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Quick Chart
 Introduction

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
 Clinical Presentation
  • Increasing BP
  • Severe headache
  • Visual disturbances – flashing lights
  • Nausea and Vomiting
  • Abdominal pain
  • Hyper-reflexia
  • Convulsions/seizures – eclampsia
  • Increased bleeding/bruising
  • Intrauterine growth restrictions
 Exclusion Criteria
Exclusion Criteria
 Risk Assessment
  • 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
 Management
Primary Care
Intermediate Care
  • 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
Advanced Care
  • 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
Transport Decision
  • < 20 weeks – nearest/allocated ED
  • ≥ 20 weeks – obstetric unit
  • ALL pregnant patients suffering major trauma, follow Major Trauma Guideline
Critical & Extended Care
  • As per Advanced Care guidelines
 Additional Information
  • 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
Key Terms & Links
Settings
Extended Care:
Colour assist:

References
References

Document Control


Directorate
Clinical Services

Responsible Manager
Head of Clinical Services

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Published Date

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