Obstetric Emergencies

Eclampsia

IN REVIEWv4🇮🇳 India-firstPENDING CLINICAL VERIFICATION⚡ Eclampsia

Generalised seizures in a woman with pre-eclampsia (any time antepartum/intrapartum/up to several days postpartum). MgSO4 halves recurrent seizures; stabilise THEN deliver. National Eclampsia Registry: >50% antepartum, ~13% postpartum.

Admission & discharge ↓

Reviewer note: Medication regimens and dependent emergency instructions checked 17 October 2026. These targeted checks do not certify every statement in the module. Admission/discharge guidance checked 18 October 2026. This adds a scoped clinical synthesis and does not certify every statement in the module.

Admission & discharge

Care setting: Hospital assessment; severe disease needs admission and possible critical care

Admission/discharge guidance checked 2026-10-18 against the linked sources. This is a clinical checklist for an individual decision, not an automatic discharge order.

When admission or continued hospital care is needed

Admit for severe/persistent hypertension, seizure or neurological symptoms, pulmonary oedema, renal/liver/platelet deterioration, significant pain or fetal compromise.
Eclampsia/HELLP or organ-support needs require appropriate high-dependency/critical-care monitoring, with transfer after initial stabilisation when necessary.

When clinic, day care or home care may be suitable

Antenatal outpatient care is a specialist decision only when maternal/fetal assessment and reliable surveillance support it; recent eclampsia or HELLP is not a routine outpatient pathway.

Before going home

Postnatal NICE transfer criteria: no pre-eclampsia symptoms, BP ≤150/100 mmHg with or without treatment, and blood results stable or improving; all criteria must be met.
Following eclampsia/HELLP, complete indicated seizure prophylaxis/monitoring and document neurological, respiratory, urine-output and blood-test recovery before considering home care. Critical-care step-down and discharge home are separate decisions.
A seizure-free interval alone does not establish readiness: review other neurological causes, medication completion and the obstetric/critical-care course.

Discharge medicines and treatment changes

Continue the selected oral antihypertensive. Stop methyldopa within 2 days after birth; document replacement and review.
The prescriber should consider reduction below 140/90 and reduce below 130/80 mmHg under NICE; provide an individual written adjustment plan. Magnesium loading/infusions are inpatient treatment, not take-home medication.

Medicine doses — use only when indicated

Use the medicines selected for this patient. Listed alternatives are not instructions to prescribe all of them together. Confirm the actual remaining course, pregnancy/postnatal context and monitoring plan.

One selected oral BP option; do not prescribe every alternative together.

Labetalol oralMSFchecked

DoseStart 100 mg twice daily; increase by 100–200 mg increments according to BP; higher daily doses divided three times daily

RouteOral

FrequencyTwice daily initially; three divided doses if higher doses needed

DurationContinue while clinically required; titrate down rather than stop abruptly, with a postpartum review plan

Preparation100 mg or 200 mg tablets; prescribe the strength, dose and administration times

Max dose2400 mg/day

Indication: Maintenance hypertension during pregnancy/postpartum

Monitoring

BP/heart rate, postural symptoms; neonatal glucose/heart-rate observation after late-pregnancy exposure

Contraindications: Asthma, heart block, marked bradycardia, decompensated heart failure

Alternative/adjunct only within the documented BP plan.

Nifedipine extended releaseGovernment of India, MoHFW / NHMchecked

DoseStart sustained-release nifedipine 10 mg twice daily; titrate according to BP and the exact release formulation

RouteOral extended release

FrequencyTwice daily for the cited sustained-release regimen

DurationWhile hypertension persists; reassess after birth and reduce when BP allows

PreparationUse the specified sustained-release tablet, swallowed intact. Other extended-release products may use different strengths/schedules; do not interchange them or use them for acute oral loading.

Max dose80 mg/day for the NHM CEmONC sustained-release regimen

Indication: Maintenance hypertension in pregnancy/postpartum

Monitoring

BP, headache, flushing, oedema and pulse

Contraindications: Maternal hypotension or significant cardiac outflow obstruction

Postpartum only when prescribed, with renal function/potassium monitoring.

