In 2004 we conducted a national survey of clinical guidelines in severe pre-eclampsia/eclampsia (sPET) and demonstrated that the standard of guidelines in individual maternity units was poor. NICE published guidance in this area in 2010. Our aim was to determine if the last decade has seen improvements.Methods
229 UK maternity units were contacted and asked for their guideline for the management of sPET. We had 137 responses (59.8%), with 108 guidelines available to review. Guidelines were assessed against the criteria used in 2004.Results/Discussion
Overall guideline standard has improved. 99.1% of the guidelines had clear inclusion criteria compared with 86.1% (p < 0.05) in 2004. The importance of senior input has been recognised with 91.7% recommending consultant input compared with 26.4% (p < 0.05) in 2004. 99.1% now recommend using magnesium sulphate and advise fluid restriction. Whilst BP targets are now included in 96.3% of guidelines (56.1% in 2004, p < 0.05) there continues to be varying advice on target ranges. There has been a significant shift in recognition of the importance of systolic hypertension with only 14.8% of guidelines now recommending a target systolic BP (sBP) of >160 mmHg. In 2004, 43.8% of guidelines did not contain a target sBP and all of those which did recommended >160 mmHg.Conclusion
Although there has been a significant improvement in guideline standard nearly 1 in 7 of responding units are still not adherent with safe BP targets, as intracerebral haemorrhage is the biggest killer of women with PET, this perhaps needs to be flagged again nationally.