Koopmans, N.K. (Nienke) (2013) Management van chronische hypertensie tijdens de zwangerschap in Nederland. thesis, Medicine.
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Abstract
Introduction: Chronic hypertension during pregnancy is defined as a systolic blood pressure equal or above 140mmHg or a diastolic blood pressure equal or above 90mmHg, already existing pre-pregnancy or before the 20th week of pregnancy. Chronic hypertension complicates approximately 0.2-1.5% of all pregnancies and is associated with a higher risk of adverse perinatal and maternal outcomes. Preventing these adverse outcomes is a major goal in the treatment of pregnant women with chronic hypertension. However, only little literature is available on this subject, therefore, we expect that there is a wide variation in the practiced management strategies. The aim of this study was to determine current clinical practice and underlying rationale in the management of chronic hypertension in pregnancy by gynaecologists in The Netherlands Methods: In this cross-sectional study a questionnaire regarding the management of chronic hypertension during pregnancy was sent to all gynecologists registered at the Dutch Society for Obstetrics and Gynecology. Gynecologists who were not working in the Netherlands or who did not take care of obstetric patients, directly or by supervision of residents, were excluded. The questionnaire covered nine aspects of the management of chronic hypertension during pregnancy. Data regarding demographics, work and acquaintance with guidelines were collected as well. The questionnaire was presented online. We sent a short version of the questionnaire to all non-responders after six weeks. Descriptive analyses were performed. Results: The questionnaire was sent to 898 gynecologists. In total 40.3% (n=387) of them responded. 30.2% (n = 387) of the questionnaires were useful for analyses. There was considerably agreement, ranging from a small majority upon more than 90%, regarding the aspects of preconceptional advice, evaluation up on diagnosis, choice of anti-hypertensive agents and fetal- and maternal monitoring. On the aspects definitions and lifestyle advices there was agreement on most parts of the management but there was also disagreement on a few parts of the aspects. There was great difference in management practiced by gynecologists on the aspects of target blood pressure and timing of delivery, only 15–30% agreed on those aspects. 88% of the gynecologists reported to use a guideline in their management, in two third of the cases they used the national guideline. Conclusion: Our study presents an overview of the management of chronic hypertension during pregnancy practiced by gynecologists in The Netherlands. Although there are some aspects of the management that gynecologists agree on, there are also aspects about which there is great variation in the practice of different gynecologists. The national guideline advises only on some aspects of the management, these advices are often, but not always followed by the gynecologists. With knowledge of the current practice it is easier to interprete and evaluate the pregnancy outcomes of women with chronic hypertension. This study will facilitate implementation of research results in the future as well. Besides that, it is now possible to give an impression of current Dutch management on chronic hypertension during pregnancy that is not stated by a study protocol.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Broekhuijsen, Drs. Kim and Franssen, Dr. Maureen T.M. |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:47 |
| Last Modified: | 25 Jun 2020 10:47 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/804 |
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