Enalapril — postpartum hypertensionMilpharm / emcchecked

DoseStart 5 mg once daily; use a lower supervised initial dose if volume depleted or renally impaired; titrate to BP response

RouteOral

FrequencyOnce daily initially

DurationReview BP and dose after birth; reduce/stop as hypertension resolves or continue for persistent hypertension after medical review

Preparation5 mg tablet swallowed with water, with or without food. Correct volume depletion; check creatinine and potassium before starting

Max dose40 mg/day in the product label; usual maintenance 20 mg/day, not an automatic postpartum target

Indication: After birth only; NICE recommends enalapril with maternal renal-function and potassium monitoring
Renal / hepatic: Renal impairment requires a lower initial dose and adjustment from the product renal table, not the unadjusted 5 mg starter.
NICE NG133 supplies the postpartum choice. Breastfeeding requires extra caution with premature/very young infants; use a suitable alternative when clinically indicated.

Monitoring

BP, symptoms, creatinine/eGFR and potassium before and after initiation/dose changes; infant feeding, alertness and urine output if breastfeeding

Contraindications: Pregnancy, prior ACE-inhibitor angioedema, significant hyperkalaemia; avoid starting in unresolved AKI or severe volume depletion

Tests, pending results and their reviewer

Review platelet count, transaminases and creatinine at 48–72 hours after birth/critical-care step-down; abnormal results need a repeat plan until recovery.
At 6–8 weeks check urine protein; persistent proteinuria (1+ or more) needs a 3-month renal review and referral if kidney function is abnormal.

Home care and counselling

Provide the BP schedule, named reviewer, medicine list and explicit severe-symptom instructions. Discuss recurrence, future-pregnancy planning and long-term cardiovascular risk.

Follow-up: when and what to review

When	Action / responsible service
If on antihypertensives: every 1–2 days for up to 2 weeks after transfer	NICE BP surveillance until off treatment with no hypertension; adapt intensity to findings.
If not on antihypertensives: day 3–5 after birth	Check BP; repeat on alternate days if abnormal.
2 weeks if still on treatment; 6–8 weeks for all	Review medicines, BP, recovery and urine protein; arrange renal follow-up when indicated.

Return urgently

Seizure, severe/persistent headache, visual disturbance, epigastric pain, dyspnoea, chest pain or severe BP: return immediately; postpartum onset can occur after discharge.

Open the complete discharge checklist →

Sources for this plan:

NICE · NG133checked MSFchecked Government of India, MoHFW / NHMchecked Milpharm / emcchecked

Treatment

① Immediate stabilization — first minutes

Protect from injury, left-lateral positioning, suction and airway support; do not restrain forcibly or place objects in the mouth. Check glucose immediately. Give oxygen for hypoxaemia and assist ventilation if needed.
Give ONE magnesium regimen from the cards: IV/IM OR IV maintenance, not both. Maintain a running magnesium dose/time record.
Treat persistent systolic ≥160 OR diastolic ≥110 mmHg promptly with the selected acute-BP sequence. Magnesium treats seizures; it does not replace antihypertensive treatment.
Assess reflexes, respiration and urine output throughout treatment. For toxicity: stop magnesium, support ventilation, call anaesthesia and give calcium gluconate as below.

③ First-line treatment & drug regimens

Magnesium sulfate — IV/IM regimenMSFchecked

Dose4 g IV loading, then 5 g deep IM into EACH buttock (10 g IM total); maintenance 5 g IM into alternate buttocks

RouteIV loading + deep IM

FrequencyLoading once; maintenance every 4 hours

DurationContinue until 24 hours after birth OR the last seizure, whichever is later

PreparationUsing 50% (500 mg/mL): 4 g = 8 mL; dilute in 100 mL sodium chloride 0.9% and infuse over 15–20 min. Each 5 g IM dose = 10 mL of 50% solution. Check the actual ampoule strength.

Max doseDo not give maintenance when toxicity criteria are present; do not run an additional magnesium regimen

Eclampsia: stop seizures and prevent recurrence

Monitoring

Check patellar reflexes, respiratory rate and hourly urine output; monitor BP, pulse and consciousness
Withhold magnesium for absent reflexes, respiratory rate <12/min or urine <100 mL in 4 h; obtain serum magnesium and senior review
Stop magnesium and support ventilation for toxicity; give the calcium-gluconate antidote shown below

Contraindications: Myasthenia gravis, heart block or magnesium toxicity · Renal impairment or oliguria requires reduced/withheld maintenance and more frequent assessment

