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 suitable for analysis. South African obstetricians disagree on the definitions of various hypertensive disorders of pregnancy.
Methyldopa was the
antihypertensive used most frequently for the treatment of mild to moderate
hypertension (diastolic blood pressure between 90 and 109 mmHg), while intravenous
dihydralazine was preferred in severe
hypertension (diastolic blood pressure > or = 110 mmHg and
proteinuria > or = +2). 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 further convulsions. The intramuscular route was the preferred method of administration for MgSO4. In cases of
eclampsia, 273 respondents (64%) said they would use intravenous
dihydralazine to lower
high blood pressure (> or = 160/110 mmHg) and
proteinuria; 98 respondents (23%) said they would use
methyldopa, 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 respondents (78%) said they would use MgSO4 as prophylaxis, 46 (11%)
diazepam, and 6 (1.4%)
phenobarbitone. Forty-three of the respondents did not prescribe prophylactic
anticonvulsant therapy. To prevent
pre-eclampsia, 247 of the respondents (58%) said they would prescribe low-dose
aspirin.
CONCLUSION: This study demonstrates that South African obstetricians show great uniformity in terms of the treatment of hypertensive disorders of pregnancy.