Guidelines issued for standardized care to patients with severe hypertension during pregnancy

The National Partnership for Maternal Safety, under the guidance of the Council on Patient Safety in Women’s Health Care, has issued a patient safety bundle that assists the healthcare professionals in providing a standardized care to patients with severe hypertension during pregnancy and the postpartum period.

The consensus  bundle was published online  ahead of print in Journal of Obstetrics and Gynecology. The safety bundle is organized into 4 domains and outlines clinical practices that should be practiced at every maternity unit.

The four domains are: Readiness, Recognition and Prevention, Response, and Reporting and Systems Learning.

Readiness

The readiness domain consists of 5 key components to prepare each maternity unit for prompt and effective management of women with hypertension in pregnancy. It includes:

Each maternity setting should have standardized criteria for recognizing the warning signs, to diagnose, monitor and treat preeclampsia and eclampsia.

The staff should undergo regular drills to practice the protocols.

The maternity unit, along with the OPD and ER should be well equipped for dealing with patients with severe preeclampsia or eclampsia.

All the medications used in emergency treatment should be readily available and stocked continuously.

Appropriate consultations from various concerned department and means of transportation to tertiary center should be available all the time.

Recognition and Prevention

All women should be educated about the warning signs of hypertension in pregnancy.

Standard protocols should be developed for measuring B.P and urine analysis for all women during pregnancy and postpartum period.

Standard protocols should be developed and followed for investigating all women with hypertension in pregnancy. The investigations should include complete blood count with platelets, aspartate transaminase, and alanine transaminase.

Response (Every Case of Severe Hypertension or Preeclampsia)

Each facility should be well equipped with management of severe hypertension, Eclampsia, seizure prophylaxis, and magnesium over dosage and recognizing symptoms of postpartum hypertension.

The concerned physician or primary care provider should be immediately notified if systolic blood pressure is 160 mm Hg or greater or diastolic blood pressure is 110 mm Hg or greater for two measurements within 15 minutes.

If the second blood pressure reading is also high, treatment should be initiated immediately. Guidelines for initiation and maintenance of Magnesium Sulfate should be readily available everywhere.

Escalation measures should be lined out for patients unresponsive to initial treatment along with follow up and education protocols at 7-14 days postpartum.

Reporting and Systems Learning (Every Unit)

All the members of the multidisciplinary team should receive debriefing about the way the emergency was handled, what went well along with areas of improvement.

The team should also review all other patients admitted with severe hypertension and eclampsia about the outcome. Robust data system should be present to report accurate outcomes to all the concerned persons. The review should include all the measures taken since the woman arrived in emergency room till postpartum education and follow-up.

One very important key element in reducing maternal morbidity and mortality and neonatal morbidity and mortality is time to treatment after the recognition of severe hypertension.

The full text of the article can be accessed here.