The Role of Emergency Nurses in Managing Pregnant Women with Hypertensive Crisis
Keywords:
Emergency department, Hypertensive Disorders in Pregnancy, ISBAR, Magnesium sulfate, PreeclampsiaAbstract
Hypertensive crisis in pregnancy is a critical obstetric emergency associated with a high risk of maternal and fetal morbidity and mortality. This article aims to review the role of emergency nurses in the management of pregnant women with this condition, based on clinical practice guidelines published within the past five years, including those from the American College of Obstetricians and Gynecologists (ACOG), World Health Organization (WHO), International Society for the Study of Hypertension in Pregnancy (ISSHP).
A review of current clinical practice guidelines indicates that the role of emergency nurses in managing pregnant women with hypertensive crisis can be categorized into four key domains: 1) rapid assessment and triage to identify severe hypertension and acute hypertension-mediated organ damage (A-HMOD); 2) timely initiation of evidence-based treatment, including antihypertensive agents and magnesium sulfate; 3) continuous clinical monitoring, particularly of vital signs, neurological status, and urine output; and 4) coordination of multidisciplinary care and handover using structured communication tools such as ISBAR.
Emergency nurses therefore play a crucial role in supporting time-sensitive care, which requires rapid, accurate, and systematic responses to reduce treatment delays and enhance maternal and fetal safety. They serve as a key mechanism in driving emergency response within the first 60 minutes, thereby improving the quality and safety of healthcare delivery in the Thai context.
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Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: A report of the American college of cardiology/American heart association task force on clinical practice guidelines. Hypertension. 2018;71(6):e13-e115. doi:10.1161/HYP.0000000000000065
Balahura AM, Moroi ștefan I, Scafa-UdriŞte A, et al. The management of hypertensive emergencies-is there a “magical” prescription for all? J Clin Med. 2022;11(11):3138. doi:10.3390/jcm11113138
อริสรา สุขวัจนี, เพชรัตน์ รุจิพงศ์ และวิมลวรรณ เลิศวงศ์เผ่าพันธุ์ การพัฒนาแนวปฏิบัติทางการพยาบาลในการดูแลผู้ป่วยที่มีภาวะความดันโลหิตสูง ที่แผนกฉุกเฉิน. พยาบาลสาร มหาวิทยาลัยเชียงใหม่. 2568;52(1):167-183. https://he02.tci-thaijo.org/index.php/cmunursing/article/view/270303
American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins-Obstetrics. Gestational hypertension and preeclampsia: ACOG Practice Bulletin, number 222: ACOG Practice Bulletin, number 222. Obstet Gynecol. 2020;135(6):e237-e260. doi:10.1097/AOG.0000000000003891
World Health Organization. WHO Recommendations on Antiplatelet Agents for the Prevention of Pre-eclampsia. World Health Organization; 2021. https://www.who.int/publications/i/item/9789240037540. Accessed September 20, 2025.
Institute for Healthcare Improvement. Patient Safety Essentials Toolkit. Institute for Healthcare Improvement. https://www.ihi.org/library/tools/patient-safety-essentials-toolkit. Accessed March 20, 2025.
ราชวิทยาลัยสูตินรีแพทย์แห่งประเทศไทย. แนวทางเวชปฏิบัติของราชวิทยาลัยสูตินรีแพทย์แห่งประเทศไทย เรื่อง การดูแลความดันโลหิตสูงในสตรีตั้งครรภ์. กรุงเทพฯ: ราชวิทยาลัยสูตินรีแพทย์แห่งประเทศไทย; 2563. เอกสารหมายเลข OB 63-021.
International Council of Nurses. Core Competencies in Disaster Nursing: Competencies for Nurses Involved in Emergency Medical Teams (Level III). Geneva, Switzerland: International Council of Nurses; 2022.
