Quality statement 6: Timing of birth for women with pre-eclampsia

Quality statement

Women with pre-eclampsia have a senior obstetrician involved in any decisions about the timing of birth.

Rationale

Some women who have pre-eclampsia with mild or moderate hypertension will progress to severe pre-eclampsia, which is associated with serious adverse outcomes. Because the progress of the condition differs between women, a senior obstetrician should be involved in any decisions about the timing of birth.

Quality measures

Structure

Evidence of local arrangements to ensure that women with pre-eclampsia have a senior obstetrician involved in decisions about the timing of birth.

Data source: Local data collection.

Process

Proportion of women with pre-eclampsia who have given birth who had a senior obstetrician involved in decisions about the timing of birth.

Numerator – the number of women in the denominator who had a senior obstetrician involved in decisions about the timing of birth.

Denominator – the number of women who have given birth who had pre-eclampsia.

Data source: Local data collection, for example, an audit of patient maternity notes.

Outcome

a) Number of maternal deaths of women with pre-eclampsia.

Data source: Local data collection.

b) Number of fetal deaths for women with pre-eclampsia.

Data source: Local data collection.

c) Number of admissions of women with pre-eclampsia to intensive care units (ICU).

Data source: Local data collection.

d) Number of admissions of babies born to women with pre-eclampsia to neonatal intensive care units (NICU).

Data source: Local data collection.

What the quality statement means for different audiences

Service providers ensure that there are local arrangements in place for women with pre-eclampsia to have a senior obstetrician involved in decisions about the timing of birth.

Healthcare practitioners ensure that women with pre-eclampsia have a senior obstetrician involved in decisions about the timing of birth.

Commissioners ensure they commission services that assign a senior obstetrician to women with pre-eclampsia.

Women with pre-eclampsia (a pregnancy-related rise in blood pressure with protein in the urine that happens in some pregnancies) have a senior specialist (called an obstetrician) involved in decisions about the timing of birth.

Source guidance

Hypertension in pregnancy: diagnosis and management (2019) NICE guideline NG133, recommendation 1.5.8

Definitions of terms used in this quality statement

Pre-eclampsia

New hypertension (over 140 mmHg systolic or over 90 mmHg diastolic) presenting after 20 weeks of pregnancy and the coexistence of 1 or more of the following new-onset conditions:

  • Proteinuria (urine protein:creatinine ratio of 30 mg/mmol or more, or albumin:creatinine ratio of 8 mg/mmol or more, or at least 1 g/litre [2+] on dipstick testing) or

  • other maternal organ dysfunction:

    • renal insufficiency (creatinine 90 micromol/litre or more, 1.02 mg/100ml or more)

    • liver involvement (elevated transaminases [alanine aminotransferase or aspartate aminotransferase over 40 IU/litre] with or without right upper quadrant or epigastric abdominal pain)

    • neurological complications such as eclampsia, altered mental status, blindness, stroke, clonus, severe headaches or persistent visual scotomata

    • haematological complications such as thrombocytopenia (platelet count below 150,000/microlitre), disseminated intravascular coagulation or haemolysis

  • uteroplacental dysfunction such as fetal growth restriction, abnormal umbilical artery Doppler waveform analysis, or stillbirth.

[NICE's guideline on hypertension in pregnancy, terms used in this guideline]

Timing of birth

For indications for timing of birth, see NICE's guideline on hypertension in pregnancy, recommendations 1.5.7 to 1.5.12.

Severe pre-eclampsia

Pre-eclampsia with severe hypertension that does not respond to treatment or is associated with ongoing or recurrent severe headaches, visual scotomata, nausea or vomiting, epigastric pain, oliguria and severe hypertension, as well as progressive deterioration in laboratory blood tests such as rising creatinine or liver transaminases or falling platelet count, or failure of fetal growth or abnormal Doppler findings.

[NICE's guideline on hypertension in pregnancy, terms used in this guideline]