How do South African obstetricians manage hypertensive disorders of pregnancy - A survey

Objective. To determine the current management of hypertensive disorders of pregnancy in South Africa. Method. A postal questionnaire was sent to 600 South African obstetricians. Results. The response rate was 72% (432/600) with 425 questionnaires suitab le for analysis. South African obstetricians disagree on the definitions of various hypertensive disorders of pregnancy. Methyldopa was the antihypert ensive used most frequently for the treatment of mild to moderate hypertens ion (diastolic blood pressure between 90 and 109 mmHg), while intravenous d ihydralazine was preferred in severe hypertension (diastolic blood pressure greater than or equal to 110 mmHg and proteinuria greater than or equal to ++). To stop convulsions in eclampsia, 256 respondents (60%) said they would use diazepam, 28 (11%) said they would continue with a diazepam infusion, and the remaining 228 (89%) preferred magnesium sulphate (MgSO4) to prevent fur ther convulsions. The intramuscular route was the preferred method of admin istration for MgSO4. In cases of eclampsia, 273 respondents (64%) said they would use intravenou s dihydralazine to lower high blood pressure (greater than or equal to 160/ 110 mmHg) and proteinuria; 98 respondents (23%) said they would use methyld opa, 38 (9%) nifedipine, and 8 (2%) apresoline. Eight (2%) said they would not use antihypertensives. In patients with severe pre-eclampsia and impending eclampsia, 330 responde nts (78%) said they would use MgSO4 as prophylaxis, 46 (11%) diazepam, and 6 (1.4%) phenobarbitone. Forty-three of the respondents did not prescribe p rophylactic anticonvulsant therapy. To prevent pre-eclampsia, 247 of the re spondents (58%) said they would prescribe low-dose aspirin. Conclusion. This study demonstrates that South African obstetricians show g reat uniformity in terms of the treatment of hypertensive disorders of preg nancy.