This integrative review of the literature focused on sodium (Na) content in drinking water (H?O) supplies and the subsequent effect on blood pressure levels in children. Studies for this review were drawn from the Cumulative Index of Nursing and Allied Health, PubMED, Science and Technology Databases, PsychInfo, United States (US) Environmental Protection Agency (EPA) and EPA in Florida websites. Criterion for inclusion in the data base searches were hypertension, high blood pressure, sodium in drinking water, drinking water salinity, children or preg'. Subsequently, further article selection criteria included children (under 18 years of age) and published in the English language (N=59). Findings of the review as summarized in this thesis could guide nursing research, education, policy and practice related to primary, secondary and tertiary interventions associated with sodium levels in drinking as a contributing factor to blood pressure levels in children.

PURPOSE: Hypertension (HTN) affects one in every three adults in the United States. Often associated with the older population, this silent killer has emerged in an unsuspecting group, young military soldiers. With the rapid succession of multiple deployments, long intervals between blood pressure (BP) assessments, and the absence of cardiovascular (CV) measures during the pre and post deployment health screenings; soldiers may be at higher risk for HTN than their civilian counterparts of the same age. The purpose of this study was to explore real-time continuous CV measures of soldiers before, during, and after exposure to a simulated combat stressor as well as to assess which personal characteristics played a significant role. METHODS: Applying the Allostasis/Allostatic Load theoretical framework, a repeated measure quasi-experimental design was used to compare the CV measures of two groups: one exposed to a physical combat stressor (experimental) and the other exposed to a psychological combat stressor (control). A convenience sample of 60 college Army Reserve Officer Training Corps cadets were fitted with Tiba Medical Ambulo 2400 ambulatory BP monitors for 48 continuous hours. Several CV indices were analyzed using one-way Analysis of Variance (ANOVA), paired t-test, and independent sample t-test. Four instruments (Participant Information Sheet, State-Trait Anxiety Inventory, Paintball Perceived Stress Questionnaire, and Army Physical Fitness Test) were used to assess which characteristics played the most significant role in the CV response. RESULTS: Demographic characteristics between the two 30-cadet groups were not statistically different, with the exception of deployment history (experimental = 4, control= 0). Hours after the stress exposure, subjects in the experimental group had a higher mean awake systolic blood pressure (SBP) when compared to the control group (113.76 mm Hg vs 102.98 mm Hg, p= 009). When assessing pre and post stressor morning BP surge and evening BP decline, the control group showed the biggest change. Significant bivariate correlations (p > .05) found that: Females consistently had higher pulse rates (PR) throughout each of the phases. Age positively correlated with elevated BP during the stressor, and increased morning BP surge post stressor. African Americans had higher sleep BPs pre stressor, and decreased SBP recovery post stressor; Hispanics had higher PRs during and after the stressor. Waist circumference positively correlated with elevated BP morning surge pre stressor but, body mass index (BMI) positively correlated with elevated BP morning surge post stressor as well as elevated BP during the stressor. Family history of HTN played no significant role; however, deployment history correlated with mean awake SBP post stressor. Trait anxiety scores negatively correlated with SBP recovery while state anxiety scores positively correlated with post stressor awake mean arterial pressure and evening SPB decline. Perceived stress during the stressor negatively correlated with post stressor SBP morning surge with females reporting higher anxiety and stress. Finally, Army Physical Fitness (APFT) total scores as well as APFT run scores negatively correlated with pre and post stressor sleep PRs. DISCUSSION/IMPLICATIONS: Age, female gender, African American descent, Hispanic ethnicity, waist circumference, BMI, previous deployment history, level of fitness and the psychological stress state during and after a stressor played significant roles in soldiers' CV response. SBP was the most dynamic and informative of the CV indices and a psychological stressor was comparable to a physical stressor when observing the residual effect of stress. If a combat exercise was enough of a stressor to produce residual CV effects that lasted well into following morning, the residual effect of a lengthy strenuous deployment may be alarming. This study not only provided a snapshot of the CV health of incoming young soldiers, but also provided evidence to support policy change regarding the implementation of regular CV health assessments before and after deployment.

