Management of maternal pulse and blood pressure abnormalities during labour and childbirth: evidence-based algorithms for intrapartum care decision support

Aims To develop evidence-based clinical algorithms for assessment and management of abnormal maternal pulse and blood pressure during the intrapartum period. Population Low risk singleton, term, pregnant women in labour. Setting Institutional births in low- and middle-income countries. Search strategy A review of the literature was performed to retrieve evidence-based guidelines, systematic reviews, and papers on maternal pulse and blood pressure during labour. We searched a number of international clinical guidelines and PubMed using the corresponding key terms in November 2018 and updated the search in May 2020. Case scenarios Four common intrapartum case scenarios of abnormal pulse and blood pressure were identified for which algorithms were developed: hypertension, hypotension, tachycardia and bradycardia. Algorithms were constructed after reviewing guidelines and relevant papers, with input from a panel of experts. Thresholds for upper and lower limits of normal maternal pulse and blood pressure measurements are defined, evidence-based interventions for the initial management of abnormal parameters are described (resuscitation and monitoring) and guidance is provided on exploration of the potential causes for each case scenario, with links to pathways for their management. Conclusions Evidence-based algorithms to support the identification, and management of deviations in pulse and blood pressure during intrapartum care have been developed for hypertension, hypotension, tachycardia and bradycardia. The algorithms focus on initial resuscitation and monitoring, with an exploration of causes and early identification of underlying maternal conditions. These algorithms will help provide a standardised approach to investigation and management of these abnormal parameters to guide clinical practice. Tweetable abstract Algorithms for abnormal maternal pulse and blood pressure during labour allow standardised approach to early identification and management of complications.

Automated summary

This study aims to develop evidence-based clinical algorithms for the assessment and management of abnormal maternal pulse and blood pressure during the intrapartum period in institutional births in low- and middle-income countries. The algorithms focus on hypertension, hypotension, tachycardia, and bradycardia, and provide thresholds for normal measurements, evidence-based interventions, and guidance on exploring potential causes. These algorithms aim to standardize the investigation and management of abnormal pulse and blood pressure and guide clinical practice.