Magnesium sulfate — IV regimenMSFchecked

Dose4 g IV loading over 15–20 min, then 1 g/hour

RouteIV infusion

FrequencyOne loading dose, then continuous infusion

Duration24 hours after birth or last seizure, whichever is later

Preparation50% solution: withdraw 8 mL (4 g) into 100 mL sodium chloride 0.9% for loading; for maintenance make 20 g up to a FINAL 100 mL (200 mg/mL), run at 5 mL/hour by labelled pump

Max doseUse ONE IV or IV/IM protocol; stop/adjust for toxicity or renal dysfunction

Eclampsia: alternative when a reliable infusion pump and monitoring are available
Maintenance concentration and pump rate are calculated from the prescribed 1 g/hour; independently check the preparation.

Monitoring

Check patellar reflexes, respiratory rate and hourly urine output; monitor BP, pulse and consciousness
Withhold magnesium for absent reflexes, respiratory rate <12/min or urine <100 mL in 4 h; obtain serum magnesium and senior review
Stop magnesium and support ventilation for toxicity; give the calcium-gluconate antidote shown below

Contraindications: Myasthenia gravis, heart block or magnesium toxicity · Renal impairment or oliguria requires reduced/withheld maintenance and more frequent assessment

Magnesium sulfate — recurrent seizureMSFchecked

Dose2 g IV additional dose after senior assessment

RouteIV infusion

FrequencyOne rescue dose, followed by reassessment

DurationAcute rescue; continue the selected maintenance regimen

Preparation50% solution: 2 g = 4 mL, dilute in compatible sodium chloride 0.9%; give slowly by infusion and check the total loading already received

Max doseMSF ceiling: no more than 8 g IV in the first hour; persistent fits need anaesthesia/ICU, not repeated blind magnesium dosing

Recurrent eclamptic convulsion after loading; reassess airway, glucose and magnesium toxicity

Monitoring

Check patellar reflexes, respiratory rate and hourly urine output; monitor BP, pulse and consciousness
Withhold magnesium for absent reflexes, respiratory rate <12/min or urine <100 mL in 4 h; obtain serum magnesium and senior review
Stop magnesium and support ventilation for toxicity; give the calcium-gluconate antidote shown below

Contraindications: Myasthenia gravis, heart block or magnesium toxicity · Renal impairment or oliguria requires reduced/withheld maintenance and more frequent assessment

Zuspan IV alternative: Use the complete magnesium IV alternative card: 4 g over 15–20 minutes, then 1 g/hour in the cited MSF regimen. Choose one complete monitored regimen rather than mixing loading/maintenance schedules.

④ Drug treatment detail (4 agents)

Calcium gluconate 10%MSFchecked

Dose1 g (10 mL of 10% solution) slowly

RouteIV

FrequencyInitial antidote dose; reassess breathing, ECG and calcium before further dosing

DurationEmergency reversal; stop magnesium and support the airway concurrently

Preparation10% = 100 mg/mL; 10 mL contains 1 g calcium gluconate, NOT 1 g elemental calcium. Give over at least 5 min through a patent IV line; do not mix with other drugs

Max doseNo automatic repeated-dose course; further calcium requires monitored reassessment

Indication: Antidote for clinically significant magnesium toxicity

Monitoring

Continuous ECG/heart rate; respiratory status, reflexes and injection site; serum calcium/magnesium where available

Contraindications: Extravasation can cause tissue injury; take special care with digoxin · Do not confuse calcium gluconate with calcium chloride

Labetalol IVGovernment of India, MoHFW / NHMchecked

Dose20 mg over 2 min; reassess at 10 min, then 40 mg; further 80 mg doses at 10-min intervals if severe BP persists

RouteIV bolus

Frequency10-minute reassessment and dose sequence

DurationAcute control, then change to an appropriate oral regimen

Preparation5 mg/mL stock: 20 mg = 4 mL, 40 mg = 8 mL, 80 mg = 16 mL. Give each dose slowly, record cumulative dose and check the stock strength

Max dose300 mg cumulative in the cited Indian CEmONC regimen; seek escalation before continuing beyond it

Indication: Persistent severe hypertension in pregnancy or postpartum (systolic ≥160 OR diastolic ≥110 mmHg)

Monitoring

Check BP and pulse before and after each acute dose; fetal monitoring when appropriate
Persistent severe BP despite the initial sequence requires senior/anaesthetic review, a different agent and HDU-level monitoring; avoid uncontrolled stacking

