Community monitoring of blood pressure and proteinuria Maternity

Transcription

1 Community monitoring of blood pressure and proteinuria V3 Page 1 of 5 Community monitoring of blood pressure and proteinuria Maternity 1. Introduction and who the guideline applies to: This guideline applies to staff caring for pregnant women in the antenatal period. Description Definition Action by midwife / GP Consider transfer into hospital by ambulance if significantly raised BP or symptomatic. This should be based on an individual. If there is uncertaintly discuss with a Community Team Lead or the referring hospital. Diastolic BP 90 and < 100 mmhg On 2 readings at least 10 minutes apart Refer for hospital within 48 hours, or recheck at home within 48 hours and refer in to hospital if still raised New hypertension without proteinuria after 20 weeks Diastolic BP 90 and < 100mmHg with significant symptoms* Systolic BP 150 mmhg Diastolic BP 100 mmhg Description Definition Action by midwife / GP New hypertension and proteinuria after 20 weeks Diastolic BP 90 mmhg and / or Systolic BP of 150 mmhg and new proteinuria 1+ on dipstick Diastolic BP 110 mmhg and new proteinuria 1+ on dipstick Refer for same day hospital

2 Community monitoring of blood pressure and proteinuria V3 Page 2 of 5 Systolic BP 160 mmhg and new proteinuria 1+ on dipstick Diastolic BP 90 mmhg and new proteinuria 1+ on dipstick and significant symptoms* New proteinuria without hypertension after 20 weeks 1+ on dipstick Repeat pre eclampsia in the community in 1 week. If still 1+ proteinuria send PCR to lab and review following week 2+ or more on dipstick Send urine PCR to lab and refer for hospital within 48 hours 1+ on dipstick with significant symptoms* Refer for same day hospital Maternal symptoms or fetal signs and symptoms without new hypertension or proteinuria Headache and or visual disturbances with diastolic blood pressure less than 90 mmhg and a trace or no protein Depending on severity / nature of symptoms consider referral for same day hospital OR reduce interval before next antenatal in community. Epigastric pain with diastolic blood pressure less that 90 mmhg and a trace or no protein Depending on severity / nature of symptoms consider referral for same day hospital OR reduce interval before next antenatal in community. Reduced fetal movements or small for gestation age infant with diastolic blood pressure less than 90 mmhg and a trace or no protein Refer to UHL Reduced Fetal Movements guideline Consider reducing interval before next full pre eclampsia *Epigastric pain, vomiting, headache, visual disturbances, reduced fetal movements, small for gestational age infant

3 Community monitoring of blood pressure and proteinuria V3 Page 3 of 5 Headache and visual disturbances Severe pounding headache, partial loss of visual acuity, bright/flashing visual disturbances. Migraines can continue during pregnancy and any migraine can be excruciating without being life-threatening or associated with signs of preeclampsia A headache of sufficient severity to seek medical advice. (CEMD) Epigastric pain Epigastric pain, especially if severe or associated with vomiting. The most sinister epigastric pain is described by the sufferer as severe and is associated with definite tenderness to deep epigastric palpation (the woman winces). New epigastric pain (CEMD). (PRECOG)

4 Community monitoring of blood pressure and proteinuria V3 Page 4 of 5 Protein Threshold in the Community 2+ Protein or more 1 st Episode, normal blood pressure, asymptomatic of pre-eclampsia If symptomatic or raised BP send in for review to MAU on the same day Send PCR. Inform woman and document that she is aware of signs & symptoms of pre-eclampsia. Inform hospital by telephone Mon Wed Ring PAS/AAA to arrange appointment 2/7 to review PAS/AAA/MAU Thur Fri Ring MAU to arrange a morning appointment 2/7 review If PCR normal, hospital appointment can be cancelled. Please ensure patient has Community Midwife follow up appointment IF NO PCR RESULT IS AVAILABLE, THE WOMAN WILL NEED A HOSPITAL ASSESSMENT If PCR is raised Antenatal check Bloods U&E s, LFT s, FBC If PCR is 30-50, repeat PCR If PCR 50, arrange 24hr urine total protein Arrange clinic appointment 1/52 with their Consultant If Midwifery Led LRI Hypertension Clinic LGH General Obs Clinic If woman is at term discuss with Consultant to consider induction of labour *If Claire Dodd or Andrea Goodlife available we will endeavour to see these ladies.

5 Community monitoring of blood pressure and proteinuria V3 Page 5 of 5 DEVELOPMENT AND APPROVAL RECORD FOR THIS DOCUMENT Author / Lead Officer: L Payne and L Matthews Job Title: Senior Midwife Community Services and Clinical Risk and Quality Standards Midwife Reviewed by: Hypertension Team Approved by: Maternity Service Governance Group Date Approved: and Date Issue Number Reviewed By April 2014 V2 L Payne and L Matthews February V2 C Wiesender, L 2016 Payne and L Matthews June 2018 V3 L Matthews and A Goodlife REVIEW RECORD Minimal changes Description Of Changes (If Any) Consideration for ambulance transfer added in Protein threshold in the community flow chart added DISTRIBUTION RECORD: Date Name Dept Received All Midwives and Obstetricians Maternity 2.16 All Midwives and Obstetricians Maternity June 2018 All Midwives and Obstetricians Maternity