PRINCIPLES & PRACTICE
A Historical Overview of Preeclampsia‐Eclampsia

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ABSTRACT

Preeclampsia is a hypertensive, multisystem disorder of pregnancy whose etiology remains unknown. Although management is evidence‐based, preventative measures/screening tools are lacking, treatment remains symptomatic, and delivery remains the only cure. Past hypotheses/scientific contributions have influenced current understanding of preeclampsia pathophysiology and guided management strategies and classification criteria. To provide insight into how past hypotheses/scientific contributions have shaped current practice trends, this article provides a historical overview of preeclampsia‐eclampsia.

Section snippets

Theories on Disease Causation

In ancient Greece, between the late 5th and early 4th centuries BC, the Hippocratics subscribed to the theory of the four humors to describe the cause of illness and disease. They believed that the body was made up of four humors (fluids) that included blood, phlegm, yellow bile, and black bile. Health depended on a balance of the humors, and any imbalance in the humors resulted in illness (9, 16).

The wet and dry theory was used to explain the vulnerability of female physiology to disease (

Theories on Disease Causation

During the Middle Ages, medical and scientific progress came to a standstill. Between 400 and 700 AD, Christianity greatly influenced such progress, for Christians were opposed to science and forbade human dissection (8, 15). Closing of medical schools at Athens and Alexandria by Byzantium Emperor Justinian in the 6th century further slowed medicine's progression (Cianfrani). Consequently, little original work was accomplished. Instead, individuals such as Oribasius, Aetius of Amida, and Paulus

Theories on Disease Causation

In the 18th century, Boissier de Sauvages distinguished eclampsia from epilepsy. Along with the distinction he made in disease classification, de Sauvages offered his views on the cause of convulsions. He believed that convulsions resulted from nature trying to free the organism of any morbid element (Temkin, 1971).

Theories on disease causation continued to be proposed and thoroughly discussed in the writings of 19th century physicians. In his work titled Introduction to the Practice of

Theories on Disease Causation

Although researchers in the 20th century failed to uncover the etiology of preeclampsia, much progress was made in the understanding of pathophysiological changes associated with its development. In the 1960s, several groups described dramatic differences in placental physiology between placentas from pregnancies affected by preeclampsia versus placentas from pregnancies unaffected by preeclampsia. Through the examination of placental bed biopsies, it was discovered that placental trophoblast

Theories on Disease Causation

At present, the scientific community has failed to uncover the etiologic mechanisms responsible for the development of preeclampsia‐eclampsia. As evidenced by the many review articles published in the scientific literature, the theories on disease causation are numerous and diverse. Such theories are related to mechanisms involving oxidative stress, immunologic intolerance between the fetoplacental unit and maternal tissue, and angiogenic imbalance (Leeman & Fontaine, 2008). For example, the

Conclusion: Nursing Implications

This historical overview provides present‐day nurses with a broadened perspective of preeclampsia‐eclampsia related to theories on disease causation, evolution of treatments, and refinement of disease classification. With such a perspective, nurses gain insight into how past hypotheses and scientific contributions have influenced and shaped current practices. Although the etiology of preeclampsia remains unknown, ongoing research has vastly improved our understanding of preeclampsia over the

Acknowledgment

Funded by National Institute of Nursing Research grants T32NR009759 and 1F31NR011379.

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