Clinical guidelines in severe pre-eclampsia and eclampsia

Purpose - This article aims to assess the standard local recommended management of women with severe pre-eclampsia and eclampsia in relation to recommendations in a national clinical guideline using a criterion-based survey.Design methodology approach - A total of 227 maternity units in the UK were asked to provide a copy of their guideline for the management of severe pre-eclampsia and eclampsia. Responses were obtained from 107 units (47.1 per cent), 37 units were using regional guidelines and 72 guidelines were available for assessment. A total of ten audit criteria were agreed by committee, based on national recommendations. Guidelines were then audited to assess concurrence with these criteria.Findings - The standard of guidelines was highly variable with only four guidelines (4.5 per cent) satisfying all ten key guideline points. The majority of guidelines had clear criteria for inclusion (87.5 per cent) but in almost a quarter of all guidelines no mention was made of informing consultant staff once these criteria were met.Practical implications - The study shows that the standard of local guidelines for management of these potentially fatal conditions is highly variable. Confidential inquiry has repeatedly recommended the use of regional guidelines. Perhaps it is time for the development of a national guideline representing consensus agreement of an evidence-based approach.Originality value - In the UK eclampsia and pre-eclampsia continue to be a leading cause of maternal mortality and morbidity. This paper provides a valuable insight into the standard of guidelines used in the management of these conditions.