168/112.
The blood pressure is repeated.
171/110.
The nurse calls.
The patient has a headache.
Everyone knows she has severe hypertension.
And yet nothing happens.
This is one of the most disturbing forms of preventable obstetric harm because the problem is not hidden.
It has already been measured.
Severe Hypertension Is Different
Many areas of obstetrics contain uncertainty.
Electronic fetal monitoring is imperfect.
Estimated fetal weight is imprecise.
Labor progression varies enormously.
Even experienced clinicians can reasonably disagree about many management decisions.
Persistent acute-onset severe hypertension is different.
Severe hypertension during pregnancy or postpartum is a medical emergency because of the risk of stroke and other severe maternal complications.
SMFM states that expeditious treatment within 30 to 60 minutes is recommended and has created a quality metric specifically to measure whether hospitals achieve timely treatment. [1]
That makes severe hypertension an unusually revealing patient-safety problem.
The threshold is recognized.
The treatment exists.
The urgency is known.
Yet delays still occur.
