, or case studies that complement the insight of the

current dynamics of the pre-eclampsia disease and, therefore, evidence-based practice guidance

(Renfrew et al., 2014).

Recommendations for Future Studies

This would be extremely instrumental in bridging the relevance of the findings to clinical

practice application and closing the gap, with the mind that such has to be implemented in

resource-constrained settings. This refers to the actual areas to intervene for better health

outcomes for mothers and neonates (Ndwiga et al., 2020). Moreover, these researchers should

further explore the socio-demographic factors and healthcare delivery concerns that might lead to

the development of pre-eclampsia and its outcome management, hence emphasizing the big gaps

in existing literature. These are future research pursuits likely to inform evidence-based practices

toward optimizing pre-eclampsia management for improved maternal and neonatal health

outcomes at the global, indeed multi-institutional, and regional, multidisciplinary collaboration

levels.
Conclusion

The above findings carry the critically important message that early screening and a personalized

management approach must be one of the critical aspects to lessen the risks of pre-eclampsia,

particularly in settings with limited resources. Accurate predictions of differences in outcomes

between early- and late-onset pre-eclampsia highlight the need for timely interventions to ensure

improved maternal and neonatal health outcomes. This association drawn between early-onset

pre-eclampsia and its outcomes for the mother and her offspring underlines the necessity for

increased awareness among healthcare providers and pregnant women. Efforts must be directed

towards enhancing patient education and ensuring that healthcare facilities are equipped to

manage pre-eclampsia efficiently. Control of pre-eclampsia should be holistic, encompassing

early screening and detection, as well as the implementation of effective management protocols.

Expectant mothers should anticipate that the healthcare system will provide complete care, with

universally applied screening protocols and management strategies tailored to individual needs.

Policymakers must collaborate with health professionals and community stakeholders to develop

policies and practices that reduce the likelihood of adverse outcomes associated with pre-

eclampsia. By ensuring early intervention and optimal holistic management, the burden of pre-

eclampsia on maternal and neonatal health can be reduced.

These insights are valuable for the approach to pre-eclampsia management; however, there is a

clear need for future research to fill existing gaps and enhance the robustness of our

understanding. Future studies should explore alternative research methodologies and investigate

socio-demographic factors that may influence outcomes, thereby informing evidence-based

practices and enhancing maternal and neonatal health outcomes globally. Building upon the

foundation laid by this study and collaborating across disciplines and regions will allow us to
continue advancing our knowledge and improving the care provided to expectant mothers,

ultimately improving health outcomes for mothers and babies worldwide.

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Appendix

PICO Question:

In pregnant women with early-onset pre-eclampsia (Population), how does early detection and

management (Intervention) compared to late detection and management (Comparison) affect

maternal and neonatal morbidity and mortality rates (Outcome)?

Population Intervention Comparison Outcome

Pregnant women with Early detection and Late detection and Maternal and neonatal

early-onset pre-eclampsia management management morbidity and mortality

rates

Appendix 2 Literature search

Category Keywords Limiters

Keywords pre-eclampsia, eclampsia, Kenya None

Limiters early-onset, late-onset, outcomes Time (before 2019), Study Location (Kenya)