Post-partum follow-up after hypertensive disorders during pregnancy: Review of national and international clinical practice guidelines.

INTRODUCTION

Hypertensive disorders in pregnancy (HDP) are a major cause of maternal morbidity and mortality. The lack of standardized recommendations for postpartum (PP) management remains a limiting factor in care. This study aims to identify and assess clinical practice guidelines (CPGs) to summarize convergences and divergences in postpartum follow-up after HDP, with the goal of guiding clinical practice and informing research priorities.

METHODS

A systematic, language-inclusive literature search covering the past 15 years was conducted using the MEDLINE database and the websites of all member societies of the International Federation of Gynecology and Obstetrics. Two independent reviewers evaluated the quality of CPGs using the AGREE II instrument. Guidelines scoring below 50% across all domains were excluded. Specific recommendations were extracted and compared across three follow-up periods: short-term (discharge to 2 weeks), medium-term (2 weeks to 6 months), and long-term (beyond 6 months).

RESULTS

Fifteen CPGs with an average overall quality score of 63% were included. Thirty-seven recommendations were identified, but only nine reached over 50% agreement. These included: (1) regular blood pressure monitoring post-discharge; (2) use of beta-blockers, ACE inhibitors, and calcium channel blockers postpartum; (3) early postpartum consultation; (4) blood pressure assessment during consultation; (5) long-term medical follow-up; (6) promotion of healthy lifestyle habits; (7) patient education on long-term risks; (8) preconception consultations for subsequent pregnancies; (9) initiation of low-dose aspirin in future pregnancies. The low consensus rate is attributed to a high proportion of unreported data.

CONCLUSION

There is a critical need for clear, evidence-based clinical recommendations to standardize postpartum follow-up after HDP across the short, medium, and long term.