Diagnostic Criteria: Severe Hypertension Severe hypertension that is accurately measured using standard techniques and is persistent for > 15 minutes is considered a hypertensive emergency.
When to Treat: Metrics All pregnant or postpartum patients with systolic blood pressure ? 160 mm Hg or diastolic blood pressure ? 110 mm Hg that persists > 15 minutes require treatment. Severe Hypertension in Pregnancy Checklist [ ] Initiate magnesium sulfate for seizure prophylaxis (if not already initiated). Guidelines for Documentation In documentation of assessment and plan, include: Whether a diagnosis of preeclampsia has been made and, if not, what steps are being taken to exclude the diagnosis Whether antihypertensive medications are required to control BP and, if so, medication, dose, route, and frequency Current fetal status Whether magnesium sulfate is being initiated for seizure prophylaxis and if so, dosing, route, and duration of therapy Whether delivery is indicated and if so, timing, method, and route. Postpartum Surveillance: Inpatient Once a hypertensive emergency is treated and the patient is delivered, additional monitoring, follow-up, and education is necessary to prevent additional morbidity. To enable the Search feature, please click the Information Bar on the top of your browser window, and select "Allow Blocked Content".
In regard to detect secondary causes, although rare, some clinical features suggest that a potentially curable form of hypertension may be present. When renovascular hypertension is suspected, the following tests are recommended when referral, to aid in the usual screening for renal vascular disease: captopril-enhanced radioisotope renal scan, Doppler sonography, magnetic resonance angiography and computed tomographic angiography (for those with normal renal function). If pheochromocytoma is strongly suspected, the patient should be referred to a specialized hypertension centre, particularly if biochemical screening tests (Table 6) have already been found to be positive.

To screen for pheochromocytomas, 24 h urinary total metanephrines (sensitivity 95%) and urinary metanephrine to creatinine ratio (sensitivity 100%) should be assessed.
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Chronic hypertension (of any cause) SBP ? 140 or DBP ? 90 Prepregnancy or 20 weeks Absence of proteinuria or systemic signs or symptoms 3. Preeclampsia and eclampsia can develop postpartum Blood pressure should be measured every 4 hours after delivery until stable.
Plasma catecholamines and, where available, plasma metanephrines may also be considered if clinical suspicion is high, particularly during a hypertensive episode or for those with familial forms.
However, physical findings are infrequent and require additional studies to confirm a diagnosis. Urinary or plasma vanillylmandelic acid measurements should not be used as screening tests.
Still, the presence of these signs should point to the need for further evaluation of the associated conditions.
In a low-risk setting, plasma fractionated free metanephrine measurements can be used to rule out pheochromocytoma.

Also will help you look for anemia and thrombocytopenia which can be seen in HELLP (hemolysis, elevated liver enzymes and low platelets). If secondary hypertension is suspected, refer the client to a physician for further evaluation.
Also, immediately refer clients to the Emergency Room with accelerated (malignant) hypertension characterized by systolic blood pressure equal to or greater than 210 mmHg, diastolic blood pressure equal to or greater than 120 mmHg, papilledema, retinal hemorrhages and exudates, severe headache. Further 40 mg 10 minutes later if needed followed by two further doses at 80 mg 10 minutes apart, to a maximum dose of 220 mg.
If adequate response is not achieved, an alternative agent can be used.Short-acting nifedipine can be given orally at 10 mg to start, repeated at 30 minute intervals if required for up to 3 doses.
These patients need admission for observation, blood pressure control, magnesium maintenance and continuous fetal monitoring.
Get OB on board as soon as you can!Our patient's labs ended up revealed no signs of HELLP, normal uric acid, normal creatinine and 2+ protein in her urine.

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