Severe hypertension in pregnancy: Using dynamic checklists to save lives

Abstract

Severe hypertension is a major cause of morbidity and mortality. The South African Saving Mothers report (2011 -2013) indicates that cerebral injury due to severe hypertension is resulting in avoid able maternal deaths. This demands that management of severe hypertension in pregnancy needs to be improved. A rapid-acting antihypertensive is recommended for the initial management of severe hypertension during pregnancy. A single dose of a rapid-acting agent may be ineffective, in which case incremental doses of the same medication or another antihypertensive may be required for adequate blood pressure control. To ensure that appropriate antihypertensives at the correct doses are administered, the use of a guideline in a dynamic checklist format is advocated and discussed in this article. It is envisaged that the use of dynamic checklists will be valuable to all healthcare professionals providing care during pregnancy and the puerperium.

The performance of pre-delivery serum concentrations of angiogenic factors in predicting postpartum antihypertensive drug therapy following abdominal delivery in severe preeclampsia and normotensive pregnancy

“…However, BP 140-150/90-100 mmHg was treated amidst complications such as severe thrombocytopaenia (to prevent cerebrovascular accident) and renal impairment. Severe hypertension in pregnancy (BP ≥ 160/110 mmHg) is an emergency that requires rapid but controlled reduction of the high BP to achieve a target BP of 140-150/90-100 mmHg [43, 45, 46]. Therefore, the criteria that had been used to determine the use of ≥ 3 slow- and/or a rapid-acting antihypertensive drug therapy were the severity of the hypertension and the presence of other target organ complications.…”

Pre-eclampsia with severe features: management of antihypertensive therapy in the postpartum period

“…Recent guidelines recommend the use of rapid-acting nifedipine, labetalol or dihydrallazine as the first-line agent for the treatment of severe hypertension [ 19 ]. Notably, recent reviews [ 3 , 29 , 41 , 42 ] contain the essential clinical pharmacology of the drugs used for the treatment of HDP.…”

“…Of the global 830 maternal deaths that occurred daily in 2015, hypertensive disorders of pregnancy (HDP) particularly PE accounted for 14% of the mortalities [ 2 ]. A substantial proportion of deaths occurred due to poorly managed hypertension in women who had PE with severe features (sPE) that developed cerebral haemorrhage and or eclampsia [ 3 ]. To prevent maternal mortality and morbidity from severe hypertension, the judicious use of rapid-acting antihypertensive agents is required.…”