Orientação clínica das doenças hipertensivas próprias da gravidez

Abstract

Introduction: The hypertensive disorders of pregnancy are important causes of maternal and fetal morbimortality. Recent advances on the pathophysiology have changed the management of these diseases but consensus has not yet been reached. The main goal of this study is to evaluate obstetricians' agreement regarding the management of pre-eclampsia / eclampsia and HELLP syndrome as recommended by some Portuguese institutions and international organizations. Materials and Methods: Three national guidelines (protocols) and four international guidelines (guidelines) were included. The agreement of three obstetricians was obtained by using the modified Delphi method after dividing the recommendations into eight categories, from diagnosis to disease management. Experts assigned an agreement index to compare each category of the recommendations based on a 3-score-scale: "0" (disagreement with clinical significance), "0,50" or "1" (agreement). The medians of the agreement indexes were calculated, individually and globally. Results: Partial disagreement (medians of "0,50") was obtained in most categories. The less consensual were "pre-eclampsia hospital admission criteria" and "HELLP syndrome management" with a disagreement considered as of clinical significance when comparing protocols and guidelines (medians of "0,00"). Discussion: The lack of obstetricians' agreement regarding clinical management recommendations has been reported in other studies. Detected divergencies may have an impact on maternal, perinatal, and neonatal outcomes. Conclusion: The results point to the need to develop national guidelines for the management of hypertensive disorders of pregnancy, including screening and prevention, obtained through the consensus of a group of obstetricians, from different maternities in the country.