ACOG and local diagnostic criteria for hypertensive disorders of pregnancy (HDP) in La Paz-El Alto, Bolivia: A retrospective case-control study.
Eclampsia
HELLP syndrome
High altitude
Maternal mortality
Perinatal mortality
Preeclampsia
Journal
Lancet regional health. Americas
ISSN: 2667-193X
Titre abrégé: Lancet Reg Health Am
Pays: England
ID NLM: 9918232503006676
Informations de publication
Date de publication:
May 2022
May 2022
Historique:
entrez:
20
6
2022
pubmed:
21
6
2022
medline:
21
6
2022
Statut:
ppublish
Résumé
Hypertensive disorders of pregnancy (HDP) are a leading cause of maternal death in low- to middle-income countries (LMIC). The American College of Obstetricians and Gynecologists (ACOG) updated diagnostic guidelines to align signs and symptoms with those associated with maternal death. We performed an observational study to ask whether ACOG guidelines were employed and associated with adverse outcomes in La Paz-El Alto, Bolivia, an LMIC. Medical records for all HDP discharge diagnoses ( Both systems agreed with respect to eclampsia, but only 27% of all Bolivian HDP diagnoses met ACOG criteria. HDP increased adverse maternal- or perinatal-outcome risks for both systems, but ACOG guidelines enabled more pre-delivery diagnoses, graded maternal-risk assessment, and targeting of HDP terminating in maternal death. Bolivia diagnoses agreed with ACOG guidelines concerning end-stage disease (eclampsia) but not the other HDP due mainly to ACOG's recognition of a broader range of severe features. ACOG guidelines can aid in identifying pregnancies at greatest risk in LMICs, where most maternal and perinatal deaths occur. NIH TW010797, HD088590, HL138181, UL1 TR002535.
Sections du résumé
Background
UNASSIGNED
Hypertensive disorders of pregnancy (HDP) are a leading cause of maternal death in low- to middle-income countries (LMIC). The American College of Obstetricians and Gynecologists (ACOG) updated diagnostic guidelines to align signs and symptoms with those associated with maternal death. We performed an observational study to ask whether ACOG guidelines were employed and associated with adverse outcomes in La Paz-El Alto, Bolivia, an LMIC.
Methods
UNASSIGNED
Medical records for all HDP discharge diagnoses (
Findings
UNASSIGNED
Both systems agreed with respect to eclampsia, but only 27% of all Bolivian HDP diagnoses met ACOG criteria. HDP increased adverse maternal- or perinatal-outcome risks for both systems, but ACOG guidelines enabled more pre-delivery diagnoses, graded maternal-risk assessment, and targeting of HDP terminating in maternal death.
Interpretation
UNASSIGNED
Bolivia diagnoses agreed with ACOG guidelines concerning end-stage disease (eclampsia) but not the other HDP due mainly to ACOG's recognition of a broader range of severe features. ACOG guidelines can aid in identifying pregnancies at greatest risk in LMICs, where most maternal and perinatal deaths occur.
Funding
UNASSIGNED
NIH TW010797, HD088590, HL138181, UL1 TR002535.
Identifiants
pubmed: 35719175
doi: 10.1016/j.lana.2022.100194
pmc: PMC9205446
mid: NIHMS1809858
pii:
doi:
Types de publication
Journal Article
Langues
eng
Subventions
Organisme : NICHD NIH HHS
ID : R01 HD088590
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL079647
Pays : United States
Organisme : FIC NIH HHS
ID : R21 TW010797
Pays : United States
Déclaration de conflit d'intérêts
Declaration of interests The corresponding and all other authors of this manuscript declare no conflicts of interest.
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