{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T15:39:24Z","timestamp":1787585964407,"version":"build-2736575974"},"reference-count":25,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2018,10,26]],"date-time":"2018-10-26T00:00:00Z","timestamp":1540512000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003554","name":"Lundbeck Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003554","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004102","name":"Laerdal Foundation for Acute Medicine","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004102","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004954","name":"Augustinus Fonden","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004954","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001734","name":"K\u00f8benhavns Universitet","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001734","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Gynecology &amp; Obste"],"published-print":{"date-parts":[[2019,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To estimate the effect of locally tailored clinical guidelines on intrapartum care and perinatal outcomes among women with severe hypertensive disorders in pregnancy (<jats:styled-content style=\"fixed-case\">sHDP<\/jats:styled-content>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A pre\u2013post study at Zanzibar's low\u2010resource Mnazi Mmoja Hospital was conducted. All labouring women with <jats:styled-content style=\"fixed-case\">sHDP<\/jats:styled-content> were included at baseline (October 2014 to January 2015) and at 9\u201312\u00a0months after implementation of the ongoing intervention (October 2015 to January 2016). Background characteristics, clinical practice, and delivery outcomes were assessed by criterion\u2010based case file reviews.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Overall, 188 of 2761 (6.8%) women had <jats:styled-content style=\"fixed-case\">sHDP<\/jats:styled-content> at baseline, and 196 of 2398 (8.2%) did so during the intervention months. The median time between last blood pressure recording and delivery decreased during the intervention compared with baseline (<jats:italic>P<\/jats:italic>=0.015). Among women with severe hypertension, antihypertensive treatment increased during the intervention compared with baseline (relative risk [<jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content>] 1.37, 95% confidence interval [<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>] 1.14\u20131.66). Among the neonates delivered (birthweight \u22651000\u00a0g), stillbirths decreased (<jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content> 0.56, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.35\u20130.90) and Apgar scores of seven or more increased during the intervention compared with baseline (<jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content> 1.17, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.03\u20131.33).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Although health system strengthening remains crucial, locally tailored clinical guidelines seemed to help work\u2010overloaded birth attendants at a low\u2010resource hospital to improve care for women with <jats:styled-content style=\"fixed-case\">sHDP<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>ClinicalTrials.org<\/jats:title><jats:p>NCT02318420.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ijgo.12692","type":"journal-article","created":{"date-parts":[[2018,10,11]],"date-time":"2018-10-11T14:17:10Z","timestamp":1539267430000},"page":"27-36","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Effect of locally tailored clinical guidelines on intrapartum management of severe hypertensive disorders at Zanzibar's tertiary hospital (the PartoMa study)"],"prefix":"10.1002","volume":"144","author":[{"given":"Nanna","family":"Maal\u00f8e","sequence":"first","affiliation":[{"name":"Global Health Section Department of Public Health University of Copenhagen  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camilla B.","family":"Andersen","sequence":"additional","affiliation":[{"name":"Global Health 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