EFFECT OF CLINICAL GUIDELINE-BASED FOLLOW-UP ON THE DEVELOPMENT OF POSTPARTUM PREECLAMPSIA AND ITS COMPLICATION
Creators: name: AISHA HASSAN MOHAMED
name: SHADIA ABDEL KADER HASSAN
name: ABEER SAAD ZAGHLOL
name: HAYTHAM BADRAN
name: AMAL SHAABAN ABDELMONEM
Publisher: name: Zenodo
Year: 2024
Subjects: NICE Guidelines, Pregnancy, Postpartum Preeclampsia, Hypertension, New-Onset Postpartum Preeclampsia, Postpartum, Postpartum Eclampsia, Gestational Hypertension.

description:  

Abstract

Background: High blood pressure in the postpartum period is most commonly seen in women with antenatal hypertensive disorders, but it can develop de novo in the postpartum time frame. Whether postpartum preeclampsia or eclampsia represents a separate entity from preeclampsia or eclampsia with antepartum onset is unclear. the diagnosis of postpartum preeclampsia should be considered in women with new-onset hypertension 48 hours to 6 weeks after delivery. Aim of the study: to examine the effect of clinical guidelines-based follow up on developing of postpartum preeclampsia and its complications. Design: A time series quasi-experimental design was adopted in the current study. In the current study, the women with a history of antepartum preeclampsia or gestational hypertension were followed from the postpartum period until the 2 months through home visits as a recommendation of clinical NICE guidelines. Setting: The current study was conducted at two settings, the postpartum unit in the department of Obstetrics and Gynecology at El-Fayoum university hospital, and participant's home as well to perform the home visits follow up. Participants: A convenience sample of 80 women who attended the postpartum unit at El-Fayoum university hospital, and home visit follow-up  were recruited For the study  for nine months, the sample was one group who received protocol of care for postpartum preeclampsia according to the following inclusion criteria; women who have antepartum pre-eclampsia or gestational hypertension, while women with pre-gestational hypertension, and women with chronic hypertension, were excluded from the study. Results: The age range was 25 - 30 years old, 33.8 % of the age range were 30 - 35 years old, and 15% the age range were 35-40, the complications during postpartum 26.3% had uncontrolled blood pressure, 16.3% developed eclampsia, while HEELP syndrome was represented to 12.5% of the study sample, and 15% had Postpartum hemorrhage. There were highly statistically significant differences between the first home visit and fourth home visit after follow-up and implemented clinical guidelines regarding vital signs, systolic and diastolic respectively (p value= 0.001*, p value= 0.001*).  46.3% & 62.5% of women on the 1st home visit had blurred vision, and headache respectively, while on 4th home visit 0% the of them have blurred vision and headache, there is statistically significant difference between both of them (P-value 0.001*). Conclusion: The current study concluded that postpartum preeclampsia women who applied clinical guidelines (NICE guidelines) were less likely develop postpartum preeclampsia and complications. Recommendations: Application of clinical guidelines (NICE guidelines) for all cases who had preeclampsia should be included in health care system for all risky groups and to be apart from postpartum care.