Pathways development:
The HDP management pathways drafts had been developed from statements
that reached consensus from the first and the second round survey. HDP
management pathways drafts were presented in three flowcharts: (i) HDP
diagnosis, (ii) HDP management, and (iii) HDP maternal surveillance
flowchart in primary care. The HDP management pathway itself was divided
into five sections: (i) screening for preeclampsia risk factors at the
first pregnancy visit, (ii) HDP screening activities during routine ANC,
(iii) HDP management and monitoring, (iv) delivery plans for women with
HDP, and (v) postpartum follow up for women with HDP in primary care.
The project investigators also considered and discussed statements that
had not achieved consensus at the first and second round survey. The
pathways accomodated statements related to contraception and
antihypertensive medication used for women with HDP history were later
accommodated using information tables (that are not included in this
publication). Another statements were also considered not to be
re-tested in the third-round survey, i.e IVF as isk factor for
preeclampsia.
Third-round
Most participants agreed on the HDP management pathway drafts. The
pathways’ agreement scores ranged from 78.4% for HDP monitoring to 89.2
% for preeclampsia risk factors screening (Table 2). Eleven
participants revised their response on statement that had not received
consensus at the previous rounds. Their revised responses, however, only
changed agreement score for platelet count as baseline data for pregnant
women with risks of preeclampsia (from 68.2% to 70.8%). The complete
final agreement score for each statement and the diagnosis flowchart are
attached as supplementary materials.
There were participants opinions and suggestions obtained from the
third-round free text questions. Spme participants suggested improvement
on the triage for pregnant women. A participant expessed his
disagreement on HDP pathway development through the survey. He mentioned
that the pathways drafts were way too complicated and they should not be
developed through surveys. There were, again, a suggestion to
differentiate management of mild and severe preeclampsia and further
pressure to refer women with HDP to hospitals. Further suggestion was
also obtained for the HDP surveillance pathway to respect on the
patients’ confidentiality during patient management. It was previously
mentioned at the surveillance pathways drafts that any HDP cases should
be referred to public primary care clinics for surveillance data and be
follow up by cadre home visits or receiving supports from community
leaders. The suggestion on patient confidentiality was used to improve
the statements listed in the surveillance pathway (Table 3).