Part 2 book “Obstetric triage and emergency care protocols” has contents: Preeclampsia with severe features, labor evaluation, vaginal bleeding in pregnancy, severe medical complications in pregnancy, common general surgical emergencies in pregnancy, management of biohazardous exposure in pregnancy, and other contents. | Preeclampsia With Severe Features, Eclampsia, and Hypertensive Issues Agatha S. Critchfield and Asha J. Heard Acute hypertension in pregnancy is a severe obstetric complication that requires immediate evaluation and treatment. It can occur in the context of a variety of disorders of pregnancy and is associated with significant maternal and fetal morbidity and potential mortality. Hypertension in pregnancy can occur along a spectrum as noted in Table . The spectrum of pregnancy-related hypertensive disorders frequently presenting with acute changes in blood pressure control will be presented. The common presenting symptomatology, the initial steps in maternal/fetal evaluation (history, physical examination, and laboratory evaluation), and management in the obstetric triage setting will be covered. In addition, other possible etiologies of acute hypertension, preeclampsia with severe features, and possible imitators of HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome will be discussed. DEFINITIONS Hypertension in pregnancy, otherwise known as gestational hypertension (GHTN), is defined as a systolic blood pressure level of 140 mmHg or greater and a diastolic blood pressure level of 90 mmHg or greater (National High Blood Pressure Education Program Working Group, 2000). Severe hypertension is defined as persistent systolic blood pressure of 160 mmHg or greater or diastolic blood pressure of 110 mmHg or greater. Severe hypertension is associated with a significantly higher rate of potentially catastrophic maternal and fetal events, including maternal stroke or other central nervous complications, and placental abruption with subsequent fetal compromise (Magee & von Dadelszen, 2009). Of note, elevated systolic blood pressure has been more strongly associated with maternal cerebral vascular accident than diastolic blood pressure (Martin et al., 2005). As many as 25% of women with GHTN will go on to develop preeclampsia (Saudan, Brown, Buddle, &
