Role of Nurses and Midwives in Controlling Preeclampsia in Rural and Urban Slums of Sindh, Pakistan: A Structured Narrative Review

Abstract

Background: Preeclampsia is a major contributor to maternal and perinatal morbidity and mortality, particularly in low- and middle-income countries. Rural districts and urban slums of Sindh, Pakistan face intersecting risks, including low antenatal care continuity, home delivery, transport delays, limited emergency obstetric services, low health literacy, and shortage of skilled providers.

Objective: To synthesize evidence on how nurses, midwives, Lady Health Workers, and community midwives can prevent, detect, stabilize, and refer women with preeclampsia in rural and urban underserved settings of Sindh.

Methods: A structured narrative review was conducted using PRISMA-informed selection principles. Literature from 2015-2025 was reviewed from PubMed, Scopus, Web of Science, WHO, UNFPA, DHS/PMMS reports, Sindh MICS, and relevant grey literature. Thirty sources were included and synthesized thematically.

Results: Evidence supports five key nursing and midwifery roles: early screening and risk stratification, patient/family education, community outreach, protocol-based initial management, and referral coordination. Trials such as CLIP Pakistan and CRADLE demonstrate the feasibility of community-level blood pressure monitoring, decision support, and task-sharing, although impact depends heavily on referral facility quality and system readiness.

Conclusion: Nurses and midwives are central to preeclampsia control in Sindh. However, their impact requires enabling policies, adequate staffing, reliable blood pressure devices, urine protein testing, magnesium sulfate and antihypertensive availability, transport support, and strengthened referral facilities.