A Survey of Canadian Practitioners Regarding the Management of the Hypertensive Disorders of Pregnancy
A Survey of Canadian Practitioners Regarding the Management of the Hypertensive Disorders of Pregnancy
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加拿大从业者关于妊娠期高血压疾病管理的调查
DOI：
10.1081/prg-120028282
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发表时间：
2004
影响因子：
1.5
通讯作者：
L. Magee
中科院分区：
文献类型：
--
作者：
M. Caetano;M. Ornstein;P. Dadelszen;M. Hannah;A. Logan;A. Gruslin;A. Willan;L. Magee
背景：加拿大医生如何管理妊娠高血压疾病（HDP）尚不清楚，特别是与加拿大高血压协会（CHS） 1997年出版的指南有关。方法：邮寄给加拿大妇产科学会（SOGC）所有成员（N = 1757，包括产科医生、产科家庭医生和助产士）一份法文和英文版本的调查（涵盖妊娠高血压的诊断、评估和管理）。此外，在加拿大皇家内科医生和外科医生学院注册的内科医生[即所有肾病科医生（N = 191）和随机抽取的25%的普通内科医生（N = 450）]被抽样。调查以两份邮件和一张提醒卡的形式分发。将数据输入Microsoft Access，并使用Graph Pad Prism对响应进行汇总[N(%)]。检验了不同专业之间的实践差异，使用Bonferroni校正来计算基于比较次数和alpha 0.05的显著p值。结果：受访者人数为1187人（49.5%），其中466人对研究目的没有提供信息（由于退休或不包括高血压孕妇）。最终的分析包括721份已完成的调查。对于所有类型的HDP，大多数内科医生、家庭医生和助产士在dBP 80-89 mmHg（即一级预防）时开始非药物治疗（最常见的建议是辞职）。只有在子痫前期，产科医生最常使用这个阈值；否则，通常选择dBP 90 - 99mmhg。对于非严重高血压，降压药治疗（最常见的是甲基多巴或拉贝他洛尔）由大多数医生在dBP 90-99 mmHg开始，尽管产科医生更有可能选择更高的阈值（p < 0.0001）。对于dBP的治疗目标，各方意见不一；大多数内科医生和家庭医生将dBP正常化，而产科医生似乎对所有HDP的dBP目标在80-89（46-51%）和90-99 mmHg（41-44%）上存在分歧（p = 0.66）。严重的高血压通常用静脉注射肼、拉贝他洛尔或硫酸镁治疗。短效或缓释硝苯地平很少或从不被大多数从业者使用。大约三分之一的产科医生和家庭医生使用地西泮治疗子痫。绝大多数患有先兆子痫的妇女预防性使用MgSO4。解释：这项调查明确了目前对HDP妇女的管理，并确定了对dBP治疗目标的研究，以优化HDP妇女的妊娠结局，并将明确的研究转化为临床实践。
Background: How Canadian practitioners are managing the hypertensive disorders of pregnancy (HDP) is not known, particularly in relation to the 1997 guidelines published by the Canadian Hypertension Society (CHS). Methods: A survey, with French and English versions (and covering diagnosis, evaluation, and management of pregnancy hypertension), was mailed to all members of the Society of Obstetricians and Gynaecologists of Canada (SOGC) (N = 1757, including obstetricians, family doctors practicing obstetrics, and midwives). Additionally, internists [i.e., all nephrologists (N = 191) and a random sample of 25% of general internists (N = 450)] registered with the Royal College of Physicians and Surgeons of Canada were sampled. The survey was distributed in two mailings and one reminder card. Data were entered into Microsoft Access, and Graph Pad Prism used to summarize responses [N (%)]. Differences in practice between specialties were examined, with a Bonferroni correction used to calculate a significant p value based on the number of comparisons and alpha of 0.05. Results: Respondents numbered 1187 (49.5%), with 466 not informative for the purpose of the study (due to retirement, or practices that do not include pregnant women with hypertension). The final analysis included 721 completed surveys. For all types of HDP, most internists, family doctors, and midwives initiate nonpharmacological therapy (most common advice to quit work) at dBP 80–89 mmHg (i.e., primary prevention). Only for preeclampsia do obstetricians most frequently use this threshold; otherwise, dBP 90–99 mmHg is usually chosen. For nonsevere hypertension, antihypertensive drug therapy (most commonly methyldopa or labetalol) is started by most practitioners at dBP 90–99 mmHg, although obstetricians are more likely to choose a higher threshold (p < 0.0001). There is little agreement about dBP treatment goal; most internists and family doctors normalize dBP, whereas obstetricians appear to be divided on dBP goals of 80–89 (46–51%) vs. 90–99 mmHg (41–44%) for all HDP (p = 0.66). Severe hypertension is commonly treated with parenteral hydralazine, labetalol, or magnesium sulphate. Short‐acting or sustained release nifedipine is used rarely/never by most practitioners. Approximately one‐third of obstetricians and family doctors use diazepam to treat eclampsia. The vast majority use MgSO4 prophylactically in women with preeclampsia. Interpretation: This survey has clarified current stated management of women with HDP, and identified the need for both research into the dBP treatment goal that optimizes pregnancy outcomes among women with HDP, and translation of definitive studies into clinical practice.