Management of Severe Maternal Hypertension During Pregnancy and Postpartum

Guideline Watch |
August 28, 2017

Management of Severe Maternal Hypertension During Pregnancy and Postpartum

  1. Allison Bryant, MD, MPH

In this patient safety bundle, timely standardized management of severe hypertension is recommended to promote maternal safety.

  1. Allison Bryant, MD, MPH

Sponsoring Organization: Council on Patient Safety in Women's Health Care

Target Audience: Obstetric care providers

Background and Objective

Hypertensive disorders of pregnancy are leading causes of maternal morbidity and mortality, yet treatment varies across U.S. maternity hospitals. In keeping with the mission to develop standard, evidence-based guidance for acute care maternity institutions, the National Partnership on Maternal Safety recently released its safety bundle on management of severe hypertensive disorders of pregnancy.

Key Recommendations

  • Know the diagnostic criteria for severe hypertension: Systolic blood pressure (BP) ≥160 mm Hg, diastolic BP ≥110 mm Hg, or both, persisting for ≥15 minutes. Delaying treatment to confirm diagnosis of preeclampsia (persistence of acute-onset severe hypertension for 4 hours) is inappropriate.

  • Uphold hospital-based processes to provide prompt (within 30–60 minutes) treatment for women with severe hypertension no matter where the diagnosis is made (e.g., labor and delivery units, outpatient offices, emergency departments).

  • Assure ready access to recommended first-line medications for initial management of hypertension and seizure prophylaxis.

    • Hypertension: Labetalol (20-mg intravenous [IV] bolus), hydralazine (5–10-mg IV), or nifedipine (10–20-mg oral).

    • Seizure prevention: Magnesium sulfate (4–6-g IV bolus followed by 2 g per hour; continue for at least 24 hours after delivery).

  • Educate women and families in the prenatal and postpartum settings regarding warning signs of hypertensive disorders.

  • Extend vigilance for severe hypertension into the postpartum period by arranging BP checks within the first 7 to 10 days after delivery for women with known hypertensive disorders of pregnancy.

  • Establish unit-based mechanisms for huddles, case debriefs and review, and hypertension drills that allow interdisciplinary simulation of potential high-risk scenarios.


Although some clinicians worry that safety bundles and treatment standardization detract from the art of medicine, it has become increasingly clear in obstetrics that establishing baseline expectations for managing certain high-risk conditions will improve overall patient safety. With the increasing focus (among healthcare professionals and the lay public alike) on threats to maternal well-being, this bundle from the National Partnership for Maternal Safety provides welcome guidance, particularly by virtue of its detailed recommendations for timely, evidence-based, effective medication choices and dosing.

Editor Disclosures at Time of Publication

  • Disclosures for Allison Bryant, MD, MPH at time of publication Editorial Boards Obstetrics and Gynecology; American Journal of Obstetrics and Gynecology; New England Journal of Medicine; Maternal and Child Health


Reader Comments (1)

Sabar Petrus Fellow-In-Training, Internal Medicine, Columbia Asia Hospital Medan

Useful guidelines.
Need it a lot

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