Ghaith S, Campbell RL, Ginsberg Z, et al. Characteristics, Interventions, and Outcomes for Patients Presenting to the Emergency Department With Abdominal Pain. Acad Emerg Med. 2026;33(1):e70110. doi:10.1111/acem.70110
National Institute for Health and Care Excellence (NICE). Hypertension in pregnancy: diagnosis and management. https://www.nice.org.uk/guidance/ng133. Accessed April 28, 2025.
Bress AP, Anderson TS, Flack JM, et al. The management of elevated blood pressure in the acute care setting: A scientific statement from the American heart association. Hypertension. 2024;81(8):e94-e106. doi:10.1161/HYP.0000000000000238
น้ำทิพย์ ด้วงเงิน. การพยาบาลหญิงตั้งครรภ์ที่มีภาวะความดันโลหิตสูงรุนแรง. กรุงเทพฯ: โรงพยาบาลนพรัตนราชธานี กรมการแพทย์. http://nrh.nopparat.go.th/academic/public/view/read.php?id=79 Accessed March 20, 2025.
สมาคมความดันโลหิตสูงแห่งประเทศไทย. แนวทางการรักษาโรคความดันโลหิตสูง ในเวชปฏิบัติทั่วไป พ.ศ. 2562. กรุงเทพมหานคร: สมาคมความดันโลหิตสูงแห่งประเทศไทย; 2562.
Magee LA, Brown MA, Hall DR, et al. The 2021 International Society for the Study of Hypertension in Pregnancy classification, diagnosis & management recommendations for international practice. Pregnancy Hypertens. 2022;27:148-169. doi:10.1016/j.preghy.2021.09.008
Brown MA, Magee LA, Kenny LC, et al. Hypertensive disorders of pregnancy: ISSHP classification, diagnosis, and management recommendations for international practice: ISSHP classification, diagnosis, and management recommendations for international practice. Hypertension. 2018;72(1):24-43. doi:10.1161/HYPERTENSIONAHA.117.10803.
Emergency Nurses Association. Emergency Nursing Core Curriculum. 8th ed. Elsevier; 2026.
Galli A, Andreoli E, Pallua FY, et al. Improvement of nursing handover in emergency department: a prospective observational cohort study. Discov Health Syst. 2025;4(1). doi:10.1007/s44250-025-00180-3
รุ่งฤดี พันธุ์ประเสริฐ. การพยาบาลหญิงตั้งครรภ์ที่มีภาวะความดันโลหิตสูงรุนแรง: กรณีศึกษา. วารสารโรงพยาบาลสิงห์บุรี. 2563;29(1):17-27. https://he01.tci-thaijo.org/index.php/shj/article/view/248790.
Bernstein PS, Martin JN Jr, Barton JR, et al. Consensus bundle on severe hypertension during pregnancy and the postpartum period. J Obstet Gynecol Neonatal Nurs. 2017;46(5):776-787. doi:10.1016/j.jogn.2017.05.003
Mancia G, Kreutz R, Brunström M, et al. 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension: Endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA): Endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA). J Hypertens. 2023;41(12):1874-2071. doi:10.1097/HJH.000000000000348
Prior A, Taylor I, Gibson KS, Allen C. Severe hypertension in pregnancy: Progress made and future directions for patient safety, quality improvement, and implementation of a patient safety bundle. J Clin Med. 2024;13(17):4973. doi:10.3390/jcm13174973
Chaica V, Marques R, Pontífice-Sousa P. ISBAR: A handover nursing strategy in emergency departments, scoping review. Healthcare (Basel). 2024;12(3):399. doi:10.3390/healthcare12030399
Sims TD, Shubert L, Denning S, Shay L, Green C, Davidson C. Impact of a maternal early warning system and severe hypertension safety bundle on timely treatment of hypertensive emergencies: A quality improvement and health equity initiative. BJOG. 2025;132(13):2160-2167. doi:10.1111/1471-0528.18273
Barnard NB, Rothmann S, De Beer LT, Lubbe W. Burnout of emergency nurses in a South African context: the role of job demands and resources, and capabilities. Front Psychol. 2023;14:1119063. doi:10.3389/fpsyg.2023.1119063
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