Poster Presentation Society of Obstetric Medicine of Australia and New Zealand and Australasian Diabetes in Pregnancy Society Joint Scientific Meeting 2017

Audit of the Urgent Management of Severe Hypertension over a 12-month period at the Royal Hospital for Women, Randwick (#140)

Amanda Beech 1 , Sandra Lowe 2
  1. Royal Brisbane and Women's Hospital, Herston, QLD, Australia
  2. Royal Hospital for Women, Randwick, NSW, Australia

Hypertensive disorders are the most commonly encountered medical complications of pregnancy, and can result in significant maternal and perinatal morbidity and mortality, ranging from maternal end organ damage to iatrogenic prematurity.1,2  Worldwide, hypertensive disorders affect 10% of pregnancies, with approximately 1% pre-existing hypertension, 5-6% gestational hypertension without proteinuria, and 1-2% pre-eclampsia.3 

Severe hypertension requiring urgent management, is present if the systolic blood pressure is greater than or equal to 170mmHg, with or without a diastolic blood pressure greater than or equal to 110mmHg.4,5 We undertook an audit to review our current established clinical guidelines around the management of severe, urgent hypertension, identify areas of compliance and strengths within our treatment protocol, as well as areas in which improvements need to be implemented.

 

A total of 3949 women were delivered at the Royal Hospital for Women, Randwick during the 12-month review. A diagnosis of pre-eclampsia was made in 2.8%, and there were 56 episodes of severe hypertension requiring urgent management.  The gestation at which the episodes occurred ranged from 23+3 days to 4 days postpartum, with 53% of these occurring pre-term.  Antenatally, 84% received appropriate medication according to the local policy, either IV hydralazine or oral nifedipine.  A concurrent oral long-acting medication was administered in 46% of all episodes.  11% received a magnesium sulphate infusion for maternal seizure prophylaxis.  Correct administration of an intravenous bolus of normal saline was administered in 80% of antenatal women and appropriate 5-minute BP measurements were taken in 72% of women. Eleven percent of women required commencement of an intravenous hydralazine infusion.

 

To reduce the risk of maternal and fetal morbidity, local operating procedures which follow established guidelines should be implemented.  To ensure ongoing effectiveness, compliance with these procedures should be regularly audited, and the findings discussed with medical, nursing and midwifery staff.

  1. 1. Allen VM The effect of hypertensive disorders in pregnancy on perinatal outcomes: a population-based cohort study. Ottawa: National Library of Canada; 2002
  2. 2. Gillon TER, Pels A, et al. Hypertensive disorders of pregnancy: A systematic review of international clinical practice guidelines. PLOS One 2014; 9(12): 1-20
  3. 3. Sibai BM. Treatment of hypertension in pregnant women. N Engl J Med 1996; 335:257-265
  4. 4. Vadhera RB, Simon M, Hypertensive emergencies in pregnancy. Clinical Obgyn 2014; 57(4):797-805
  5. 5. Lowe S, Brown MA et al. Guidelines for the management of hypertensive disorders of pregnancy 2008. ANZJOG 2009; 49: 242-246