Hypertension in pregnancy and preeclampsia: Knowledge and clinical practice among obstetrician-gynecologists

OBJECTIVE: To examine the knowledge and practice patterns of obstetrician-gynecologists concerning management of hypertensive disorders of pregnancy. STUDY DESIGN: Surveys were mailed to 1,116 fellows of the American College of Obstetrics and Gynecology; 416 of them constituted the Collaborative Ambulatory Research Network. Seven hundred more were chosen at random. The survey contained questions on physician and patient demography and on knowledge and practice patterns concerning management of various hypertensive disorders during pregnancy. RESULTS: A total of 401 completed surveys were analyzed. There was no difference between respondents and nonrespondents in either sex ratio (P=.410) or age (46.9 ± 0.4 versus 48.1 ± 0,4 years, P=.131). Most respondents (84.5%) would manage mild preeclampsia on an outpatient basis, and most (58.6%) usually managed preeclampsia independently. There was considerable variation in clinical practice. For example, about one of four respondents (27.4%) do not use seizure prophylaxis during labor in mild preeclampsia. Among physicians who do utilize magnesium sulfate for seizure prophylaxis, the mean standard loading dose was 4.5 ± .1 g intravenously. More than half the respondents (54.9%) would employ preeclampsia prevention procedures. Most respondents (74.6%) said that there is a role for management of severe preeclampsia remote from term. Intrauterine growth restriction would be used as an indication for immediate delivery by 60.6% of respondents; female physicians were more likely to use intrauterine growth retardation as an indication for immediate delivery (X²=5.7, P=.017) CONCLUSION: Much of the clinical management of hypertensive disorders of pregnancy is based on expert opinion, which often varies. Efforts to standardize management through consensus and algorithm development may be warranted pending results from conclusive evidence-based clinical investigations.