Immediate postpartum management of patients with severe hypertensive disorders of pregnancy: pathophysiology guiding practice

Abstract

Developing clinically-focused evidence and experience-based approaches to improve maternity care is a national priority. Safety and quality collaborative initiatives related to management of hypertensive disorders of pregnancy are vital in the implementation of improved care. We reviewed the obstetric literature to construct a concise summary of the core pathophysiologic issues, practice principles and clinical interventions which are foundational for physicians providing immediate postpartum care for patients with severe pregnancy-related hypertension (including those with eclampsia, HELLP syndrome, and superimposed preeclampsia inclusive of those with gestational hypertension that develop severe range blood pressures). While based largely upon the American College of Obstetrics and Gynecology (ACOG) Hypertension Task Force Guidelines released in 2013 as well as updated 2018 guidelines set forth by ACOG for hypertensive disorders of pregnancy, this summary goes beyond the basic safety bundles for hypertension management and lays a pathophysiologic foundation for the immediate postpartum care of patients with severe hypertensive disorders of pregnancy.

Keywords:

• Hypertension
• preeclampsia
• HELLP syndrome
• postpartum
• hypertensive disorders of pregnancy

Acknowledgement

No funding was received for this project.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributions

All authors have participated in the work and have reviewed and agreed with the content of the article. Each author has indicated that he or she has met the journal’s requirements for authorship.