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.