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Dr. Collier is the Director of the Mississippi Perinatal Quality Collaborative (MSPQC) and Maternal Mortality Review Committee (MMRC) at the Mississippi State Department of Health and Assistant Professor Obstetrics & Gynecology at The University of Missis
Dr. Martin is Chair of the ACOG Pregnancy and Heart Disease Task Force and Professor Emeritus of Obstetrics, Gynecology & Maternal-Fetal Medicine at The University of Mississippi Medical Center, Jackson.
Hypertensive disorders of pregnancy are among the leading contributors to maternal mortality worldwide, but up to 60% of hypertension-related maternal deaths are potentially preventable.
Hypertensive disorders of pregnancy are among the leading contributors to maternal mortality worldwide.Â Approximately 30,000 deaths annually are attributed to hypertensive disorders including preeclampsia, eclampsia, and HELLP syndrome.1,2Â In the United States, hypertension-related disorders account for approximately 7.4% of the almost 800 pregnancy-related deaths that occur each year.3Â Women with preeclampsia/eclampsia are at 3 to 25 times the risk of severe pregnancy complications including placental abruption, disseminated intravascular coagulation (DIC), renal failure, pulmonary edema and aspiration pneumonia.4,5Â Recent reviews suggest that up to 60% of hypertension-related maternal deaths are potentially preventable-there continue to be missed opportunities for appropriate, recommended care of severe maternal hypertension.6For more information:Â Hypertensive disorders of pregnancyÂ
1. Lo JO, Mission JF, Caughey AB. Hypertensive disease of pregnancy and maternal mortality. Curr Opin Obstet Gynecol. 2013;25(2):124-132.2. Kassebaum NJ, Bertozzi-Villa A, Coggeshall MS, et al. Global, regional, and national levels and causes of maternal mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384(9947):980-1004.3. Creanga AA, Syverson C, Seed K, Callaghan WM. Pregnancy-Related Mortality in the United States, 2011-2013. Obstet Gynecol. 2017;130(2):366-373.4. Zhang J, Meikle S, Trumble A. Severe maternal morbidity associated with hypertensive disorders in pregnancy in the United States. Hypertens Pregnancy. 2003;22(2):203-212.5. Ghulmiyyah L, Sibai B. Maternal mortality from preeclampsia/eclampsia. Semin Perinatol. 2012;36(1):56-59.6. Main EK, McCain CL, Morton CH, Holtby S, Lawton ES. Pregnancy-related mortality in California: causes, characteristics, and improvement opportunities. Obstet Gynecol. 2015;125(4):938-947.
Patient safety bundles
Fully implement patient safety bundles for severe maternal hypertension.
Treat severe hypertension
Urgently treat severe persistent hypertension (≥160 systolic or ≥110 diastolic)
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Use magnesium sulfate for seizure prophylaxis.
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Iatrogenic fluid overload
Limit iatrogenic fluid overload and use appropriate hemodynamic monitoring/imaging to manage fluid balance.
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Provide enhanced/early postpartum care for women with a diagnosis of hypertensive disease as well as those at risk for its development.
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