Improving Care for Women Suffering from Pregnancy-Induced Hypertension
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Improving Care for Women Suffering fromfrom Pregnancy-Induced Hypertension Russian Federation - United States of America 2001 Improving Care for Women Suffering from Pregnancy-Induced Hypertension Russian Federation - United States of America, 2001 The Health Committee Access to Quality Health Care Ministry Of Health Tver Oblast United States Department of The Quality Assurance Project Russian Federation Department of Health, Health And Human Services University Research Co., LLC Russian Federation Central Public Health Agency for Health Research Center for Human Services Research Institute (CPHRI) Quality (AHRQ) This document is in the public domain and may be used and reprinted without permission provided appropriate reference is made to the three organizations, which produced it. The work upon which this publication is based was performed under contract number HRN-C-00-69-90013-03 funded by the United States Agency for International Development. The USA–Russia Joint Commission on Economic and Technological Cooperation The Health Committee “Access To Quality Health Care” Priority Area Improving Care for Women Suffering from Pregnancy-Induced Hypertension Financed by the United States Agency for International Development Developed by: Tver Oblast Health Care Department Central Public Health Research Institute of The Ministry of Health of the Russian Federation Quality Assurance Project - University Research Co., LLC/ Center for Human Services, Bethesda, MD, USA TVER OBLAST 2001 Preface The work presented in this clinical guideline was Health Department. The US partners in this conducted under the US-Russia Joint Commission collaboration included the Agency for Health Care on Economic and Technological Cooperation, Policy and Research. The work was funded by Health Committee, Access to Quality Health Care USAID under contract to the Quality Assurance priority area. The Russian partners in this Project, implemented by University Research collaboration included the Ministry of Health, Corporation/Center for Human Services, Bethesda, Russian Federation, Central Public Health Research MD, USA. Institute (former MedSocEconomInform), and Tver Clinical Problem: Pregnancy Induced Hypertension (PIH) Title of the Document: Clinical Guideline for PIH Stages of Provision of Medical Care: Women’s consultation clinics Pregnancy complication wards Delivery departments Intensive care wards Institutions using the protocol: Maternity Hospital #1, Tver City Maternity Hospital and Women’s consultation clinic(Vyshny Volochyok) Children’s City Hospital (Vyshny Volochyok) Delivery Department with assigned women’s consultation clinics (Torzhok) Project Stage: Phase II. Dissemination of Phase I Date of Creation: July 28, 1999 Date of Changes: 2001 iv Table of Contents 1. Professionals and Consultants Who Participated in the Development of the Guideline ................................. 1 1.1. Guideline Developers .......................................................................................................................... 1 1.2. Project Team ....................................................................................................................................... 2 1.3. Acknowledgments................................................................................................................................ 2 2. Acronyms .......................................................................................................................................................... 3 3. Definitions ......................................................................................................................................................... 3 4. Introduction ....................................................................................................................................................... 4 4.1. Background .......................................................................................................................................... 4 4.2. Goals for the development and introduction of the Clinical Guideline .............................................. 4 4.3. Methodology for the development of the Clinical Guideline ............................................................. 5 4.4. Scope of Application and Purpose of the Guideline ...........................................................................6 4.4.1. Clinical description of the guideline......................................................................................... 6 4.4.2. Target groups............................................................................................................................. 8 4.4.3. Guideline users.......................................................................................................................... 8 4.4.4. Expected outcomes ................................................................................................................... 8 5. System of Medical Care Organization at all levels and for all target groups ................................................... 9 5.1. Flowchart for the Process of Care for Women with PIH..................................................................... 9 5.2. Description of the Process of Care .................................................................................................... 10 5.3. Provision for the Process of Health Care Delivery ...........................................................................10 5.3.1. Personnel ................................................................................................................................. 10 5.3.2. Medications needed ................................................................................................................ 10 5.3.3. Equipment Used in the Process of Health Care Delivery....................................................... 11 6. Medical Care provided to women with Pregnancy Induced Hypertension at different stages of disease ..... 11 6.1. Pregnancy Induced Hypertension Without Significant Proteinuria Mild Pre-eclampsia (ICD 10 – Î13) ................................................................................ 11 6.1.1. Criteria .................................................................................................................................... 11 6.1.2. Outpatient Care: ...................................................................................................................... 11 6.1.3. Outpatient Management: (See fig. 6.1.) ................................................................................. 11 6.1.4. Criteria for switching over to flowchart of the process of care for women with a more sever PIH form: ................................................................................ 13 v 6.2. Pregnancy Induced Hypertension with significant Proteinuria Moderate Pre-eclampsia (ICD 10 - O.14.0).................................................................... 13 6.2.1. Criteria: ................................................................................................................................... 13 6.2.2. Outpatient and in-patient care. Medical care providers ......................................................... 13 6.2.3. Outpatient Management .......................................................................................................... 13 6.2.4. Refer for hospitalization with the following findings: ........................................................... 15 6.2.5. Inpatient care (Conservative) .................................................................................................. 15 6.2.6. Management of women with PIH with considerable proteinuria, moderate pre-eclampsia ..........................................................................................................16 6.2.7. Criteria for switching over to flowchart of the process of care for women with a more sever PIH form ................................................................................. 16 6.3. Pregnancy Induced Hypertension with Significant Proteinuria Severe Pre-eclampsia (ICD 10 –O14.1) ......................................................................... 16 6.3.1. Criteria .................................................................................................................................... 16 6.3.2. Hospitalization and Delivery .................................................................................................. 17 6.3.3. PIH Treatment Protocol with severe pre-eclampsia (014.1) ..................................................17 6.3.4. Magnesium Sulfate Intravenous Treatment ............................................................................ 18 6.3.5. Delivery Preparation ............................................................................................................... 19 6.4. Eclampsia (ICD 10 – 015) ................................................................................................................. 19 6.4.1. Criteria: ................................................................................................................................... 19 6.4.2. Hospitalization and medical care providers............................................................................ 20 6.4.3. Treatment of Eclampsia (ICD 10 – 015) ................................................................................ 20 6.5. Treatment of Women Experiencing PIH in the Immediate Postpartum ...........................................