›Immediate stabilization and triage
›Continuous pulse oximetry if symptomatic
›Cardiac monitor if severe range BP or cardiopulmonary symptoms
›Two IV lines if severe features or concern for hemorrhage
›Left lateral positioning if hypotension concern
›Seizure precautions if neuro symptoms
›Severe range BP pathway
›If persistent severe range BP 15 minutes or more, IV or PO rapid acting antihypertensive
›Target BP range
›Systolic 140 to 150 mmHg
›Diastolic 90 to 100 mmHg
›Avoid rapid overcorrection
›Uteroplacental perfusion risk
›Maternal cerebral perfusion risk
Antihypertensive treatment
›Rapid BP control options
›Labetalol IV
›Initial 20 mg IV
›Repeat 40 mg IV after 10 minutes if needed
›Repeat 80 mg IV after 10 minutes if needed
›Maximum cumulative dose per local protocol
›Hydralazine IV
›Initial 5 mg IV
›Repeat 5 to 10 mg IV after 20 minutes if needed
›Maternal tachycardia monitoring
›Nifedipine immediate release PO
›Initial 10 mg PO
›Repeat 10 to 20 mg PO after 20 minutes if needed
›Avoid sublingual administration
›Maintenance control options
›Labetalol PO
›Typical starting dose per local protocol
›Dose titration schedule per local protocol
›Nifedipine extended release PO
›Typical starting dose per local protocol
›Dose titration schedule per local protocol
Seizure prophylaxis and treatment
›Magnesium sulfate indications
›Preeclampsia with severe features
›Eclampsia
›HELLP syndrome with severe features
›Magnesium sulfate dosing
›Loading dose
›4 g IV over 20 to 30 minutes
›Alternative 6 g IV per local protocol
›Maintenance dose
›1 g per hour IV infusion
›Alternative 2 g per hour IV infusion per local protocol
›Duration
›Continue 24 hours postpartum
›Continue 24 hours after last seizure
›Magnesium toxicity monitoring
›Deep tendon reflexes
›Respiratory rate
›Urine output
›Serum magnesium if renal impairment
›Magnesium antidote
›Calcium gluconate
›1 g IV over 3 minutes
›Repeat if persistent toxicity signs
Delivery and obstetric management
›Obstetrics consultation triggers
›Any severe range BP
›Any severe feature symptom
›Any lab severe feature
›Suspected abruption
›Nonreassuring fetal status
›Delivery timing principles
›Preeclampsia with severe features
›Delivery recommended at 34 weeks or later unless maternal or fetal instability earlier
›Earlier delivery for uncontrolled severe hypertension or worsening end organ dysfunction
›Preeclampsia without severe features
›Delivery at 37 weeks or later
›Earlier for deterioration
›Gestational hypertension
›Delivery at 37 weeks or later
›Earlier for severe range BP or symptoms
›Corticosteroids for fetal lung maturity
›Betamethasone regimen per local protocol
›Use when preterm delivery expected and time allows
Monitoring and reassessment loop
›Reassessment cadence
›BP every 10 to 20 minutes during acute control
›Neuro symptom reassessment hourly if severe features
›Strict intake and output
›Escalation triggers
›Recurrent severe range BP despite therapy
›New hypoxia
›Rising creatinine
›Falling platelets
›Worsening transaminases
›New chest pain
›Seizure