Consensus Bundle on Severe Hypertension During Pregnancy and the Postpartum Period

Abstract

Complications arising from hypertensive disorders of pregnancy are among the leading causes of preventable severe maternal morbidity and mortality. Timely and appropriate treatment has the potential to significantly reduce hypertension-related complications. To assist health care providers in achieving this goal, this patient safety bundle provides guidance to coordinate and standardize the care provided to women with severe hypertension during pregnancy and the postpartum period. This is one of several patient safety bundles developed by multidisciplinary work groups of the National Partnership for Maternal Safety under the guidance of the Council on Patient Safety in Women's Health Care. These safety bundles outline critical clinical practices that should be implemented in every maternity care setting. Similar to other bundles that have been developed and promoted by the Partnership, the hypertension safety bundle is organized into four domains: Readiness, Recognition and Prevention, Response, and Reporting and Systems Learning. Although the bundle components may be adapted to meet the resources available in individual facilities, standardization within an institution is strongly encouraged. This commentary provides information to assist with bundle implementation.

Drugs for treating severe hypertension in pregnancy: a network meta‐analysis and trial sequential analysis of randomized clinical trials

“…Similarly, guidelines from the multidisciplinary working group of the National Partnership for Maternal Safety has advised not using magnesium sulphate for the sole anti-hypertensive purpose, and so we excluded it in this review. [75] This is the first network meta-analysis in this field. The estimates generated from the present model will be useful to practitioners as it may take several years to conduct head-to-head clinical trials comparing several drugs for treating severe hypertension in pregnancy.…”

Applications and Approaches to Severe Hypertension During Pregnancy and Postpartum Period

“…Ancak, zamanında ve uygun tedavi ile hipertansiyona bağlı istenmeyen durumlar önemli ölçüde azaltılabilir. 1,2 Hipertansiyon; gebelik döneminde kronik hipertansiyon, gestasyonel hipertansiyon, kökeninde kronik hipertansiyonun yer aldığı preeklampsi/eklampsi ve gebeliğin tetiklediği hipertansiyon (preeklampsi/eklampsi) olarak sınıflandırılmaktadır. 3 Kronik hipertansiyon, gebeliğin 20. haftasından önce kan basıncının yüksek olması (sistolik kan basıncı ≥140 mmHg ve/veya diyastolik kan basıncı ≥90 mmHg) veya doğumdan sonra 12 haftadan daha uzun süre devam etmesidir.…”

“…Preeklampsi patofizyolojisinin anlaşılmasına yönelik son gelişmeler, bu durumun önlenmesi, taranması ve yönetimi için yeni yollar açmıştır. 2,6 Bu çalışmada, güncel literatür ışığında gebelik ve postpartum dönemde şiddetli hipertansiyona ilişkin yeni uygulama ve yaklaşımlar konusunda sağlık hizmeti verenleri bilgilendirmek amacıyla yazılmıştır.…”

Müttersterbefälle weltweit rückläufig, aber häufig vermeidbar!

“…Im Rahmen dieser Maßnahmen beispielhaft hervorzuheben ist die Etablierung einer "National Partnership for Maternal Safety", einem Zusammenschluss von mehr als 30 Gesundheitsorganisationen, mit dem Ziel, durch Entwicklung und Verbreitung von einfachen, Evidenz-basierten Diagnose-und Handlungsschemata (keine Leitlinien) mit strukturierten Prozessabläufen ("Safety Bundles") die mütterliche Mortalität und Morbidität in den USA innerhalb von 5 Jahren um 50 % zu senken [16]. Zu den häufigsten Ursachen der Müttersterblichkeit in den USA -Blutungen, Hypertonie und Thromboembolien -wurden inzwischen derartige "Safety Bundles" publiziert [17][18][19].…”