ABSTRACTS
Prevalence of Persistent Severe Hypertension and Rates of Treatment among Pregnant Patients in the Prehospital SettingAuthor: Austin H. Wingate | EMS Chief | Grand County EMS Associate Authors: Livingston, C.A. Maffetone, N. Wilcox, K.M. Brown, L.H. Kupas, D.F.
Background: Hypertensive disorders of pregnancy contribute to maternal-fetal morbidity and mortality, and require time-sensitive intervention. In April 2025, the American College of Obstetrics and Gynecology (ACOG), in collaboration with the National Association of EMS Physicians and the National Association of EMTs, published new guidelines on the prehospital treatment of elevated blood pressure during pregnancy. The purpose of this study was to determine the prevalence of persistent severe hypertension among pregnant emergency medical services (EMS) patients, to document the current frequency of guideline-adherent treatment, and to inform EMS systems of opportunities for improving care. Methods: Using the January 1 through December 31, 2024 ESO Data Collaborative research data set, we identified all 9-1-1 scene responses for patients documented as > 20 weeks pregnant. We excluded injury-related encounters and patients outside of the World Health Organization definition of childbearing age ( > 15 to ≤ 49). Consistent with the new guidelines, we defined persistent severe hypertension as two or more blood pressures > 160 mmHg systolic or > 110 mmHg diastolic. We defined guideline-adherent treatment as administration of both an antihypertensive medication (labetalol, hydralazine, or nifedipine) and magnesium sulfate. Results: We identified 39,546 9-1-1 scene responses for patients who were > 20 weeks pregnant meeting our inclusion criteria. The prevalence of persistent severe hypertension in this population was 3.1% (n=1,234/39,546). Of these, we found 77 patients (6.2%) who received magnesium sulfate only, 19 patients (1.5%) who received an antihypertensive only, and 10 patients (0.8%) who received both as recommended by the new ACOG guidelines. Conclusion: Approximately 1 in every 32 pregnant patients > 20 weeks gestation encountered by EMS have persistent severe hypertension. In the year prior to the dissemination of the new ACOG guidelines, few of these patients received treatment with both an antihypertensive and magnesium sulfate, demonstrating an opportunity to improve care for these patients.
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