Maternity Care Plan

Key objectives

Provide a tool for the remote management of high blood pressure in pregnancy. Reducing the amount of times expecting mothers have to come into the hospital for routine Blood Pressure readings and urinalysis, preventing patients waiting a long time to be seen.

Outcome measures

Equip expecting mothers with the medical devices they need to self-manage their high blood pressure, as well as providing the tools they need to interact digitally rather than relying on face to face consultations. Women to check BP at home and have a care plan (including an escalation plan)

Current Baselines

All activity is face to face - expecting mothers are travelling into the hospital at least weekly to have their BP and urine checked, normally waiting at least an hour in clinical to be seen.

Workflow

My High Blood Pressure Care Plan

Example care plan template code for My High Blood Pressure Care Plan HTML

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<p>Your blood pressure has recently been high in the pregnancy. Raised blood pressure can be the first sign of developing a condition called pre-eclampsia in pregnancy. This is when there is raised blood pressure either with or without protein in the urine. In addition, some women also experience symptoms such as headaches, visual disturbance or pain in the epigastric area.</p>

<p>Alternatively you may have had a pre-eclampsia/pregnancy induced hypertension in your previous pregnancy or suffer from chronic hypertension, which means you have 1 in 5 risk of redeveloping hypertensive disorder and therefore closer monitoring in the subsequent pregnancy is recommended.</p>

<p>This care plan is to help you and your family self-manage your high blood pressure while you are pregnant. Your healthcare providers will be able to observe your health records effectively and provide you with an individualised care plan for your pregnancy. You can use this plan as your online resource folder. You can access online links and track symptoms.</p>

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<h2>What is pre-eclampsia:</h2>

<ul>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;">Pre-eclampsia is a condition that affects up to 6% of pregnancies</li>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;">The cause isn't fully understood but is thought to be caused by placenta not developing properly due to a problem with the blood vessels supplying it. Typically occurring after 20 weeks of pregnancy or soon after the baby is born.</li>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;">Early signs of pre-eclampsia include high blood pressure (hypertension) and protein in the urine (proteinuria)</li>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;">Further symptoms can develop, including:

<ul>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;">sudden increase in oedema - swelling of the feet, ankles, face and hands</li>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;">severe, persistent headache</li>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;">vision problems (blurred vision or seeing flashing lights)</li>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;">epigastric pain (pain just below the ribs)</li>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;">severe heartburn</li>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;">nausea and vomiting</li>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;">excessive weight gain caused by fluid retention</li>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;">feeling very unwell with shortness of breath or chest pain</li>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;">reduced movements of your baby</li>

</ul>

</li>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;">Number of things can increase your chances of developing pre-eclampsia. These risk factors are:

<ul>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;">Pre-existing medical conditions: diabetes, chronic hypertension, kidney disease or auto-immune condition such as lupus or antiphospholipid syndrome</li>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;">first pregnancy</li>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;">age 40 years or older</li>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;">pregnancy interval of more than 10 years</li>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;">Body Mass Index (BMI) of 35 or more at first visit</li>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;">family history of pre- eclampsia</li>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;">multi-fetal pregnancy</li>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;">Hypertensive disorder in the previous pregnancy</li>

</ul>

</li>

</ul>

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<h2>Monitoring recommendations:</h2>

<ul>

<p>We recommend you take your blood pressure daily, ideally at the same time. Take two readings - let us know the second reading.</p>

<p>You can use the Medopad app to enter your blood pressure and this will automatically update your record.</p>

<p>Please test your urine for protein as often as directed by your doctor at your first appointment to start home monitoring. This will be either daily or alternate days. You can update your symptoms at the same time.</p>

<p>To enter the BP, urine and symptoms, please use the 'Edit Plan' button at the top right hand corner of this page.</p>

<label for="cp_urineProtein"><h3>Please test your urine for protein as directed by your team and record the result in the box below.</h3></label>

