Quality statement 7: Transfer of information about ongoing management

Quality statement

Women who have had hypertension in pregnancy have a plan for ongoing antihypertensive management included in their postnatal care plan, which is communicated to their GP when they are transferred to community care after the birth.

Rationale

There are particular risks to women who have had hypertension in pregnancy (such as the risk of stroke) in the immediate postnatal period. The development of an individualised care plan for women who have had hypertension in pregnancy before they are transferred to community care should support ongoing antihypertensive management and enable risks to be monitored and addressed, including variations in blood pressure.

Quality measures

Structure

Evidence of local arrangements to communicate a plan for ongoing antihypertensive management for women who had hypertension in pregnancy to their GP when they are transferred to community care after the birth.

Data source: Local data collection.

Process

The proportion of women with hypertension in pregnancy for whom a plan for ongoing antihypertensive management is communicated to their GP when they are transferred to community care after the birth.

Numerator – the number of women in the denominator for whom a plan for ongoing antihypertensive management is communicated to their GP when they are transferred to community care after the birth.

Denominator – the number of women who have given birth who had hypertension in pregnancy.

Data source: Local data collection.

What the quality statement means for different audiences

Service providers ensure that local arrangements are in place to communicate a plan for ongoing antihypertensive management to GPs of women who had hypertension in pregnancy when they are transferred to community care after the birth.

Healthcare practitioners communicate a plan for ongoing antihypertensive management to GPs of women who had hypertension in pregnancy when they are transferred to community care after the birth.

Commissioners ensure they commission services that communicate a plan for ongoing antihypertensive management to GPs of women who had hypertension in pregnancy when they are transferred to community care after the birth.

Women who had hypertension (high blood pressure) in pregnancy have a plan for continuing management of their blood pressure, which is communicated to their GP when they go home after their baby is born.

Source guidance

Hypertension in pregnancy: diagnosis and management (2019) NICE guideline NG133, recommendations 1.3.20, 1.4.14, 1.5.20 and 1.10.2

Definitions of terms used in this quality statement

A plan for ongoing antihypertensive management

This should include information about postpartum management, including a plan for ongoing management. A care plan should be written for women with gestational hypertension or pre-eclampsia who have given birth and are being transferred to community care that includes all of the following:

  • who will provide follow-up care, including medical review if needed

  • frequency of blood pressure monitoring needed

  • thresholds for reducing or stopping treatment

  • indications for referral to primary care for blood pressure review

  • self-monitoring for symptoms.

[NICE's guideline on hypertension in pregnancy, recommendation 1.5.20]

Hypertension in pregnancy

This definition includes chronic hypertension (present at the booking visit or before 20 weeks of pregnancy; this could include pre-existing hypertension), gestational hypertension (new hypertension presenting after 20 weeks without proteinuria) and pre-eclampsia (new hypertension 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]