Improving the management of obstetric hypertensive emergencies

Objectives Severe blood pressure (BP) elevations during pregnancy are associated with increased risk of maternal stroke and adverse perinatal outcomes. Obstetric hypertensive emergency (OHE) is defined as two systolic BP >160 mmHg or diastolic BP >110 mmHg values within 15-60 minutes. Our objectives were to identify care gaps in management of hypertensive disorders of pregnancy (HDP), and to define quality indicators for OHE management. Methods We identified all pregnant patients with a HDP from January 1 to December 31, 2019 at a tertiary care centre in Montreal, Canada, and constructed a retrospective cohort of patients with OHE. Data on baseline characteristics, OHE management, and patient outcomes were collected through chart review. OHE management was assessed according to 9 pre-defined quality indicators. Results Over the study period, 318 patients were diagnosed with HDP (gestational hypertension:110, preeclampsia:183, eclampsia:2, chronic hypertension:38). Of these, 22(7%) had documented OHE. Median time from confirmed BP >160/110 mmHg to goal BP Conclusions Care gaps in OHE management include lack of OHE recognition, and delayed or substandard treatment. Healthcare organizations may use these findings to adopt and implement standardized treatment algorithms for OHE management.