No description available.

A Hipertensão Arterial Sistêmica (HAS) é uma doença crônica não transmissível com etiologia multifatorial e uma das principais causas de doenças cardiovasculares que são responsáveis pela maioria das mortes mundiais. Por ser tratar de uma doença de alta prevalência e na maioria das vezes assintomática, a adesão do hipertenso ao tratamento tem uma representação muito baixa, o que requer a intervenção educacional dos profissionais da saúde no tratamento, na prevenção das complicações e na manutenção da vida. A qualidade de vida relacionada à saúde (QVRS) dos indivíduos com hipertensão arterial é menor comparada com a população geral. A avaliação dos fatores que influenciam na QVRS dos hipertensos pode servir de subsídios no planejamento de estratégias de tratamento mais eficazes para essa população. Objetivos: Caracterizar os indivíduos com hipertensão arterial participantes do grupo de convivência educativa segundo as variáveis: sócio-demográficas e econômica; hábitos de vida (atividade física, tabagismo, consumo de bebida alcoólica); dados relacionados a HAS(co-morbidades, uso de medicamentos anti-hipertensivos, controle dos níveis pressóricos, tempo de progressão da HAS) e tempo de participação nas atividades educativas em grupo, comparar a QVRS entre hipertensos participantes do grupo de convivência educativa com as variáveis sócio-demográficas, econômicas e clínicas e avaliar a contribuição do grupo de convivência na qualidade de vida dos hipertensos. Material e Métodos: Foi realizado um estudo descritivo do tipo transversal com 131 sujeitos com idade superior a 18 anos e diagnóstico de hipertensão arterial, residentes no município de Sacramento-MG, cadastrados no grupo de convivência no período mínimo de um ano anterior a data da entrevista. Os instrumentos utilizados para a coleta de dados foram: instrumento para caracterização da população quanto aos dados clínicos e sóciodemográficos e econômicos e o Medical Outcomes Short-Form Health Survey (SF-36) para avaliação da QVRS. Resultados: Dos pacientes, 98 eram mulheres e 33 homens, a maioria idosa 88(67,2%), com predomínio na faixa etária de 60 a 69 anos 43(32,8%) e ganham igual ou menos que um salário mínimo por mês 88(67,2%). As dimensões do SF-36 que obtiveram menores escores foram: vitalidade (64,4) e dor (70,3), enquanto as dimensões que apresentaram maiores escores foram: aspectos sociais (86,7) e capacidade funcional (79,4). Os fatores que apresentaram relação com a variação dos escores médios e correlação das dimensões do SF-36 foram: renda, atividade física, número de morbidades, diabetes, obesidade. A participação no grupo apresentou relação estatisticamente significante apenas no domínio saúde mental. Conclusão: Clinicamente os resultados mostraram relevância para intervenções educativas pela equipe de saúde. Os enfermeiros como elementos constituintes destas equipes devem estar presentes e ativos em todas as etapas desse trabalho, desde o planejamento, execução e avaliação colaborando na busca de meios efetivos que vão de encontro com a melhoria da qualidade de vida dessa população. / Arterial Hypertension is a non-transmissible chronic disease with multifactorial etiology and it is one of the main causes of cardiovascular diseases which are the leading cause of death in the world. Since the disease is characterized as having a high prevalence rate and in most cases it is asymptomatic, the treatment adherence rate is low, therefore requiring educational intervention from health professionals during the treatment in order to prevent complications and to keep the patient alive. Health-related quality of life (HRQoL) in patients with high blood pressure is reduced when compared to the general population. The evaluation of factors influencing on the HRQoL of high blood pressure patients point to the strategic planning of more efficient treatments to this population. Aims: Characterize the high blood pressure patients participating in the educational gathering group according to the following variables: socio-demographics and economics; lifestyles (physical activity, smoking, drinking); data related to systemic arterial hypertension (comorbidity, use of antidepressive drugs, blood pressure rate control, systemic arterial hypertension progression rate) and participation time in educational group activities, comparison of HRQoL among the group participating patients with the socio-demographical, economical and clinical variables and evaluate the contribution of the group to the quality of life of the participating patients. Methods and Materials: It was performed a descriptive cross-sectional study with 131 individuals over 18 years of age who suffered from high blood pressure. The