Awareness of obstetricians for long-term risks in women with a history of preeclampsia or HELLP syndrome

Abstract

Purpose Hypertensive disorders of pregnancy are still a leading cause of maternal and neonatal morbidity and mortality worldwide. Women with a history of preeclampsia have an increased risk for future cardiovascular and cerebrovascular disease, renal disease as well as diabetes mellitus. There is little knowledge on postpartum risk management. The aim of this study was to assess follow-up care for patients after pre-eclampsia or HELLP syndrome. Methods This questionnaire-based cross-sectional study aimed to evaluate the current recommendations of obstetricians in Austria regarding follow-up care, long-term risk counselling and risk of recurrence in future pregnancies after preeclampsia or HELLP syndrome. Data were collected using a survey, based on recommendations given by three substantial guidelines on hypertensive disorders of pregnancy, which was distributed via e-mail to 69 public obstetric departments in Austria. Each obstetric department was required to answer one questionnaire per local protocol. Results Our results revealed that of the 48 participating hospitals most obstetricians are aware of the importance of follow-up care for women after a pregnancy complicated by preeclampsia. Our data show that most physicians counselled patients about the future cardiovascular health risks associated with preeclampsia or HELLP syndrome (79.2%). Most obstetricians recommended lifestyle modification (77.1%) and continued blood pressure measurements (97.9%). All centers stated to counsel about the risk of recurrence (100%). However, counselling regarding follow-up care to exclude kidney damage (37.5%) and underlying diseases like thrombophilia (39.6%) were less prioritized. Conclusions We were able to show that counselling concerning the risk of long-term cardiovascular disease and risk of recurrence after a pregnancy complicated by preeclampsia or HELLP syndrome has been established in obstetric departments in public hospitals. Regarding the evaluation of underlying chronic diseases such as thrombophilia or renal disease, as well as counselling on the future risk of renal disease is still improvable according to our data. Further evaluation of follow-up care after hypertensive disorders of pregnancy in the outpatient and private sector and implementation of structured guidelines for follow-up, as well as screening for cardiovascular disease are necessary to ensure adequate risk management and to provide opportunities for prevention.

Hypertensive disorders of pregnancy

“…Recent studies show that healthcare professionals are aware of the long term risks for cardiovascular disease after HDP, with most counselling women about their increased cardiovascular risks 145146. However, this rising awareness has not translated into knowledge among women, with fewer than half being aware of their risk and having received heart health advice 147148.…”

A atuação dos profissionais de saúde frente a identificação do diagnóstico de síndrome de HELLP e suas complicações

“…Pois, estudos apontam que deve-se investigar o impacto da intervenção preventiva oportuna na melhoria da saúde cardiovascular nos grupos de mulheres jovens de alto riscos, bem como não apenas considerar as doenças que podem ser desenvolvidas na gravidez, mas, também já pré-existentes, como doença renal, HAS e cardiovasculares, devido o aumento de complicações somada a uma gestação. Dessa forma, recomendações sobre o tempo exato do acompanhamento, ações preventivas especificadas devem ser incluías nas diretrizes nacionais e internacionais, além disso, informar, alertar e instruir essas mulheres aos cuidados, riscos e consequências, para que auxiliem no acompanhamento adequado e qualificado, para que reduza os ricos à longo prazo (Palmrich et al, 2022).…”

Versorgungsrealität von Frauen nach hypertensiver Schwangerschaftserkrankung – eine monozentrische fragebogenbasierte Analyse

“…In einer Befragung von 212 ÄrztInnen durch Heidrich et al (2013) gaben 65% der MedizinerInnen an, Frauen nach einer HES zu möglichen Folgeerkrankungen zu beraten 17 . Palmrich et al (2022) konnten in ihrer Umfrage bei allen geburtshilflichen Kliniken in Österreich zeigen, dass 79% der Behandler das kardiovaskuläre Risiko ihrer Patientinnen überwachen und 77% eine Anpassung des Lebensstils empfohlen haben 16 . Jedoch gaben 40% der BehandlerInnen in der österreichischen Untersuchung an, eine Blutdruckmessung nur über sechs bis acht Wochen zu empfehlen.…”

“…Auch die Leitlinie zur Prävention kardiovaskulärer Erkrankungen der American Heart Association hebt die Wahrung eines gesunden Lebensstils als wichtigste Maßnahme zur Prävention von CVD hervor [14]. Dennoch bemängeln Forschergruppen in Deutschland und international fehlende Nachsorgerichtlinien mit definiertem Zeitpunkt und Umfang der Untersuchungen sowie klaren Zuständigkeiten [15,16]. Die gängige Nachsorgeroutine in Deutschland ist weitestgehend unbekannt.…”

“…Die gängige Nachsorgeroutine in Deutschland ist weitestgehend unbekannt. Eine Reihe von Studien haben bisher die Kenntnisse von ÄrztInnen in Bezug auf den Zusammenhang zwischen HES und zukünftigen Gesundheitsrisiken evaluiert und sind zu dem Ergebnis gekommen, dass die Mehrheit der befragten ÄrztInnen zur Durchführung von Nachsorgeuntersuchungen raten [16,17]. Unklar bleibt allerdings, wie viele Frauen nach HES in Deutschland tatsächlich an Nachsorgeuntersuchungen teilnehmen und welche Einfluss-faktoren bei der Beratung und Durchführung von Nachsorgeuntersuchungen exisiteren.…”