Contraindications: Asthma, bradycardia/heart block or decompensated heart failure

Hydralazine IVMSFchecked

Dose5 mg slowly IV over 2–4 min; reassess for 20 min and repeat 5 mg if still severe

RouteIV

FrequencyEvery 20 min if required after reassessment

DurationAcute control; transition to oral therapy once stable

PreparationReconstitute a 20 mg vial with 1 mL water for injection, then add 9 mL sodium chloride 0.9%: 2 mg/mL. A 5 mg dose = 2.5 mL. Use immediately; do not mix with other drugs

Max dose20 mg cumulative in this MSF bolus regimen

Indication: Alternative for acute severe hypertension
Renal / hepatic: Reduce doses with renal/hepatic impairment

Monitoring

Check BP and pulse before and after each acute dose; fetal monitoring when appropriate
Persistent severe BP despite the initial sequence requires senior/anaesthetic review, a different agent and HDU-level monitoring; avoid uncontrolled stacking

Contraindications: Marked hypotension, severe tachycardia or coronary ischaemia; use cautiously in cardiac disease

Nifedipine immediate releaseGovernment of India, MoHFW / NHMchecked

Dose10 mg swallowed; reassess at 20 min and give another 10–20 mg if still severe

RouteOral, swallowed

FrequencyReassess after each 20-minute interval; switch/escalate when the initial-course limit is reached

DurationAcute sequence, followed by senior review and a separately prescribed maintenance regimen

PreparationUse immediate-release oral tablets/capsules; swallow whole. NEVER sublingual administration; do not use an extended-release tablet as a rapid-loading substitute

Max dose30 mg cumulative for the NHM prose-based initial course; seek senior selection of another agent rather than continuing oral loading

Indication: Acute severe hypertension when oral dosing is appropriate
NHM CEmONC contains an internal discrepancy: its prose caps the initial course at 30 mg, while the adjacent flowchart shows 10 mg then 20 mg then 20 mg. The app uses the 30 mg prose limit with prompt escalation; confirm the locally approved sequence.

Monitoring

Check BP and pulse before and after each acute dose; fetal monitoring when appropriate
Persistent severe BP despite the initial sequence requires senior/anaesthetic review, a different agent and HDU-level monitoring; avoid uncontrolled stacking

Contraindications: Hypotension, significant aortic stenosis or acute cardiac compromise · Magnesium co-administration requires close respiratory/neuromuscular and BP monitoring; follow the named unit protocol

Non-drug treatment

Left lateral tilt/position; padding rails
Suction ready; bite protection
Catheterise for strict urine output
Quiet environment; minimise stimulation

Definitive treatment

Recurrent seizure: reassess airway, glucose and magnesium exposure/toxicity before the additional magnesium dose. Continued convulsions require anaesthetic/ICU support and a refractory-seizure plan.
Once maternal seizures, oxygenation and BP are controlled, plan birth irrespective of a reassuring gestational-age threshold; eclampsia is not managed by simply waiting until 34 weeks. Choose route by obstetric circumstances rather than automatic caesarean.
Continue the chosen magnesium regimen until 24 h after birth or the last seizure, whichever is later; individualise for renal dysfunction or toxicity.

Monitoring

Check	Standard	Action if failed
Patellar reflex	Present	Withhold maintenance dose; assess level
Respiratory rate	≥12/min	Withhold; O₂; consider calcium gluconate if RR <12 + weakness
Urine output	≥25 mL/h	Withhold; assess renal function/fluid status
Serum Mg²⁺ (if available)	4–7 mg/dL therapeutic; >9–10 mg/dL toxic	Stop infusion; calcium gluconate 10% 10 mL IV over 3 min

Response assessment

No further seizures on maintenance
Improving conscious level
BP approaching target
Stable fetal state

Treatment failure

Seizure recurs despite MgSO4: Give additional MgSO4 2 g IV over 5 min (after checking RR/reflexes — if depressed, treat toxicity with calcium gluconate FIRST). Consider thiopentone/levetiracetam/phenytoin loading per anaesthetist; secure airway; ICU. Re-image if atypical.

Second-line treatment

Airway: RSII intubation if repeated seizures/coma
Levetiracetam 1–1.5 g IV or phenytoin 15–18 mg/kg (anaesthetist-led) as adjunct when magnesium-refractory
Mannitol/intensive-care measures for raised ICP suspicion

Rescue treatment

Recurrent/prolonged seizures, inability to protect airway, hypoxia, pulmonary oedema, coma or organ failure: ICU/anaesthesia immediately.

