Abstract
In South Africa, large numbers of individuals with medical emergencies initially visit a general practitioner or family physician. In the case of maternity care, this may occasionally involve acute onset of severe hypertension during the antenatal period. Primary care providers (PCPs) are therefore faced with the conundrum of treating and stabilising high blood pressure or referring the patient to an appropriate hospital. Case reviews within groups of medical practitioners provide an opportunity for learning in the practical management of obstetric emergencies. The case history of a patient with severe hypertension was presented, and reflections on this patient encounter were highlighted. Amongst the challenges faced by generalists in their interactions with the public health sector are availability of standard clinical protocols, medicines, the need to work in partnership and the need to have ‘feedback’.
Highlights
In South Africa, severe hypertension in pregnancy (SHP) is the most common direct cause of maternal mortality.[1]
This is a rare event, for private primary healthcare practitioners, it is important to recognise that cerebral haemorrhage is the most common cause of mortality associated with SHP.[1]
The standard clinical guidelines recommend the use of nifedipine (10 mg tablet) orally; this calcium channel blocker lowers the high blood pressure (BP) within 20–30 min.[3,4]
Summary
In South Africa, severe hypertension in pregnancy (SHP) is the most common direct cause of maternal mortality.[1] Many pregnant women from the low socio-economic strata seek medical advice and help from private medical practitioners, including family physicians in general practice, if they have severe symptoms. This health-seeking behaviour may be the result of anxiety of long waiting periods, poor staff attitudes and the possibility of being turned away from public health facilities for various reasons.[2] Private primary care providers (PCPs) should be prepared to deal with obstetric emergencies they may only rarely encounter such situations. As the PCP recognised this to be an obstetric emergency, following shared decision-making with the patient of the likely diagnosis (imminent eclampsia), and because of the fact that she was accompanied by a relative, who had a motor vehicle, immediate referral to the district hospital was made
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Schedule a callMore From: South African family practice : official journal of the South African Academy of Family Practice/Primary Care
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