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.