patients lived in the city of Sacramento ? MG and had been participating in the gathering group for at least one year prior to the interview. The following tools were used to collect the data: Tools to characterize the population according to clinical, socio-demographical and economical data; Medical Outcomes Short-Form Health Survey (SF-36) to evaluate HRQoL. Results: From the total of 131 patients, 98 were female and 33 were male. Most of them (88 patients or 67.2%) were in an advanced age ranging from 60 to 69 years old (43 patients or 32.8%) and earned minimal wage or less (88 patients or 67.2%). The SF-36 dimensions with the lowest scores were: Vitality (64.4) and pain (70.3), whereas the dimensions with the highest scores were: Social functioning (86.7) and functional status (79.4). The factors presenting relation to the average score variation and dimension correlation in the SF-36 were: Income; physical activity; death rate; diabetes, obesity. The participation in the group was statiscally significant relation only to the mental health dimension. Conclusion: The results clinically showed the relevance of educational interventions performed by the health team. The nurses, as part of this team, must be present and active in all the stages of this work, planning, performing and searching for effective methods that lead to the improvement of life quality for this population.

The transcranial direct current stimulation (tDCS) is a neuromodulatory technique able to modify cortical excitability and presumably modulate the neural activity of cortical areas involved in autonomic regulation, such as the medial prefrontal cortex (MFPC) and insular cortex (IC). Regarding the ANS, there is evidence of hyper-sympathetic activation in people with HTN. To contribute to the discussion, this thesis was divided as follows: The first chapter titled "Heart rate variability (HRV): analytical methods and their applicability " consists of a review article, aiming at the theoretical foundation about methods of assessment of HRV and its prospects for use. The second chapter consists of an original paper entitled "Effect of transcranial direct current stimulation on heart rate variability in hypertensive women". This research applied anodal tDCS, cathodic and simulated (sham) separately on the left temporal lobe (T3) of hypertensive women showed significant increases in parasympathetic activity, only with the application of cathodic tDCS. However, one cannot say which specific area of the brain was responsible for variations in HRV, since the two electrodes were about regions involved in autonomic control and still not know what the real impact of bipolar stimulation on brain physiology. Although there are limitations, our results may assist in developing a new tool to explore noninvasively the autonomic nervous system, and even open new therapeutic perspectives for treatment of their disorders such as hypertension. / Fundação de Amparo a Pesquisa do Estado de Alagoas / A estimulação transcraniana por corrente contínua (ETCC) é uma técnica neuromodulatória capaz de modificar a excitabilidade cortical e supostamente modular a atividade neural de áreas corticais envolvidas na regulação autonômica, como o córtex pré-frontal medial (CPFM) e o córtex insular (CI). Com relação ao SNA, existem evidências de hiper-ativação simpática em pessoas com HAS. Para colaborar com a discussão, esta dissertação foi dividida da seguinte forma: o primeiro capítulo intitulado de Variabilidade da frequência cardíaca (VFC): métodos de análise e sua aplicabilidade , sendo constituído por um artigo de revisão, objetivando a fundamentação teórica a respeito dos métodos de avaliação da VFC e suas perspectivas de utilização. O segundo capítulo é composto por um artigo original intitulado: Efeitos da estimulação transcraniana por corrente contínua sobre a variabilidade da frequência cardíaca de mulheres hipertensas . Neste estudo foi aplicada a ETCC anódica, catódica e simulada (sham), separadamente, sobre o lobo temporal esquerdo (T3) de mulheres hipertensas e evidenciou aumentos significativos na atividade parassimpática, somente com a aplicação da ETCC catódica. Todavia, não se pode afirmar qual área específica do cérebro foi responsável pelas variações na VFC, pois, os dois eletrodos estavam sobre regiões envolvidas no controle autonômico e ainda não sabemos qual o real impacto da estimulação bipolar no cérebro sobre parâmetros fisiológicos. Embora haja limitações, nossos resultados podem auxiliar no desenvolvimento de uma nova ferramenta para explorar de forma não invasiva o sistema nervoso autônomo, e até mesmo abrir novas perspectivas terapêuticas para tratamento de seus distúrbios como é o caso da hipertensão.

