O&G Cases · Antenatal care — maternal medicine
Severe-range hypertension in the antenatal day unit — emergency management station
Emergency management station: severe-range hypertension with neurological symptoms in a stand-alone antenatal day unit. Tests recognition of a hypertensive emergency, the 30 to 60 minute treatment target with named drug and dose, magnesium loading, fluid restriction, corticosteroids, escalation and transfer, and communication with a frightened woman. Includes assessor timeline, marking domains, assessor key and fail criteria.
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Station brief
Format. Emergency management station, approximately 12 minutes. You are the obstetric registrar in a stand-alone antenatal day unit attached to a level 4 maternity service. One midwife is with you. The consultant is in theatre and the anaesthetist is on call from home. The assessor runs the clock and feeds new observations. [1]
Candidate instruction. Recognise and manage this presentation. Verbalise your actions, your drug orders with dose and route, your escalation triggers, and your communication with the woman and the team. [1][3]
You have read the opening of this case. The complete unit — every section and its primary-source references — is part of the Obstetrics & Gynaecology fellowship atlas.
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- [1]American College of Obstetricians and Gynecologists Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222 Obstet Gynecol, 2020.PMID 32443079
- [2]Magee LA, Brown MA, Hall DR, et al. The 2021 International Society for the Study of Hypertension in Pregnancy classification, diagnosis & management recommendations for international practice Pregnancy Hypertens, 2022.PMID 35066406
- [3]Shanmugalingam R, Barrett HL, Beech A, et al. A summary of the 2023 Society of Obstetric Medicine of Australia and New Zealand (SOMANZ) hypertension in pregnancy guideline Med J Aust, 2024.PMID 38763516
- [4]Altman D, Carroli G, Duley L, et al. Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? The Magpie Trial: a randomised placebo-controlled trial Lancet, 2002.PMID 12057549
- [5]Easterling T, Mundle S, Bracken H, et al. Oral antihypertensive regimens (nifedipine retard, labetalol, and methyldopa) for management of severe hypertension in pregnancy: an open-label, randomised controlled trial Lancet, 2019.PMID 31378394
- [6]Roberts D, Brown J, Medley N, Dalziel SR Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth Cochrane Database Syst Rev, 2017.PMID 28321847
- [7]von Dadelszen P, Payne B, Li J, et al. Prediction of adverse maternal outcomes in pre-eclampsia: development and validation of the fullPIERS model Lancet, 2011.PMID 21185591