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.

Prompt

A 28-year-old G1P0 at 30+4 weeks attends the antenatal day unit for a routine blood pressure check after two readings of 146/92 mmHg last week. The midwife records 174/116 mmHg on a manual sphygmomanometer, repeated at 170/112 mmHg. The woman says she has had a frontal headache since yesterday and has been seeing 'sparkles'. She has not been admitted before. You are the registrar; the consultant is in theatre and the day unit has one midwife and no resident anaesthetist.

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]

References7Show

[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

Severe-range hypertension in the antenatal day unit — emergency management station

Station brief

References7Show

[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