Increased adherence to ACOG diagnostic guidelines for HDP following a workshop in Bolivia, a LMIC.

• Hypertensive disorders of pregnancy (HDP) are a major cause of maternal deaths in low- to middle-income countries (LMIC). • Workshops to review critical barriers for preeclampsia diagnosis in La Paz-El Alto, Bolivia increased detection of severe diease but its diagnosis remained underreported due to use of outdated prenatal forms. • Biomarker tests that can be applied at point-of-care, ongoing workforce training and timely adoption of updated prenatal forms can help lessen maternal mortality in LMIC. Hypertensive disorders of pregnancy (HDP) exert a heavy mortality burden in low- to middle-income countries (LMIC). ACOG revised HDP diagnostic guidelines to improve identifying pregnancies at greatest risk but whether they are used in LMIC is unknown. We held a workshop to review ACOG guidelines in La Paz, Bolivia (BO) and then reviewed prenatal, labor and delivery records for all HDP diagnoses and twice as many controls at its three largest delivery sites during the year before and the nine months after a workshop (n = 1376 cases, 2851 controls during the two periods). HDP diagnoses, maternal, and infant characteristics. Bolivian and ACOG criteria identified similar frequencies of gestational hypertension (GH) or eclampsia, but preeclampsia with severe features (sPE) was under- and preeclampsia without severe features (PE) over-reported during both periods. Increases occurred after the workshop in testing for proteinuria and the detection of abnormal laboratory values and severe hypertension in HDP women. Any adverse maternal outcome occurred more frequently after the workshop in women with BO PE or sPE diagnoses who met ACOG sPE criteria. Utilization of ACOG guidelines increased following the workshop and improved identification of PE or sPE pregnancies with adverse maternal outcomes. Continued use of a CLAP perinatal form recognizing HELLP as the only kind of sPE resulted in under-reporting of sPE. NIH TW010797, HD088590, HL138181. [ABSTRACT FROM AUTHOR]