Management of severe pre-eclampsia and eclampsia by UK consultants.
OBJECTIVE
To determine the current management of severe pre-eclampsia and eclampsia in the United Kingdom.


METHODS
One-page postal survey to all (1007) UK consultant obstetricians with questions about use of antihypertensive and anticonvulsant drugs in severe pre-eclampsia and eclampsia, other management strategies, definition of factors determining severity, protocol development and regional review.


RESULTS
688 replies (69.6% response rate). The antihypertensive drugs used were mainly oral labetalol (35%), oral methyl dopa (23%) and parenteral hydralazine (29%); diuretics were not used. Diazepam was the preferred drug in eclampsia. Very few consultants used magnesium sulphate (2%). Anticonvulsants were also prescribed by 85% of consultants to prevent fits; the drugs then preferred were diazepam (41%), phenytoin (30%) and chlormethiazole (24%). Two-thirds of consultants felt there was a need for trials to study the effectiveness of antihypertensive and anticonvulsant drugs. In a woman with proteinuric hypertension, 15% of consultants did not regard the development of headache as indicating severe pre-eclampsia. Consistent management practices were not associated with agreement about protocols. Regional review does not appear to have occurred.


CONCLUSIONS
Antihypertensive and anticonvulsant therapies are widely used but trials are considered necessary. Improvements in the management of women with severe pre-eclampsia or eclampsia might occur if UK obstetricians sought more collective opinion and undertook regional audit of protocols.
Hutton
J D
JD
Department of Obstetrics and Gynaecology, Wellington School of Medicine, University of Otago, New Zealand.
James
D K
DK
Stirrat
G M
GM
Douglas
K A
KA
Redman
C W
CW
D000927:Anticonvulsants / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002985:Clinical Protocols; D003253:Consultants; D004461:Eclampsia / Q000188:drug therapy*; D005260:Female; D006801:Humans; D011225:Pre-Eclampsia / Q000188:drug therapy; D011247:Pregnancy; D012720:Severity of Illness Index; D006113:United Kingdom
D000927:Anticonvulsants; D000959:Antihypertensive Agents