EFM Case Study #18: Hypertensive Crisis & Stroke

Course overview

Hypertensive crisis and stroke are on the rise in the pregnant population. Over the past 20 years, the incidence of preeclampsia has increased by approximately 25% in the US and is the leading cause of maternal and infant illness and death. Once severe features of this condition manifest, a hypertensive crisis is more imminent. Preeclampsia and any other form of hypertension make a stroke six- to nine-times more likely to happen. In the US, approximately two to 70 women out of 100,000 births will have a stroke. With an annual birth rate of four million, perinatal units can expect as many as 6,800 pregnancy-induced strokes each year. Stroke and the hypertensive crisis that may precede it are medical emergencies requiring treatment within 30-60 minutes of onset yet proper management is delayed or lacking; this increases medical-malpractice risk. This case study examines the current recommendations for the management of acute-onset severe hypertension in pregnancy.