<option value="--">Select</option>

<option value="Negative">Negative</option>

<option value="Trace">Trace</option>

</select>

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<li style="list-style:inherit; margin-left: 15px; font-size:16px;"> If you have been started on medication for your blood pressure, take as prescribed</li>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;"> Monitor the movements of your baby</li>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;"> If you notice your blood pressure is rising, detect proteinuria or you develop any symptoms or concerns please contact our maternity specialist for advice on 0203 315 6000, option 1. Blood tests and a heart rate tracing called cardiotocography (CTG) of your baby may be recommended. An additional ultrasound to monitor the growth of your baby and an admission to the hospital may be considered.</li>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;"> If > 1+ proteinuria to contact your healthcare provider on 0203 315 6000 (option 1) so that that they can send a sample for measurement.</li>

</ul>

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<h2>Lab tests:</h2>

<ul>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;">Blood tests for pre-eclampsia include full blood count, liver function test (ALT), renal (kidney) function, urates, urea and electrolytes.</li>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;">If liver function test (ALT) is abnormal or if the platelets are abnormal, clotting screen (APTT, PT, fibrinogen) tests are required.</li>

</ul>

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<h2>Online resources:</h2>

<ul>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;">Pre-eclampsia - causes: <a href="https://www.nhs.uk/conditions/pre-eclampsia/causes/ " target="_blank">https://www.nhs.uk/conditions/pre-eclampsia/causes/ </a></li>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;">Diagnosis: <a href="https://www.nhs.uk/conditions/pre-eclampsia/diagnosis/ " target="_blank">https://www.nhs.uk/conditions/pre-eclampsia/diagnosis/ </a></li>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;">Symptoms: <a href="https://www.nhs.uk/conditions/pre-eclampsia/symptoms/ " target="_blank">https://www.nhs.uk/conditions/pre-eclampsia/symptoms/ </a></li>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;">Treatment: <a href="https://www.nhs.uk/conditions/pre-eclampsia/treatment/ " target="_blank">https://www.nhs.uk/conditions/pre-eclampsia/treatment/ </a></li>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;">Complications: <a href="https://www.nhs.uk/conditions/pre-eclampsia/complications/ " target="_blank">https://www.nhs.uk/conditions/pre-eclampsia/complications/ </a></li>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;">Recommendations: <a href="https://www.nice.org.uk/guidance/ng133/chapter/Recommendations " target="_blank">https://www.nice.org.uk/guidance/ng133/chapter/Recommendations </a></li>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;">Hypertension in pregnancy: <a href="https://www.nhs.uk/conditions/pregnancy-and-baby/hypertension-blood-pressure-pregnant/ " target="_blank">https://www.nhs.uk/conditions/pregnancy-and-baby/hypertension-blood-pressure-pregnant/ </a></li>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;">RCOG 'Information for you' leaflet: <a href="https://www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/pi-pre-eclampsia.pdf " target="_blank">https://www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/pi-pre-eclampsia.pdf </a></li>

</ul>

<h2>Other useful links</h2>

<ul>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;">Your routine Antenatal appointment schedule: <a href="https://www.nhs.uk/conditions/pregnancy-and-baby/antenatal-appointment-schedule/ " target="_blank">https://www.nhs.uk/conditions/pregnancy-and-baby/antenatal-appointment-schedule/ </a></li>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;">How to take blood pressure <a href="https://www.youtube.com/watch?v=gTNmNUrh9Kk " target="_blank">https://www.youtube.com/watch?v=gTNmNUrh9Kk </a></li>

<li style="list-style:inherit; margin-left: 15px; font-size:16px;">Pre-eclampsia foundation: <a href="http://www.preeclampsia.org/ " target="_blank">http://www.preeclampsia.org/ </a></li>

</ul>

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<h2>Routine Antenatal appointments during your pregnancy:</h2>

<p>In addition to your home monitoring you will be routinely seen in the Antenatal Clinic by a midwife and an Obstetric Consultant. As well as having these routine appointments, monitoring your blood pressure, proteinuria and symptoms through the personalised health portal will save you time by minimising the attendances to the Reuben's Maternity Assessment Suite.</p>

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Further maternity care plans can be found here: pregnancy, birth and beyond care plans