Lock It In
Priority Recognition
Antepartum deterioration is often recognized first through a change in pattern rather than one isolated number.
Antepartum deterioration is often recognized first through a change in pattern rather than one isolated number. A new severe headache, visual disturbance, right-upper-quadrant pain, falling urine output, vaginal bleeding, painful contractions, leaking fluid, reduced fetal movement, or a blood pressure in the severe range changes the priority from routine surveillance to urgent assessment and escalation. Use an immediate maternal–fetal sequence: 1. Assess airway, breathing, circulation, level of consciousness, pain, and visible bleeding. 2. Obtain a properly measured blood pressure and repeat it promptly when severe. 3. Assess fetal heart rate and movement, uterine activity, and uterine tenderness. 4. Establish or maintain intravenous access as ordered, obtain focused investigations, and notify the appropriate obstetric clinician or rapid-response team. 5. Reassess response to every intervention rather than assuming that a treatment has worked. A blood pressure of at least 160 mm Hg systolic or 110 mm Hg diastolic is an obstetric emergency. Do not wait four hours for confirmation before initiating the severe-hypertension pathway; the four-hour interval applies to confirming non-severe hypertension. Persistent severe pressure increases the risk of stroke, placental separation,...