Restrict maintenance fluids appropriately in severe pre-eclampsia, including drug-carrier volumes; titrate any resuscitation to clinical need and avoid fluid overload.

Procedure / surgery

Caesarean under GA if coagulopathic/refractory; regional acceptable when platelets/coags safe and seizures controlled. Neonatal team informed (hyper magnesaemia → floppy infant, respiratory support readiness).

Escalation

ICU for: recurrent seizures, ventilation, renal failure, coagulopathy, coma
Peripheral-centre rule: stabilise (airway+MgSO4+BP) THEN refer with escort — never transfer mid-seizure

⑮ Complications & their management

Recurrent seizures

Reload per failure pathway; check adherence to maintenance schedule

Aspiration pneumonitis

Antibiotics per sepsis pathway if fever/infiltrate; physiotherapy; O₂

Intracranial haemorrhage

CT; neurosurgery; BP 130–150 systolic; corrected coagulopathy

Acute kidney injury

Fluid stewardship; dialysis indications per ICU

Neonatal Mg toxicity

Inform paediatrics: hypotonia, respiratory depression — nursery observation

Post-treatment care

MgSO4 maintenance continues 24 h AFTER last seizure (even if delivered)
Postnatal BP + labs surveillance ≥48–72 h
Counselling: recurrence risk, future-pregnancy aspirin plan
Psychological debrief; contraception planning

Diagnosis & assessment

Red flags:

THIS IS THE RED FLAG EVENT
Recurrent seizures despite MgSO4
Apnoea/desaturation between fits
Injury/tongue bite/aspiration
Stillbirth/abnormal CTG after fit
Intracranial bleed suspicion (prolonged coma, focal deficits)

Definition: Occurrence of generalised tonic-clonic seizures in a woman with pre-eclampsia, in the absence of other neurological cause (FOGSI GCPR 2026 §3.x; atypical eclampsia recognised).

Initial assessment

RECOGNISE: convulsion in hypertensive pregnant/postpartum woman
CALL FOR HELP (senior obstetrician, anaesthetist; note time)
During fit: do NOT restrain; protect from injury; nothing in mouth
After fit: left lateral position; suction secretions; O₂ 15 L/min non-rebreather; airway adjunct if needed
IV access ×2; send bloods (incl. Mg level baseline, coags, crossmatch)
Start MgSO4 LOADING DOSE IMMEDIATELY (before transport/imaging)
BP assessment + antihypertensive if ≥160/110
Continuous fetal monitoring once maternal stabilisation under way (fetal bradycardia common transiently post-fit — observe 10–15 min before emergency caesarean unless persistent)

Investigations

Test	Looking for
CBC, platelets, coagulation	HELLP/DIC coexistence
Creatinine, LFTs, LDH	Organ dysfunction severity
Serum magnesium (where available)	Baseline before maintenance; toxicity checks
SpO₂/ABG if cyanosis/desaturation	Aspiration/pulmonary oedema
CT brain ONLY if atypical (coma >expected, focal signs, age atypical, no HTN/proteinuria)	ICH/venous sinus thrombosis/other pathology — do not delay MgSO4

Algorithm

Entry pointSEIZURE in pre-eclamptic woman

ActionCALL HELP · time it · protect injury

NextLeft lateral · suction · O₂ 15 L/min ↓

ActionLeft lateral · suction · O₂ 15 L/min

NextMgSO4 LOADING: 4 g IV slow + 5 g IM ×2 buttocks (Pritchard) ↓

ActionMgSO4 LOADING: 4 g IV slow + 5 g IM ×2 buttocks (Pritchard)

NextBP ≥160/110 → labetalol/hydralazine/nifedipine ↓

ActionBP ≥160/110 → labetalol/hydralazine/nifedipine

NextAnother seizure? ↓

DecisionAnother seizure?