The clinical hallmark of acute myocardial infarction is chest pain, typically located in the substernal region or sometimes in the epigastrium which frequently radiates to the neck, left arm and left shoulder. Anginal equivalents such as dyspnoea and epigastric discomfort may also occur. The physical findings can include diaphoresis, pale cool skin, sinus tachycardia and sometimes hypotension. The objective of my thesis is to describe the health-social overall impact. I have been interested in acute myocardial infarction problems since my first education as a rescuer. I used the method of classificatory frequency analysis of documents, comparing and analogy results each other. The main task was to show how the people live after acute myocardial infarction, if they are able to work or not. Graphical analysis shows patient{\crq}s social anamnesis, productivity, gender ratio and etc. Sample for analysis forms 109 patients, from that 16 forms employment history results, which are made separate.

A Hipertensão Arterial Sistêmica (HAS) é uma doença crônica não transmissível com etiologia multifatorial e uma das principais causas de doenças cardiovasculares que são responsáveis pela maioria das mortes mundiais. Por ser tratar de uma doença de alta prevalência e na maioria das vezes assintomática, a adesão do hipertenso ao tratamento tem uma representação muito baixa, o que requer a intervenção educacional dos profissionais da saúde no tratamento, na prevenção das complicações e na manutenção da vida. A qualidade de vida relacionada à saúde (QVRS) dos indivíduos com hipertensão arterial é menor comparada com a população geral. A avaliação dos fatores que influenciam na QVRS dos hipertensos pode servir de subsídios no planejamento de estratégias de tratamento mais eficazes para essa população. Objetivos: Caracterizar os indivíduos com hipertensão arterial participantes do grupo de convivência educativa segundo as variáveis: sócio-demográficas e econômica; hábitos de vida (atividade física, tabagismo, consumo de bebida alcoólica); dados relacionados a HAS(co-morbidades, uso de medicamentos anti-hipertensivos, controle dos níveis pressóricos, tempo de progressão da HAS) e tempo de participação nas atividades educativas em grupo, comparar a QVRS entre hipertensos participantes do grupo de convivência educativa com as variáveis sócio-demográficas, econômicas e clínicas e avaliar a contribuição do grupo de convivência na qualidade de vida dos hipertensos. Material e Métodos: Foi realizado um estudo descritivo do tipo transversal com 131 sujeitos com idade superior a 18 anos e diagnóstico de hipertensão arterial, residentes no município de Sacramento-MG, cadastrados no grupo de convivência no período mínimo de um ano anterior a data da entrevista. Os instrumentos utilizados para a coleta de dados foram: instrumento para caracterização da população quanto aos dados clínicos e sóciodemográficos e econômicos e o Medical Outcomes Short-Form Health Survey (SF-36) para avaliação da QVRS. Resultados: Dos pacientes, 98 eram mulheres e 33 homens, a maioria idosa 88(67,2%), com predomínio na faixa etária de 60 a 69 anos 43(32,8%) e ganham igual ou menos que um salário mínimo por mês 88(67,2%). As dimensões do SF-36 que obtiveram menores escores foram: vitalidade (64,4) e dor (70,3), enquanto as dimensões que apresentaram maiores escores foram: aspectos sociais (86,7) e capacidade funcional (79,4). Os fatores que apresentaram relação com a variação dos escores médios e correlação das dimensões do SF-36 foram: renda, atividade física, número de morbidades, diabetes, obesidade. A participação no grupo apresentou relação estatisticamente significante apenas no domínio saúde mental. Conclusão: Clinicamente os resultados mostraram relevância para intervenções educativas pela equipe de saúde. Os enfermeiros como elementos constituintes destas equipes devem estar presentes e ativos em todas as etapas desse trabalho, desde o planejamento, execução e avaliação colaborando na busca de meios efetivos que vão de encontro com a melhoria da qualidade de vida dessa população. / Arterial Hypertension is a non-transmissible chronic disease with multifactorial etiology and it is one of the main causes of cardiovascular diseases which are the leading cause of death in the world. Since the disease is characterized as having a high prevalence rate and in most cases it is