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cardio.hypertensive-emergency.eclampsia.v1

Severe pre-eclampsia / eclampsia (peripartum hypertensive crisis)

cardiologyacuteadultpregnancyacuteinpatienttransitionoutpatient
Start encounter →Print handoutPRODUCTION

Phase E variant of cardio.hypertensive-emergency.core.v1 — narrowed to severe pre-eclampsia / eclampsia (peripartum HTN crisis). Inherits HTN-emergency framework from parent; specializes for pregnancy-safe drug profile (labetalol IV + hydralazine IV + nifedipine PO; AVOID ACEi/ARB fetotoxic, AVOID nitroprusside fetal cyanide, AVOID atenolol FGR). MgSO4 4-6 g IV load + 1-2 g/h infusion for seizure prophylaxis + treatment (MAGPIE PMID 12053139; Lucas PMID 7494569). DELIVERY is curative per ACOG 2020. Postpartum lifetime CV risk elevation per Bellamy BMJ 2007. Manifest pointer reuses cardio.hypertensive-emergency.core.v1 manifest. Design-brief pointer reuses parent (eclampsia-specific differences documented inline). Status INTEGRATED until terminology + RxNav-validated drug codes are reconciled. Authored 2026-05-14 by shard-06-cardio-acute as part of HTN emergency Phase E variant batch.

Entry points (4)

  • vital_abnormality
    BP ≥160/110 in pregnancy or postpartum (ACOG 2020)
    sbp_ge_160_or_dbp_ge_110_in_pregnancy
  • symptom
    Severe features: severe HA, vision changes, RUQ/epigastric pain, AMS, low platelets, AKI, transaminitis, pulmonary edema (ACOG 2020)
    pre_eclampsia_severe_features
  • symptom
    Seizure on background of pre-eclampsia → eclampsia (ACOG 2020)
    eclampsia_seizure
  • history
    Currently pregnant OR within 6 weeks postpartum (ACOG 2020)
    pregnancy_or_postpartum_within_6_weeks

Required inputs (12)

  • agerequired
    demographic • used at CONTEXT
    Maternal age extremes (<20 or >35) increase pre-eclampsia risk + complication severity
  • pregnancy_gestational_agerequired
    history • used at CONTEXT
    Gestational age drives delivery decision (≥34 wk severe features → delivery; <34 wk individualized with steroids + MgSO4)
  • sbprequired
    vital • used at TREATMENT
    Goal SBP <160 within 30-60 min (ACOG 2020); avoid drop below 130/80 (preserves placental perfusion)
  • dbprequired
    vital • used at TREATMENT
    Goal DBP <110 within 30-60 min (ACOG 2020)
  • severe_features_screenrequired
    symptom • used at RED_FLAGS
    Severe features (HA, vision, RUQ, AMS, low plt, AKI, transaminitis, pulm edema) define severe pre-eclampsia → MgSO4 + delivery planning
  • seizure_history_during_pregnancyrequired
    symptom • used at RED_FLAGS
    Seizure → eclampsia → MgSO4 reload + emergent delivery
  • plateletsrequired
    lab • used at INITIAL_WORKUP
    Plt <100k = severe feature (HELLP component); <50k contraindicates regional anesthesia
  • creatininerequired
    lab • used at INITIAL_WORKUP
    AKI (Cr ≥1.1 or doubling) = severe feature
  • ast_altrequired
    lab • used at INITIAL_WORKUP
    Transaminitis (>2× upper limit) = severe feature (HELLP component)
  • urine_protein
    lab • used at INITIAL_WORKUP
    Proteinuria ≥300 mg/24h or ≥2+ on UA supports pre-eclampsia diagnosis
  • magnesium_levelrequired
    lab • used at MONITORING
    Goal 4.8-8.4 mg/dL during MgSO4 infusion; reflex check + RR check + UOP
  • fetal_heart_rate_monitoringrequired
    imaging • used at MONITORING
    Continuous fetal monitoring during HTN crisis + delivery planning

12-phase flow (10)

