Increased adherence to ACOG diagnostic guidelines for HDP following a workshop in Bolivia, a LMIC.

Autor: Toledo-Jaldin L; Hospital Materno-Infantil, Caja Nacional de Salud, La Paz, Bolivia., Lazo-Vega L; Hospital Materno-Infantil, Caja Nacional de Salud, La Paz, Bolivia., Grau L; Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado-Anschutz Medical Campus, Aurora, CO 80045, United States., Lawrence I; University of Colorado Denver School of Medicine, Aurora, CO 80045, United States., Larrea-Alvarado A; Hospital Materno-Infantil, Caja Nacional de Salud, La Paz, Bolivia., Mizutani R; Universidad Nuestra Señora de La Paz, Escuela de Medicina, La Paz, Bolivia., Rocabado S; Universidad Nuestra Señora de La Paz, Escuela de Medicina, La Paz, Bolivia., Vasan V; Krieger School of Arts and Sciences, The Johns Hopkins University, Baltimore, MD, United States., Sammel M; Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado-Anschutz Medical Campus, Aurora, CO 80045, United States; Department of Obstetrics and Gynecology, University of Colorado Denver, Aurora, CO 80045, United States., Julian CG; Department of Medicine, University of Colorado Denver, Aurora, CO 80045, United States., Moore LG; Department of Obstetrics and Gynecology, University of Colorado Denver, Aurora, CO 80045, United States. Electronic address: Lorna.Moore@cuanschutz.edu.
Jazyk: angličtina
Zdroj: Pregnancy hypertension [Pregnancy Hypertens] 2023 Dec; Vol. 34, pp. 19-26. Date of Electronic Publication: 2023 Sep 29.
DOI: 10.1016/j.preghy.2023.09.004
Abstrakt: Objectives: Hypertensive disorders of pregnancy (HDP) exert a heavy mortality burden in low- to middle-income countries (LMIC). ACOG revised HDP diagnostic guidelines to improve identifying pregnancies at greatest risk but whether they are used in LMIC is unknown.
Study Design: We held a workshop to review ACOG guidelines in La Paz, Bolivia (BO) and then reviewed prenatal, labor and delivery records for all HDP diagnoses and twice as many controls at its three largest delivery sites during the year before and the nine months after a workshop (n = 1376 cases, 2851 controls during the two periods).
Main Outcome Measures: HDP diagnoses, maternal, and infant characteristics.
Results: Bolivian and ACOG criteria identified similar frequencies of gestational hypertension (GH) or eclampsia, but preeclampsia with severe features (sPE) was under- and preeclampsia without severe features (PE) over-reported during both periods. Increases occurred after the workshop in testing for proteinuria and the detection of abnormal laboratory values and severe hypertension in HDP women. Any adverse maternal outcome occurred more frequently after the workshop in women with BO PE or sPE diagnoses who met ACOG sPE criteria.
Conclusions: Utilization of ACOG guidelines increased following the workshop and improved identification of PE or sPE pregnancies with adverse maternal outcomes. Continued use of a CLAP perinatal form recognizing HELLP as the only kind of sPE resulted in under-reporting of sPE.
Funding: NIH TW010797, HD088590, HL138181.
Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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