asymptomatic, the treatment adherence rate is low, therefore requiring educational intervention from health professionals during the treatment in order to prevent complications and to keep the patient alive. Health-related quality of life (HRQoL) in patients with high blood pressure is reduced when compared to the general population. The evaluation of factors influencing on the HRQoL of high blood pressure patients point to the strategic planning of more efficient treatments to this population. Aims: Characterize the high blood pressure patients participating in the educational gathering group according to the following variables: socio-demographics and economics; lifestyles (physical activity, smoking, drinking); data related to systemic arterial hypertension (comorbidity, use of antidepressive drugs, blood pressure rate control, systemic arterial hypertension progression rate) and participation time in educational group activities, comparison of HRQoL among the group participating patients with the socio-demographical, economical and clinical variables and evaluate the contribution of the group to the quality of life of the participating patients. Methods and Materials: It was performed a descriptive cross-sectional study with 131 individuals over 18 years of age who suffered from high blood pressure. The patients lived in the city of Sacramento ? MG and had been participating in the gathering group for at least one year prior to the interview. The following tools were used to collect the data: Tools to characterize the population according to clinical, socio-demographical and economical data; Medical Outcomes Short-Form Health Survey (SF-36) to evaluate HRQoL. Results: From the total of 131 patients, 98 were female and 33 were male. Most of them (88 patients or 67.2%) were in an advanced age ranging from 60 to 69 years old (43 patients or 32.8%) and earned minimal wage or less (88 patients or 67.2%). The SF-36 dimensions with the lowest scores were: Vitality (64.4) and pain (70.3), whereas the dimensions with the highest scores were: Social functioning (86.7) and functional status (79.4). The factors presenting relation to the average score variation and dimension correlation in the SF-36 were: Income; physical activity; death rate; diabetes, obesity. The participation in the group was statiscally significant relation only to the mental health dimension. Conclusion: The results clinically showed the relevance of educational interventions performed by the health team. The nurses, as part of this team, must be present and active in all the stages of this work, planning, performing and searching for effective methods that lead to the improvement of life quality for this population.

MPH / Department of Public Health / High blood pressure is a global public health problem. High blood pressure shows no signs or symptoms and it can only be detected through BP measurements by a health professionals. It’s a chronic condition which requires long term management. Poor control of high blood pressure can lead to complications and even death. The aim of the study was to determine the prevalence of high blood pressure among University of Venda academic staff. UNIVEN is situated in Thohoyandou, Vhembe District in Limpopo. A cross-sectional design was used. A modified WHO stepwise questionnaire for non-communicable diseases version 3.1 was used to collect data regarding demographic characteristics, BP status, and stress and lifestyle characteristics. Charts and graphs were used to present the results of the study. The Statistical Package of Social Sciences was used to analyse data. The Chi-square test was used to determine the association between blood pressure and risk factors. A total of 179 respondents were selected, their ages of were ranged from 22 to 68 years. Their blood pressure, weight and height of the participants were also measured. The prevalence of high blood pressure was 20%, while 46% were on prehypertension stage and about 34% had a normal BP. About 23% had been previously diagnosed with HBP, while about 90% were on treatment for high blood pressure. Only 13% had their BP under control. The prevalence of high blood pressure was associated with gender, family history, vegetable intake and diabetes. Department of Sports need to introduce sports among academic staff as a way of prevention and management of high blood pressure.

