A Survey of Canadian Practitioners Regarding Diagnosis and Evaluation of the Hypertensive Disorders of Pregnancy

Abstract

This survey has clarified the current state of practice with respect to the diagnosis and evaluation of women with all types of HDP. In particular, we have identified areas of potential variability in BP measurement, and provided data on the feasibility of enrolling women with sub types of preeclampsia into intervention studies aimed at prolonging pregnancy.

A Survey of Canadian Practitioners Regarding the Management of the Hypertensive Disorders of Pregnancy

“…Surveys not informative for the study were those returned due to an incorrect mailing address (N = 51), and those from individuals who do not care for pregnant women with hypertension: 168 gynaecologists, 21 ''other'' SOGC members, 148 internists, and 78 retirees. Representation was seen from all regions of Canada (consistent with the national distribution of practitioners), and from practitioners with a wide range of practice experience in ur-ban and rural settings (7). Table 1 shows that only 20% of internists ''frequently'' advise women to quit work, which is significantly less than most obstetricians (60%), family doctors (60%), and midwives (52%) (all p < 0.0001).…”

“…Practitioners were also asked whether they would be prepared to randomize their patients in a trial of ''less tight'' vs. ''tight'' control of BP in pregnancy, and/or whether their practice would be changed by the results of such a trial. Questions about characteristics of the practitioner, practice, and community were also included at the end of the survey and are published in a separate manuscript (7). Revisions were made in accordance with feedback (on format and content) obtained by presentation of the survey and review by experienced colleagues.…”

“…The design of the study has been previously described in detail (7). Briefly, a survey, with French and English versions (and covering diagnosis, evaluation, and management of pregnancy hypertension), was mailed to all members of the SOGC (N = 1757, including obstetricians, family doctors practicing obstetrics, and midwives).…”

“…This publication deals specifically with the management of women with HDP, with diagnosis and evaluation dealt with in a separate article (7).…”

Antepartum eclampsia <34 weeks case series: advisable to postpone delivery to administer corticosteroids for fetal pulmonary benefit?

“…2 As stated by Leitch et al, 3 for eclampsia 'the mainstay of treatment has always been the delivery of the patient'. Thus, some consider eclampsia to be 'an absolute contraindication to expectant management'; [4][5][6] definitive treatment is recommended by some to be prompt termination of the pregnancy 'as soon as maternal hemodynamic stabilization is achieved'. 7,8 Concerns about delay of delivery include fear of disease progression with multiorgan system deterioration, especially in the maternal central nervous system and sudden placental abruption that could threaten fetal wellbeing in utero and thereafter.…”