Adherence to Guidelines in Postpartum Management of Hypertensive Disorders in Pregnancy in Tertiary Health Facilities in Nigeria: A Multi-centre Study

Lawal Oyeneyin*, Salisu Ishaku, Onyebuchi Azubuike, Innocent Agbo, Lamaran Dattijo, Aminu Baffah, Gbenga Kayode, Olorunfemi Owa, Patience Odusolu, Karima Tunau, Jamilu Tukur, Charlotte Warren, Hannifa Abubakar, Musa Abdulkarim, Arie Franx, Diederick Grobbee, Joyce Browne

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Hypertensive disorders in pregnancy (HDPs) are a leading cause of maternal morbidity and mortality. Available guidelines for their postpartum management are expected to be optimally utilized. This study aimed to determine adherence to guidelines in selected Nigerian tertiary hospitals. It was nested in a cohort of women with HDPs who delivered in eight facilities between October 2017 and June 2018. Nine weeks after delivery, their cases were evaluated on prespecified indicators and supplemented with interviews. The level of adherence to the guidelines was determined using descriptive analyses, including frequencies, percentages, means, and standard deviations, as well as charts. Of the 366 participants, 33 (9%), 75 (20%), 200 (55%), and 58 (16%) had chronic hypertension, gestational hypertension, preeclampsia, and eclampsia, respectively. Only about a third had their blood pressure measured between postpartum days three and five. Similarly, a third of those with persistent hypertension (≥140/90 mmHg) were not on antihypertensive medications within the first week postpartum. In addition, 37% and 42% of participants were not counseled on contraceptives and early subsequent antenatal visits, respectively. Among those with preeclampsia/eclampsia, 93% were not offered postpartum screening for thromboprophylaxis. Although all women with preeclampsia/eclampsia remained hypertensive two weeks after discharge, only 24% had medical reviews. Overall, only 58% and 44% of indicators were adhered to among all HDPs and preeclampsia/eclampsia-specific indicators, respectively. Level of adherence to guidelines on postpartum management of HDPs in Nigerian tertiary hospitals is poor. It is recommended that institutionalization of guidelines be prioritized and linked to the entire continuum from preconception through longer term postpartum care.

Original languageEnglish
Article numbere1932229
JournalHealth systems and reform
Volume7
Issue number1
DOIs
Publication statusPublished - 31 Jul 2021

Bibliographical note

Funding Information:
This work was supported by the US Agency for International Development (USAID) under the terms of cooperative agreement number USAID APSOAA-14-000048. The study was also supported by the UMC Utrecht Global Health Fellowship Program. This article reflects the views of the authors and does not represent the views of the US Government. The authors hereby acknowledge the invaluable contributions of all supporting staff of the Population Council–Nigeria and the study hospital sites. In particular, the authors  thank those at the Department of Obstetrics and Gynecology of the University of Medical Sciences Teaching Hospital, Ondo, namely, Dr. Temitope Ogedengbe (resident doctor), Patience Agbonmuserin (chief nursing officer), Bimpe Adeniyi (nursing officer), Bose Omodara (health information manager), and Adeola Awotale (research assistant).

Publisher Copyright:
© 2021 The Author(s). Published with license by Taylor & Francis Group, LLC.

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