Abstract
Hypertensive disorders in pregnancy (HDP) are a leading obstetric cause for maternal morbidity and mortality nationally as well as globally. The Saving Mothers is a report published every three years by the National Committee for Confidential Enquiry, which reports the trends in maternal deaths in South Africa. The last three Saving Mothers reports identified many gaps in the management of HDP and interventions to address these gaps were recommended. The recently published national guidelines on the management of HDP have highlighted approaches for the diagnosis, assessment and management of HDP. This article synthesises the national guidelines and provides approaches for the primary care physician working at the primary healthcare or the district hospital level. The algorithms provide easy clinical pathways once the correct assessment has been made.
Highlights
The recently published guidelines on the management of hypertensive disorders in pregnancy (HDP) highlighted the concerning trends in maternal deaths in South Africa
78% of deaths occurred at higher levels of care, many of the emergencies are thought to have originated at the primary healthcare (PHC) or the district hospital (DH) level.[1]
If the patient is at a PHC clinic or a Community Health Centre (CHC), one member of the team should inform the regional or tertiary referral hospital whilst other members should stabilise the patient according to the principles of resuscitation based on the Essential Steps in Managing Obstetric Emergencies (ESMOE), which follows a structured approach.[9]
Summary
The recently published guidelines on the management of hypertensive disorders in pregnancy (HDP) highlighted the concerning trends in maternal deaths in South Africa. 160/110 mmHg. If the patient is at a PHC clinic or a CHC, one member of the team should inform the regional or tertiary referral hospital whilst other members should stabilise the patient according to the principles of resuscitation based on the Essential Steps in Managing Obstetric Emergencies (ESMOE), which follows a structured approach.[9] An intravenous line of ringer’s lactate running in at 80 mL/h should be started, and the patient should be loaded with magnesium sulphate 14 g (4 g intravenous infusion [IVI] in 200 mL of normal saline over 20 min and 10 g given as intramuscular injection [IMI] – 5 g in each buttock).[1] The BP could be brought down with 10 mg of oral nifedipine and a start dose of 1000 mg of oral alpha methyldopa. Anaesthesia for patients who need urgent CD is complex and should preferably be given by an experienced anaesthetist.[13]
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