Hypertensive disorders of pregnancy (HDP) cover a range of diagnoses, including chronic hypertension, gestational hypertension, white coat hypertension and preeclampsia/eclampsia. Further investigations are needed to explore the acceptability and feasibility of the developed HDP pathways in primary care practice. Most evidence-based management recommendations achieved consensus and were included in the developed HDP management pathways, which can potentially be implemented in Indonesian settings. Drafts of HDP management pathways were also agreed upon and received suggestions from the participants. Agreement scores for the statements ranged from 70.8–100.0%, and potential implementation barriers of the pathways were identified. Consensus was reached for 115 of the 125 statements on HDP definition, screening, management and long-term follow-up. ResultsĪ total of 52 participants were included, with 48, 45 and 37 of them completing the first, second and third round of the survey respectively. The participants’ responses and suggestions to the free text questions were analysed thematically. The participants’ agreement scores were calculated with a statement needing a minimum of 70% agreement to be included in the HDP pathways. The third-round survey presented the drafts of HDP pathways and sought participants’ agreement and further suggestions. At the first and second-round survey, the participants were asked to rate their agreement on whether each of 125 statements about HDP and HDP management is appropriate for use in Indonesian primary care settings. They participated in a consensus development process that applied a mix of quantitative and qualitative questions in three Delphi survey rounds. Maternal health experts, including GPs, midwives, nurses, medical specialists and health policy researchers from Indonesia and overseas were recruited for the study. This study aims to achieve consensus among the experts regarding the recommendations suitability and to develop HDP pathways in Indonesian primary care. A previous review of 16 international HDP guidelines has identified opportunities for improving HDP management in Indonesian primary care, but it has not determined the suitability of the recommendations in practice. At the moment, limited guidelines are available to assist primary care providers in managing HDP cases. Hypertensive disorders of pregnancy (HDP) are a significant contributor to the high maternal mortality rate in Indonesia.
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