PROTOCOL ON SEVERE PIH

Order Set for Severe Intrapartum or Postpartum Hypertension

Initial First-Line Management with Labetalol*

1. Notify physician if systolic BP measurement is greater than or equal to 160 mm Hg or if diastolic BP measurement is greater than or equal to 110 mm Hg.
2. Institute fetal surveillance if undelivered and fetus is viable.
3. Administer labetalol (20 mg IV over 2 minutes).
4. Repeat BP measurement in 10 minutes and record results.
5. If either BP threshold is still exceeded, administer labetalol (40 mg IV over 2 minutes). If BP is below threshold, continue to monitor BP closely.
6. Repeat BP measurement in 10 minutes and record results.
7. If either BP threshold is still exceeded, administer labetalol (80 mg IV over 2 minutes). If BP is below threshold, continue to monitor BP closely.
8. Repeat BP measurement in 10 minutes and record results.
9. If either BP threshold is still exceeded, administer hydralazine (10 mg IV over 2 minutes). If BP is below threshold, continue to monitor BP closely.
10. Repeat BP measurement in 20 minutes and record results.
11. If either BP threshold is still exceeded, obtain emergency consultation from maternal–fetal medicine, internal medicine, anesthesia, or critical care specialists.
12. Give additional antihypertensive medication per specific order.
13. Once the aforementioned BP thresholds are achieved, repeat BP measurement every 10 minutes for 1 hour, then every 15 minutes for 1 hour, then every 30 minutes for 1 hour, and then every hour for 4 hours.
14. Institute additional BP timing per specific order.

Abbreviations: BP, blood pressure; IV, intravenously.

*See text for important adverse effects and contraindications.

Data from Report of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy. Am J Obstet Gynecol 2000;183:S1–S22.

Order Set for Severe Intra partum or Postpartum Hypertension

Initial First-Line Management with Hydralazine*

1. Notify physician if systolic BP is greater than or equal to 160 mm Hg or if diastolic BP is greater than or equal to 110 mm Hg.
2. Institute fetal surveillance if undelivered and fetus is viable.
3. Administer hydralazine (5 mg or 10 mg IV over 2 minutes).
4. Repeat BP measurement in 20 minutes and record results.
5. If either BP threshold is still exceeded, administer hydralazine (10 mg IV over 2 minutes). If BP is below threshold, continue to monitor BP closely.
6. Repeat BP measurement in 20 minutes and record results.
7. If either BP threshold is still exceeded, administer labetalol (20 mg IV over 2 minutes). If BP is below threshold, continue to monitor BP closely.
8. Repeat BP measurement in 10 minutes and record results.
9. If either BP threshold is still exceeded, administer labetalol (40 mg IV over 2 minutes) and obtain emergency consultation from maternal–fetal medicine, internal medicine, anesthesia, or critical care specialists.
10. Give additional antihypertensive medication per specific order.
11. Once the aforementioned BP thresholds are achieved,repeat BP measurement every 10 minutes for 1 hour,then every 15 minutes for 1 hour, then every 30 minutes for 1 hour, and then every hour for 4 hours.
12. Institute additional BP timing per specific order.

Abbreviations: BP, blood pressure; IV, intravenously.

*See text for important adverse effects and contraindications.

Data from Report of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy. Am J Obstet Gynecol 2000;183:S1–S22.