Introduction:

Hypertensive disorders of pregnancy (HDP) cover a range of diagnoses, including chronic hypertension, gestational hypertension, white coat hypertension and preeclampsia/eclampsia (1). In Indonesia, HDP remains the leading cause of maternal mortality, and with its current increasing trend, may soon replace postpartum hemorrhage as the most common cause of direct maternal mortality (2, 3).
Research shows that maternal mortality from HDP is preventable if the women receive appropriate management, however, many maternal deaths from HDP in Indonesia are not well anticipated due to lack of practice guidance in primary care(4). Current Indonesian primary care guidelines merely recommend general practitioners (GPs) to refer women with HDP to hospitals(5-7), but details of further management such as screening, monitoring, and long-term postpartum follow-up treatment for HDP women are lacking(8). Meanwhile, the country’s disparities in health due to community beliefs, inadequate obstricians availability and geographical locations also challenges the referral which impact on the women often are already too severe for hospital management(3, 9, 10). Due to these rationals, therefore, the need to upgrade primary care providers in HDP management is more than ever in Indonesia.
This research is part of a larger study to improve quality of HDP management in Indonesian primary care (11). Our previous review has identified potential evidence-based practice improvements for HDP management (12); and we have also explored the way HDP is managed in Indonesian primary care through interviews with key stakeholders (8). However, to adopt these recommendations and to develop the HDP management pathways as improvement interventions would require additional contextualisation process. Findings in our review indicate that not all recommendations from the international HDP guidelines can directly be adopted into the local context due to different practice environments, such as different professional authority, facilities, policies or public insurance (JKN/Jaminan Kesehatan Nasional ) regulation (8, 12). There are also further considerations when contextualising HDP recommendations for Indonesian primary care. Public primary care services (Puskesmas/Pusat Kesehatan Masyarakat ) in Indonesia has to undertake maternal surveillance and maternal audit processes in the community in addition to provide individual patient treatment(8). There are also community health workers (cadres) involved in maternal health activities but their job description in the current Indonesian guidelines remains unclear (13, 14).
This research then aims to establish experts’ consensus on the identified 125 international and local HDP management recommendations to develop HDP management pathways for Indonesian primary health care setting.