Hypertension occurs in 4% of all pregnancies in WA.
Hypertension in pregnancy is defined as;
- Systolic BP ≥140mmHg and/or diastolic ≥90mmHg
- Severe hypertension systolic ≥170mmHg and/or diastolic ≥110mmHg
Any elevation 20mmHg above normal pre-pregnancy blood pressure may be significant to indicate hypertension or preeclampsia
Gestational
- Hypertension ≥20 weeks gestation
Pre-eclampsia
- Hypertension ≥20 weeks gestation with one or more signs of organ involvement
Eclampsia
- Rare condition where hypertension results in seizures
- Increasing BP
- Severe headache
- Visual disturbances – flashing lights
- Nausea and Vomiting
- Abdominal pain
- Hyper-reflexia
- Convulsions/seizures – eclampsia
- Increased bleeding/bruising
- Intrauterine growth restrictions
- If the patient is presenting with hypertension and symptoms of preeclampsia, the patient should be treated as high risk and transported on priority to the nearest obstetric unit.
- if the patient has had an eclamptic episode that has resolved, transport on priority to the nearest obstetric unit and anticipate further seizure activity
- Primary Survey
- Vital Sign Survey
- Consider Oxygen
- Treat seizure as per CPG
- Secondary / CNS Survey (as required)
- Apply cardiac monitor if trained and authorised
- Monitor patient persistently, recording full observations every 10 minutes (or 5 minutes if time critical)
- Transport Priority 1 if patient time critical, pre-notifying receiving facility
- Transport in left lateral position to avoid supine hypotension
- Apply cardiac monitor
- Establish vascular access
- Treat seizures as per CPG
- Monitor patient persistently, recording full observations every 10 minutes (or 5 minutes if time critical)
- Transport Priority 1 if patient time critical as per transport decision guidelines, pre-notifying receiving facility
- Transport in left lateral position to avoid supine hypotension
- < 20 weeks – nearest/allocated ED
- ≥ 20 weeks – obstetric unit
- ALL pregnant patients suffering major trauma, follow Major Trauma Guideline
- As per Advanced Care guidelines
- Liaise with obstetrics units in the metropolitan area, recording all advise given on ePCR
- Liaise with local hospitals in country areas, recording all advice given on ePCR
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