Audit of Preeclampsia Management Protocols at Secondary and Tertiary Hospitals in Ondo State

Preeclampsia and its severe complications, including eclampsia and HELLP syndrome, are responsible for a significant proportion of maternal deaths in Ondo State, South West Nigeria, with management quality heavily influenced by protocol adherence and provider competency. This study audits preeclampsia management against national Society of Obstetrics and Gynaecology of Nigeria (SOGON) guidelines at secondary and tertiary hospitals in Ondo State. Eight hospitals including Ondo State University Teaching Hospital and seven secondary hospitals were audited using a structured audit tool covering blood pressure monitoring frequency, proteinuria assessment, magnesium sulphate prescription, antihypertensive therapy, and planned delivery timing. Case note reviews of 120 preeclampsia cases supplemented facility assessments. Magnesium sulphate was prescribed in only 61 percent of severe preeclampsia cases. Antihypertensive threshold was correctly applied in 54 percent of audited cases. Planned delivery timing consistent with SOGON guidelines was documented in 39 percent of cases at secondary level versus 68 percent at tertiary level. Protocol documentation was available in all tertiary facilities but only 62 percent of secondary hospitals. The study reveals significant secondary-tertiary management disparity and protocol non-adherence. Professional recommendations include state-wide preeclampsia management protocol distribution, mentorship linkages between secondary and tertiary hospitals, and annual preeclampsia management audit cycles led by the Ondo State Ministry of Health. Keywords: preeclampsia management, protocol audit, Ondo State, SOGON guidelines, maternal safety