South African Medical Journal

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

S M Khedun, J Moodley, T Naicker, B Maharaj


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 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 ;0, 110 rnrnHg and proteinuria ≥, ++). To stop convulsions in eclampsia, 256 respondents (60%) said they would use diazepam, 28 (11%) said tlIey woUld continue with a diazepam infusion, and the remairling 228 (89%) preferred magnesium sulphate (MgS04) to prevent further convulsions. The intramuscular route was the preferred method of administration for MgS04. In cases of eclampsia, 273 respondents (64%) said they would use intravenous dihydralazine to lower high blood pressure (≥, 160/110 rnrnHg) and proteinuria; 98 respondents (23%) said they would use met.'1yldopa, 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 MgS04 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 Iow-dose aspirin.
Conclusion. This study demonstrates that South African obstetricians show great uniformity in terms of the treatment of hypertensive disorders of pregnancy.

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