  1. 1FRAME
    Severe pre-eclampsia / eclampsia = pregnancy or postpartum (within 6 wk) + BP ≥160/110 ± severe features ± seizure. Pregnancy-safe drug profile (labetalol / hydralazine / nifedipine). MgSO4 for seizure prophylaxis + treatment (MAGPIE PMID 12053139; Lucas PMID 7494569). DELIVERY is curative (ACOG 2020). Inherits parent HTN-emergency framework.
    inputs: sbp, dbp, pregnancy_gestational_age
    advance: eclampsia/pre-eclampsia phenotype confirmed
  2. 2ENTRY
    Recognize BP ≥160/110 in pregnancy/postpartum; screen for severe features; activate OB team + anesthesia + neonatology
    inputs: age, sbp, dbp, pregnancy_gestational_age
    advance: OB team activated + workup launched
  3. 3CONTEXT
    Gestational age, prior pre-eclampsia, chronic HTN, CKD, multiple gestation, IVF, family history, obesity
    inputs: age, pregnancy_gestational_age
    advance: context complete
  4. 4RED_FLAGS
    Eclampsia seizure → MgSO4 reload + benzodiazepine + emergent delivery; HELLP (hemolysis + low plt + transaminitis); pulmonary edema; placental abruption; DIC; postpartum hemorrhage risk
    inputs: severe_features_screen, seizure_history_during_pregnancy, platelets
    actions: htn_emergency
    advance: red flags screened + delivery plan documented
  5. 5INITIAL_WORKUP
    CBC + smear (HELLP), BMP, LFTs, urine protein, coags, fibrinogen, type & screen, β-hCG (confirm pregnancy if uncertain), fetal monitoring, US for fetal/placental assessment
    inputs: platelets, creatinine, ast_alt
    actions: panel.cardiac, panel.renal
    advance: workup documented + severity classified
  6. 6BRANCHING_WORKUP
    Gestational age + severity decision: ≥34 wk severe → delivery; <34 wk severe → individualized (steroids + MgSO4 + tertiary center transfer if NICU resources limited); HELLP → expedited delivery; placental abruption → emergent delivery
    inputs: pregnancy_gestational_age, severe_features_screen
    advance: delivery plan finalized
  7. 7TREATMENT
    IV labetalol 20 → 40 → 80 mg q10 min (max 300 mg cumulative) FIRST-LINE per ACOG 2020 OR IV hydralazine 5-10 mg q15-20 min OR nifedipine 10-20 mg PO. Goal SBP <160 + DBP <110 within 30-60 min. AVOID below 130/80 (preserves placental perfusion). MgSO4 4-6 g IV load over 20 min then 1-2 g/h infusion (MAGPIE PMID 12053139; Lucas PMID 7494569). AVOID ACEi/ARB (fetotoxic), nitroprusside (cyanide → fetal toxicity), atenolol (FGR association). Delivery is definitive treatment.
    inputs: sbp, dbp, pregnancy_gestational_age
    advance: BP at target + MgSO4 loaded + delivery plan in motion
  8. 8DISPOSITION
    L&D for active labor / induction; OR for emergent C-section; ICU postpartum if HELLP / pulm edema / continued instability
    advance: unit assigned + delivery underway or planned
  9. 9MONITORING
    q5-15 min BP; continuous fetal monitoring; q1h reflexes + RR + UOP during MgSO4 infusion; goal Mg 4.8-8.4 mg/dL; CBC + LFTs + Cr q6-12h; daily fetal assessment if ongoing pregnancy
    inputs: sbp, magnesium_level, fetal_heart_rate_monitoring
    actions: panel.renal
    advance: BP at target + MgSO4 stable + fetal/maternal status reassuring
  10. 10FOLLOWUP
    Postpartum: continue MgSO4 24 h post-delivery; transition to oral labetalol or nifedipine for postpartum HTN; 1-2 wk postpartum BP check; 3-mo cardiology + nephrology assessment; lifetime CV risk elevation discussion (pre-eclampsia is independent CV risk factor)
    advance: postpartum oral regimen + 1-2 wk follow-up booked