Farrar, Diane

Sheldon, Trevor Andrew

Tuffnell, Derek

English

White Rose Research Online

This is a repository copy of An evaluation of the influence of the publication of the UK National Institute for Health and Care Excellence’s guidance on Hypertension in Pregnancy: a retrospective analysis of clinical practice.White Rose Research Online URL for this paper:https://eprints.whiterose.ac.uk/156364/Version: Accepted VersionArticle:Farrar, Diane, Tuffnell, Derek and Sheldon, Trevor Andrew orcid.org/0000-0002-7479-5913(Accepted: 2020) An evaluation of the influence of the publication of the UK National Institute for Health and Care Excellence’s guidance on Hypertension in Pregnancy: a retrospective analysis of clinical practice. BMC Pregnancy and Childbirth. ISSN 1471-2393(In Press) eprints@whiterose.ac.ukhttps://eprints.whiterose.ac.uk/Reuse Items deposited in White Rose Research Online are protected by copyright, with all rights reserved unless indicated otherwise. They may be downloaded and/or printed for private study, or other acts as permitted by national copyright laws. The publisher or other rights holders may allow further reproduction and re-use of the full text version. This is indicated by the licence information on the White Rose Research Online record for the item. Takedown If you consider content in White Rose Research Online to be in breach of UK law, please notify us by emailing eprints@whiterose.ac.uk including the URL of the record and the reason for the withdrawal request. Questions for_An evaluation of the level of clinician's adherence to the NICE hypertension in pregnancy guideline across maternity units in England_version_1.0_June2017  Survey Questions: A00a & A00b  Infant’s month and year of birth     A001-A004 Prevention If any one (or more) risk factor below is present this signifies high risk and need for aspirin • hypertensive disease (gestational hypertension/pre-eclampsia) during a previous pregnancy • chronic kidney disease • autoimmune disease such as systemic lupus erythematosis or antiphospholipid syndrome • type 1 or type 2 diabetes • chronic hypertension.  If any two moderate risk factors are present  this signifies moderate risk and need for aspirin • first pregnancy • age 40 years or older • pregnancy interval of more than 10 years • body mass index (BMI) of 35 kg/m² or more at first visit • family history of pre-eclampsia • multiple pregnancy.   B001-B003 Surveillance  Hypertension that is present at the booking visit or before 20 weeks (140/90) or if the woman is taking antihypertensive medication when pregnancy is diagnosed. The raised BP can be primary or secondary to another condition. B001-B003 Surveillance ACE or ARBs are not recommended for use in pregnancy therefore alternatives  should be prescribed as soon as pregnancy is confirmed  Angio converting enzyme (ACE) inhibitors Benazepril - Lotensin Captopril - Capoten Enalapril - Vasotec, Epaned Fosinopril - Monopril Lisinopril - Prinivil, Zestril Moexipril - Univasc Perindopril - Aceon Quinapril - Accupril Ramipril - Altace trandolapril - Mavik Angiotensin receptor blockers (ARBs)  Candesartan - Amias Eprosartan - Teveten  Irbesartan - Aprovel, CoAprovel  Losartan - Cozaar, Cozaar Comp  Olmesartan - Olmetec, Olmetec Plus  Telmisartan - Micardis, Micardis Plus  Valsartan - Diovan, Co-Diovan, Exforge B004-B007 Surveillance Refers to each separate antenatal visit that necessitates an ‘antenatal assessment’, it could be that a woman was seen on the same day more than once, so each admission to the maternity assessment unit, each antenatal day unit visit or each community Questions for_An evaluation of the level of clinician's adherence to the NICE hypertension in pregnancy guideline across maternity units in England_version_1.0_June2017  clinic or a home visit, irrespective of the reason for the visit  B008-B009 Surveillance If a woman with hypertension was seen within the maternity unit (secondary care facility) was there evidence that an initial automated reagent-strip reading device was used or evidence that a urine specimen was sent to the lab for protein: creatinine ratio (PCR) estimation for each antenatal visit/assessment  (automated reagent –strip reading device use is not recommended for women seen in primary care facilities (GP surgeries for example) please do  not include assessments conducted in primary care in this section)  If automated reagent-strip reading device showed equal to or more than +1 protein, was a urine sample sent to the biochemistry laboratory for protein: creatinine ratio (PCR) estimation C001 Diagnosis and treatment Is there evidence this woman had gestational hypertension (BP equal to or greater than 140/90 on two occasions at least 4 hours apart, this includes two readings at least 4 hours apart with a systolic BP equal to or greater than 140 with a normal diastolic or a diastolic equal to or greater than 90 with a normal systolic) with or without proteinuria  C002 Diagnosis and treatment Did BP ever reach or exceed the  recommended treatment threshold 150/100 two occasions at least 4 hours apart C003 Diagnosis and treatment If this woman was diagnosed with gestational hypertension (irrespective of BP level), what treatment was started C004 Diagnosis and treatment If the women was diagnosed with gestational hypertension (irrespective of BP level), was proteinuria estimated at that time C005 Diagnosis and treatment If the woman had proteinuria (at the time her BP exceeded the threshold for treatment) what method was used to estimate the proteinuria (tick all that apply) C006 Diagnosis and treatment Was the woman ever admitted to hospital because of high blood pressure (antenatal admission only) C007-C008 Diagnosis and treatment If this woman was admitted to hospital because of high blood pressure antenatally, what was her highest blood pressure prior to admission (the highest diastolic and systolic readings may not be recorded together, i.e. may have occurred at different times) C008 Diagnosis and treatment If admitted to hospital antenatally, what was the protein estimation prior to admission C009 Diagnosis and treatment If admitted because of high blood pressure were antihypertensive medications prescribed C009 Diagnosis and treatment If antihypertensive medications were prescribed when admitted because of high blood pressure, which medication (s) was/were prescribed D001 Timing of birth Was early delivery (before 37 weeks) offered because of hypertension (induction or caesarean section) D002 Timing of birth If early birth offered (before 37 weeks) was BP generally above 160/110 Questions for_An evaluation of the level of clinician's adherence to the NICE hypertension in pregnancy guideline across maternity units in England_version_1.0_June2017    D003 Timing of birth Was early delivery (after 37 weeks) offered because of hypertension (induction or caesarean section) D004 Timing of birth If early birth offered (after 37 weeks) was BP generally above 160/110 E001 Postnatal follow-up If diagnosed with hypertension or pre-eclampsia, was there any evidence that future risk of gestational hypertension and pre-eclampsia was discussed E002 Postnatal follow-up Was there any evidence that a postnatal review appointment was given E003 Postnatal follow-up If there was evidence that the woman attended a postnatal review (6–8 weeks after the birth) was a medical review within that appointment recorded 

An evaluation of the influence of the publication of the UK National Institute for Health and Care Excellence’s guidance on Hypertension in Pregnancy: a retrospective analysis of clinical practice

https://eprints.whiterose.ac.uk/156364/1/Data_questions_Additional_File1.pdf

An evaluation of the influence of the publication of the UK National Institute for Health and Care Excellence’s guidance on Hypertension in Pregnancy: a retrospective analysis of clinical practice

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