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Acta Obstétrica e Ginecológica Portuguesa

versión impresa ISSN 1646-5830


MONTEIRO-BRAS, Inês; REYNOLDS, Ana; GUEDES-MARTINS, Luís  y  SILVA, Patrícia. Clinical management of hypertensive disorders of pregnancy. Acta Obstet Ginecol Port [online]. 2022, vol.16, n.3, pp.213-233.  Epub 30-Sep-2022. ISSN 1646-5830.

Overview and Aims:

The hypertensive disorders of pregnancy are important causes of maternal and fetal morbidity and mortality. Recent advances on the physiopathology have changed the management of these diseases but consensus on the best approach has not yet been reached. The main goal of this study is to evaluate obstetricians’ agreement regarding the management of pre-eclampsia/eclampsia and HELLP syndrome as recommended by some Portuguese institutions and international organizations.


Two national protocols (protocols) and four international guidelines (guidelines) were included. The agreement of three obstetricians was obtained by using the modified Delphi method. The recommendations were divided into eight categories, from diagnosis to disease management. Experts assigned an agreement index to compare each category of the recommendations based on a 3-score-scale: “0” (disagreement with clinical significance), “0.50” or “1” (agreement). The medians of the agreement indexes were calculated, individually and globally.


Partial disagreement (medians of “0.50”) was obtained in most categories. The categories with less agreement were “pre-eclampsia hospital admission criteria”, “pre-eclampsia severity criteria” and “HELLP syndrome management” with a disagreement considered as of clinical significance when comparing protocols and guidelines (medians of “0.00”). The lack of obstetricians’ agreement regarding clinical management recommendations has been reported in other studies. Detected divergencies may have an impact on maternal, perinatal, and neonatal outcomes.


The results point to the need to develop national guidelines for the management of hypertensive disorders of pregnancy, including screening and prevention, obtained through the consensus of a group of obstetricians, from different maternities in the country.

Palabras clave : Preeclampsia; Eclampsia; HELLP syndrome; Practice guidelines as topic.

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