The Consensus Bundle on Hypertension in Pregnancy and the Anesthesiologist: Doing All the Right Things for All the Patients All of the Time

Mihaela Podovei, MD; Brian T. Bateman, MD, MSc


Anesth Analg. 2017;125(2):383-385. 

In This Article

Abstract and Introduction


Hypertensive disorders of pregnancy and their associated complications are a major source of maternal morbidity and mortality in contemporary obstetrical practice in the United States, accounting for a substantial fraction of pregnancy-related intensive care unit admissions, cardiac arrests, and deaths.[1–4] The prevalence of these disorders in pregnancy are increasing, potentially driven by rising rates of obesity and increasing numbers of patients of advanced maternal age.[1] It is thus timely that the National Partnership for Maternal Safety (NPMS) is publishing the obstetric bundle on severe hypertension in this month's Anesthesia & Analgesia.

The NPMS is a multidisciplinary interprofessional collaboration between 19 core organizations, including the American Society of Anesthesiologists and the Society for Obstetric Anesthesia and Perinatology. The partnership strives to generate a culture of change by creating and disseminating patient safety bundles that promote development of protocols and practices that should be implemented in all hospitals that provide obstetric care. The NPMS has identified 3 major contributors to maternal morbidity and mortality amenable to interventions that can improve outcome: hemorrhage, pulmonary embolism, and severe hypertension. Bundles focused on hemorrhage were published in 2015[5] and venous thromboembolism in 2016.[6]

The goal of the safety bundles is to facilitate doing "all the right things for all the patients all the time." Recognizing the diverse characteristics of hospitals performing deliveries in the United States, the goal is to lay out a set of guidelines to be adapted to local circumstances and create systems so that any hospital can optimally manage a condition. The bundle is organized in 4 action domains: readiness, recognition, response, and reporting and system learning. Each action domain describes key practices that should be put in place on labor and delivery units. Implementation of the bundle on labor and delivery units will require multidisciplinary and intraprofessional collaboration between anesthesiologists, obstetricians, midwives, and nurses. As such, the bundle is being simultaneously published in Obstetrics and Gynecology, Journal of Midwifery and Women's Health, and Journal of Obstetric, Gynecologic and Neonatal Nursing, in addition to Anesthesia & Analgesia.