title: Comparative analysis of recommendations in local Dutch guidelines on 'Hypertension and pregnancy'.
abstract: OBJECTIVE
  Hypertensive disorders in pregnancy remain the most prevalent cause of maternal and fetal morbidity and mortality. We hypothesise that incompleteness of local protocols 'Hypertension during pregnancy' might be associated with adverse obstetric outcome. Therefore, we analyzed the contents of the local Dutch protocols.
  
  
  METHODS
  We analyzed local Dutch protocols on 'Hypertension during pregnancy' using qualitative methods to score the completeness using the national guideline as standard. Indicators were designed using key recommendation from the national Dutch guideline 'Hypertension during pregnancy' (n=83 indicators), 22 of these indicators were classified as crucial indicators. Deficiencies in the local Dutch protocols, differences between the protocols and differences between the protocols of academically affiliated hospitals, teaching non-academic hospitals and non-teaching hospitals were analyzed using ANOVA test.
  
  
  RESULTS
  The median total score of the local protocols is 32.5 (max 83, range from 2 to 55). Thirteen indicators were described in less than 10% of the local protocols. We found more indicators lacking in the non-teaching hospitals protocols compared to academically affiliated hospitals and teaching non-academically hospitals protocols. (Six of the crucial indicators were described in less than 50% of the local protocols.)
  
  
  CONCLUSIONS
  The data from this review imply incompleteness of the local Dutch protocols. Improvement of the protocols can result in improvement of implementation and subsequent improvement of quality care for pregnant women with hypertension finally resulting in better outcome of mother and child.
authors.affiliation: Medisch Centrum Haaglanden, Department of Gynaecology, The Netherlands.
authors.forename: V S
authors.initials: VS
authors.lastname: Visser
authors.affiliation: VU University Medical Center, Department of Obstetrics and Gynaecology, The Netherlands.
authors.forename: C J M
authors.initials: CJ
authors.lastname: de Groot
authors.affiliation: VU University Medical Center, Department of Obstetrics and Gynaecology, The Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: Luitjes
authors.affiliation: VU University Medical Center, Department of Obstetrics and Gynaecology, The Netherlands.
authors.forename: M G A J
authors.initials: MG
authors.lastname: Wouters
authors.affiliation: Leids Universitair Medisch Centrum, Department of Gynaecology, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: van Lith