Diagnosis and treatment of hypertensive disorders during pregnancy in Germany. Results of a survey in German obstetric clinics

Aim: To study the management and treatment of hypertensive disorders during pregnancy in Germany and compare the results with similar surveys. Methods: A multiple choice questionnaire was sent to 717 Departments of Obstetrics/Gynaecology in Germany, of which 34% responded. Results: Most German obstetricians treat women with moderate hypertension of more than 140/95 mmHg in the second trimester with anti-hypertensive drugs based on national protocols in outpatient clinics. First choice drug was methyldopa (46.7%). Thirty-seven percent of obstetricians use beta-blockers and 19.2% dihydralazine per os. 36.8% of obstetricians gave dihydralazine i.v. if blood pressure was 170/110 mmHg or higher. 38.1% of obstetricians prescribed aspirin to patients with moderate or severe hypertension. Many different views existed with respect to severe complications of hypertension such as HELLP syndrome or the treatment of eclamptic convulsions. Thirty-eight percent of obstetricians did not answer the question on how they would treat eclampsia. Conclusions: The management of anti-hypertensive disorders and preeclampsia varies greatly among German obstetricians. This survey indicates that information on individual experiences with treatment regimes together with educational programmes and new treatment modalities for preeclampsia and severe hypertensive complications should be more widely disseminated.