Hypertension is a chronic non-communicable disease and a major risk factor for cardiovascular diseases, renal malfunction, disability, and premature death. One of the public health recommendations for the management of hypertension is the reduction of sodium/salt intake. There is need to develop and implement new evidence-based theoretical interventions to initiate and sustain behavior change in health education and promotion. Therefore, the quantitative cross-sectional method and design was used to investigate the adequacy of multi-theory model (MTM) constructs for the initiation and the sustenance of low sodium/salt intake behavior in hypertensive Nigerian adults. In addition, the impact of the MTM (initiation) constructs on actual salt/sodium intake was evaluated to validate self-reported behavior. A convenience sample of 149 consenting Nigerian adults with hypertension and of ages 20 to 60 years, self -administered the valid and reliable 39-item MTM instrument. The findings of confirmatory factor analysis showed construct validity of subscales for the initiation and sustenance model. All items loading for the two models were significant, p < 0.001. Multivariate regression analysis revealed 40.6% of the variance in initiating the consumption of low salt diets explained by advantages outweighing disadvantages, behavioral confidence, and changes in physical environment. About 41.8 % of the variance to sustain the intake of low salt diet was explained by emotional transformation, practice for change, and changes in social environment. The results justified the predictive role of MTM and adequacy of its utility to build evidence-based health education programs and interventions to address the health need of people with hypertension and contribute to social change in the country.

Thesis (MPhil)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: Pre-eclampsia is a common and dangerous condition of pregnancy. During clinical care the sensitive obstetrician will frequently recognise moral ambiguity and ethical conflicts. It is important to understand the pertinent issues and find ways of resolving them. Counselling is an important element of modern medicine. In deciding which counselling model to apply, clinicians must consider many variables including the particular clinical scenario, strength of evidence, and the justifiable limits of paternalism and autonomy in a position of shared responsibility. Couples have a moral right to procreate even when the pursuit of pregnancy involves significant risks. However, with their understanding of care ethics as well as rights ethics, informed women are well placed to negotiate the extremes of these positions when deciding whether to risk a pregnancy or not. The concept of the “fetal patient” is a helpful one. An autonomous woman may choose to confer or deny this status to her previable fetus, while obstetricians must balance autonomy- and beneficence-based obligations to the pregnant woman with beneficence-based obligations to her fetus. Maternal behaviour that harms the fetus and future child is categorised as maternal-fetal conflict. However, any pregnant woman is morally required to avoid harming the fetus, if this can be done without sacrificing her own important interests. The term non-compliance implies a hierarchical nature in the doctor-patient relationship. This reduces patient agency, erodes trust and conflicts with informed choice. Although sometimes justified, this “label” generally does more harm than good. Expectant management of early pre-eclampsia recognises that neonatal intensive care is an expensive and limited resource. The ultimate goal of expectant management remains the safety of the mother and the delivery of a live infant who will not require intensive and prolonged neonatal care. This judicious use of neonatal intensive care improves distributive justice but by consenting to expectant management as an inpatient, the pregnant woman voluntarily restricts her freedom. The decision is morally undergirded by the value accorded to the viable fetus and the scientific evidence informing the decision. When an extremely preterm, growth restricted fetus requires delivery, resuscitation may become an issue for consideration. The distinction between withholding resuscitation in such cases, or initiating but later withdrawing care is morally irrelevant. Categories of optional and obligatory treatments are more helpful, but perinatologists must determine treatment thresholds through understanding the relevant