Speakers - 2026

Title: Audit: Postnatal management of patient with hypertensive disorders

Abstract

Background:

Hypertensive disorders of pregnancy (HDP) affect a significant number of pregnancies and carry severe risks of postpartum maternal morbidity. Proper postnatal care is essential to prevent complications such as severe hypertension or stroke. Practice was measured against NICE Guideline NG133 standards for postpartum blood pressure (BP) monitoring, medication management, and structured community discharge planning.

Aim and objectives:

To assess compliance with national guidelines regarding the postnatal management of women with gestational hypertension, and pre-eclampsia. The secondary goal was to identify care gaps and implement interventions to improve safety before and after hospital discharge.

Methodology:

A retrospective clinical audit was conducted at York and Scarborough District Hospitals. Data was collected from both sides from the electronic records of 53 patients diagnosed with gestational hypertension and Preeclampsia, who gave birth between November 2025 and April 2026. Compliance was evaluated against three key standards:

1. Discharge BP <150/100 with or without medication.

2. Is there a documented follow up plan:

-Who will provide follow up care including medical review if needed.

-Frequency of BP monitoring.

-Threshold for reducing or stopping treatment.

-Indications for referral to primary care for BP review.

-Medical review with their GP or specialist in 2 weeks after transfer to community care.

-Medical review with theirs GP or specialist in 6-8 weeks after the birth.

3.Is Enalapril being offered?

Results:

Overall;

1-100% of the patient meets the discharge criteria for BP<150/100.

2-Documented plan:

-62.2% have follow up care plan.

-40.3% frequency of BP checking.

-2.15% have threshold for reducing/stopping treatment.

-15.95% have indications for referral to primary care for BP checking.

-46.2% have medical review with GP/specialist in 2 weeks.

-3.8% have medical review in 6-8 weeks with GP/specialist.

3-Only 3.3% offered enalapril.

Conclusion and Action Plan:

While inpatient monitoring and initial medication management closely aligned with national standards, a significant gap was identified in formal discharge communication for primary care teams. To address identified gaps in guideline awareness, medication clarity, and clinical thresholds, a targeted action plan was implemented. This includes introducing mandatory teaching of hypertensive disorders of pregnancy into every junior doctor rotation, updating the trust guideline with clear antihypertensive dosing pathways, and displaying visual clinical flowcharts in ward areas.

Reaudit:

A loop-closing re-audit is scheduled in 6 months to evaluate the impact of these changes.