Abstract TP201: Hypertensive Crisis in Labor: Believe it and Treat it

This evidence-based project (EBP) aims to reduce maternal morbidity and mortality by improving and standardizing the management of severe hypertension in intrapartum patients. Hypertensive complications during labor are a leading cause of maternal stroke and other life-threatening outcomes, yet they are largely preventable with timely and appropriate intervention. The most severe of these life-threatening outcomes are strokes. As leaders in Women’s Services, our initiative focused on implementing best practices for identifying and treating hypertensive crises in laboring patients. A comprehensive literature review using key terms such as “first-line antihypertensives in labor,” “hypertensive crisis in labor,” and “intrapartum blood pressure management” revealed three gold-standard practices endorsed by regulatory bodies and professional organizations: (1) prompt identification and provider notification of hypertensive crisis (defined as SBP >160 mmHg or DBP >110 mmHg on two readings within 15 minutes), (2) initiation of treatment within 60 minutes of the second elevated reading, and (3) use of standard first-line medications—IV labetalol, IV hydralazine, or oral nifedipine. Baseline chart audits showed minimal compliance with these standards. In response, targeted education was delivered to nursing staff through unit-based council meetings, daily huddles, and a mandatory skills fair. Visual aids, including posters and bedside algorithms, reinforced key messages such as “the brain does not care why the blood pressure is high” and “believe it and treat it,” empowering nurses to act swiftly and advocate for patients. The updated hypertensive management policy, launched in March, incorporated these standards and algorithms. Post-implementation audits demonstrated a significant improvement, achieving over 80% compliance with all three quality measures. This project highlights the critical role of nursing leadership, education, and standardized protocols in preventing strokes and improving maternal outcomes during labor.