Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Dec 1;9(12):e113715.
doi: 10.1371/journal.pone.0113715. eCollection 2014.

Hypertensive disorders of pregnancy: a systematic review of international clinical practice guidelines

Tessa E R Gillon  1 , Anouk Pels  2 , Peter von Dadelszen  3 , Karen MacDonell  4 , Laura A Magee  5
Affiliations

Hypertensive disorders of pregnancy: a systematic review of international clinical practice guidelines

Tessa E R Gillon et al. PLoS One. .

Abstract

Background: Clinical practice guidelines (CPGs) are developed to assist health care providers in decision-making. We systematically reviewed existing CPGs on the HDPs (hypertensive disorders of pregnancy) to inform clinical practice.

Methodology & principal findings: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register, Health Technology Assessments, and Database of Abstracts of Reviews of Effects (Ovid interface), Grey Matters, Google Scholar, and personal records were searched for CPGs on the HDPs (Jan/03 to Nov/13) in English, French, Dutch, or German. Of 13 CPGs identified, three were multinational and three developed for community/midwifery use. Length varied from 3-1188 pages and three guidelines did not formulate recommendations. Eight different grading systems were identified for assessing evidence quality and recommendation strength. No guideline scored ≧80% on every domain of the AGREE II, a tool for assessing guideline methodological quality; two CPGs did so for 5/6 domains. Consistency was seen for (i) definitions of hypertension, proteinuria, chronic and gestational hypertension; (ii) pre-eclampsia prevention for women at increased risk: calcium when intake is low and low-dose aspirin, but not vitamins C and E or diuretics; (iii) antihypertensive treatment of severe hypertension; (iv) MgSO4 for eclampsia and severe pre-eclampsia; (v) antenatal corticosteroids at <34 wks when delivery is probable within 7 days; (vi) delivery for women with severe pre-eclampsia pre-viability or pre-eclampsia at term; and (vii) active management of the third stage of labour with oxytocin. Notable inconsistencies were in: (i) definitions of pre-eclampsia and severe pre-eclampsia; (ii) target BP for non-severe hypertension; (iii) timing of delivery for women with pre-eclampsia and severe pre-eclampsia; (iv) MgSO4 for non-severe pre-eclampsia, and (v) postpartum maternal monitoring.

Conclusions: Existing international HDP CPGs have areas of consistency with which clinicians and researchers can work to develop auditable standards, and areas of inconsistency that should be addressed by future research.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Search results.
See this image and copyright information in PMC

References

    1. National High Blood Pressure Education Program (2000) Report of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy. Am J. Obstet Gynecol 183:1–22. - PubMed
    1. Yoder SR, Thornburg LL, Bisognano JD (2009) Hypertension in pregnancy and women of childbearing age. Am J. Med 122:890–895. - PubMed
    1. Magee LA, von Dadelszen P, Chan S, Gafni A, Gruslin A, et al. (2007) The Control of Hypertension In Pregnancy Study pilot trial. BJOG 114(6):770. - PubMed
    1. Fervers B, Burgers JS, Haugh MC, Brouwers M, Browman G, et al. (2005) Predictors of high quality clinical practice guidelines: examples in oncology. International Journal for Quality in Health Care. 17:123–132. - PubMed
    1. Watine J, Friedberg B, Nagy E, Onody R, Oosterhuis W, et al. (2006) Conflict between Guideline Methodologic Quality and Recommendation Validity: A. Potential Problem for Practitioners. Clinical Chemistry 52:65–72.39. - PubMed

Publication types