data and ethics issues. Finally, women do not lose their rights when they become terminally ill. When an undelivered woman is declared brain dead following complications of pre-eclampsia, her doctors and family must formulate clear plans for her and her living fetus. She must still be treated with respect and her right to die with dignity not forgotten. Extension of somatic support to optimise the outcome of her fetus can be supported ethically provided that the fetus is at the threshold of viability, the support is not prolonged (distributive justice), advanced level support is available with a successful outcome likely, and that doctors and family are in clear agreement. / AFRIKAANSE OPSOMMING: Pre-eklampsie is ‘n algemene en gevaarlike toestand van swangerskap. Die verloskundige met ‘n fyn waarnemingsvermoë sal dikwels morele dubbelsinnigheid en etiese konflik tydens kliniese sorg erken. Dit is belangrik om die kernaspekte te verstaan en maniere te vind om dit op te los. Berading is ‘n belangrike komponent van moderne geneeskunde. Tydens besluitneming oor watter model van berading toegepas moet word, moet klinici ‘n aantal veranderlikes teen mekaar opweeg insluitend die spesifieke kliniese senario, sterkte van die getuienis, die geregverdigde perke van paternalisme en outonomie in ‘n posisie van gedeelde verantwoordelikheid. Die egpare het ‘n morele reg om voort te plant selfs wanneer die verlange na swangerskap betekenisvolle risiko’s inhou. Vrouens wat goed ingelig is, het die vermoë om die uiterstes van etiek van sorg en regte teen mekaar op te weeg wanneer hulle besluit om die risiko van swangerskap te loop. Die konsep van “fetus as pasiënt” kan wel tot verdere besluitneming bydra. Die outonome vrou mag self besluit of die fetus daardie status het. Aan die ander kant moet die verloskundige outonomie en goedwilligheid- (“beneficence”) gebasseerde verpligtinge teenoor die swanger vrou opweeg teen die goedwilligheid-gebasseerde verpligting teenoor haar fetus. Moederlike gedrag wat die fetus en toekomstige kind skend, word as ‘n moeder-fetus konflik beskou. Enige swanger vrou is egter moreel verplig om nie die fetus skade te berokken nie, mits dit gedoen kan word sonder die prysgawe van haar eie noodsaaklike belange. Die term “nie-inskiklikheid” (“non-compliance”) impliseer hiërargie in die dokter-pasiëntverhouding. Hierdie hiërargie doen afbreuk aan die besluitneming van die pasiënt, ondermyn vertroue en bots met ingeligte keuses. Alhoewel besluitneming op grond van hiërargies-gebaseerde gesag soms geregverdig is, veroorsaak hierdie kategorisering gewoonlik meer kwaad as goed. Afwagtende hantering van vroeë pre-eklampsie gaan van die standpunt uit dat neonatale intensiewe sorg ‘n duur en skaars hulpbron is. Die uiteindelike doel van afwagtende hantering bly die veiligheid en gesondheid van die ma en die verlossing van ‘n lewendige baba wat nie verlengde intensiewe- en neonatale sorg benodig nie. Hierdie oordeelkundige gebruik van neonatale sorg bevorder distributiewe geregtigheid, maar wanneer sy toestemming gee tot afwagtende behandeling as binnepasiënt, beperk die swanger vrou vrywilliglik haar vryheid. Hierdie besluit word moreel ondersteun deur die waarde wat aan die lewensvatbare fetus toegevoeg word en die wetenskaplike gronde waarop die besluit berus. Wanneer ‘n erge voortydse, groeivertraagde fetus verlossing benodig, word ressussitasie soms iets wat oorweeg moet word. Die onderskeid tussen die weerhouding van ressussitasie in sulke gevalle en die onttrekking van sorg waar dit aanvanklik begin is, is moreel irrelevant. Kategorieë van opsionele en verpligte behandelings is meer behulpsaam, maar perinatoloë moet die behandelingsdrempels bepaal deur die relevante data en etiek te verstaan. Laastens, vroue verloor nie hul regte wanneer hulle terminaal siek word nie. Wanneer die komplikasies van pre-eklampsie breindood van die vrou veroorsaak voor die verlossing van haar baba, moet haar dokters en familie duidelike planne vir die hantering van haar en haar fetus ontwikkel. Sy moet nogsteeds met respek behandel word en haar reg om met waardigheid te sterf, mag nie uit die oog verloor word nie. Verlenging van die ondersteuning van lewensfunksies om die uitkoms van haar fetus te verbeter, kan eties ondersteun word, mits die fetus na aan lewensvatbaarheid is, die ondersteuning nie te lank duur nie (distributiewe geregtigheid), gevorderde ondersteuning beskikbaar is met ‘n goeie kans vir suksesvolle uitkoms en dat die dokters en familie ten volle saamstem.