YESMgSO4 2 g IV (check RR/reflexes; calcium gluconate if toxicity) · secure airway · ICU ↓NOSTABILISED → deliver: ≥34 wks now; <34 individualise (steroids if delay) ↓

ActionMgSO4 2 g IV (check RR/reflexes; calcium gluconate if toxicity) · secure airway · ICU

NextSTABILISED → deliver: ≥34 wks now; <34 individualise (steroids if delay) ↓

OutcomeSTABILISED → deliver: ≥34 wks now; <34 individualise (steroids if delay)

Principles & follow-up

Management principles

Guideline conflict

India NHM CEmONC, chapter 4 — prose
Acute oral nifedipine: 10 mg, reassess at 20 minutes, repeat 10–20 mg; stated initial-course maximum 30 mg.

Same NHM chapter — adjacent flowchart
The flowchart shows 10 mg, then 20 mg, then another 20 mg at 20-minute reassessments, implying 50 mg.

Population/setting difference: These refer to the same severe-pregnancy-hypertension setting; this is an internal document discrepancy, not a demonstrated population difference.

Practical India consideration: Confirm the sequence formally approved in the treating unit. Extended-release maintenance tablets are a separate regimen.

App default: Use the prose-based 30 mg initial limit with prompt senior reassessment and selection of another agent if severe BP persists.
Reason: This avoids silently combining incompatible limits or prolonging oral loading in uncontrolled severe hypertension.

Guideline conflict

India NHM CEmONC, chapter 4 — prose
20 mg, then 40 mg, then 80 mg at 10-minute reassessments; further dosing may reach a cumulative 300 mg.

Same NHM chapter — adjacent flowchart
Stops the displayed 20 → 40 → 80 mg sequence at a stated 140 mg maximum.

Population/setting difference: Same emergency setting; the flowchart and prose show different stopping points.

Practical India consideration: Use the approved local sequence and track every previous IV dose. Persistent severe BP needs senior/anaesthetic involvement.

App default: The card records the prose ceiling of 300 mg; persistent severe BP after the initial 140 mg sequence requires senior reassessment before additional doses or another agent.
Reason: A cumulative ceiling is not an instruction to continue dosing without reassessing treatment failure and contraindications.

Sources (14)

FOGSI / GESTOSIS-India / ICOG — Hypertensive Disorders in Pregnancy — Good Clinical Practice Recommendations (GCPR), 3rd Edition
2026-01 · checked 2026-08-23 · verified-live
Open source ↗

PDF served from fogsi.org (2026 upload path) — definitions, HDP-Gestosis score, treatment threshold ≥140/90 (WOG), targets ≤140/90, delivery timing (GH term; mild PE 37 wks; severe PE after 34 wks; eclampsia deliver once stabilised post-MgSO4; ≤24 wks immediate delivery better; individualise 24–33+6…

ISSHP — The 2021 ISSHP classification, diagnosis & management recommendations for international practice
2021 (publ 2022 Hypertension) · checked 2026-08-23 · verified-live
Open source ↗

Full PDF: standardised BP measurement; proteinuria PrCr ≥30 mg/mmol, ACR ≥8 mg/mmol or ≥300 mg/day or dipstick 2+ if confirmatory testing unavailable; no 'mild/severe' PE label in ongoing pregnancy; treat all HDP with antihypertensives; severe HTN ≥160/110 treat within minutes-hours monitored; targe…

MSF — Magnesium sulfate: IV/IM and IV regimens
· checked 2026-10-17 · verified-live
Open source ↗

Loading and maintenance doses, 24-hour stopping rule, recurrence ceiling, urine/reflex/respiratory monitoring and toxicity management.

MSF — Calcium gluconate injectable
· checked 2026-10-17 · verified-live
Open source ↗

10% strength, adult initial 1 g IV dose over at least 5 minutes for magnesium toxicity/severe hypocalcaemia; ECG and extravasation precautions.

Government of India, MoHFW / NHM — Revised CEmONC Curriculum 2024, Part 1 — chapter 4
· checked 2026-10-17 · verified-live
Open source ↗

Scanned primary PDF pages 103–104 examined by OCR and visual review: labetalol prose sequence/cumulative 300 mg, sustained-release nifedipine 10 mg twice daily/max 80 mg, and internal prose/flowchart differences for acute nifedipine and labetalol. The app exposes rather than merges the differences.

MSF — Hydralazine injectable
· checked 2026-10-17 · verified-live
Open source ↗

20 mg reconstituted/diluted to 10 mL (2 mg/mL), 5 mg over 2–4 minutes, 20-minute reassessment and cumulative 20 mg bolus regimen.

NICE — NG133 — hypertension in pregnancy
25 June 2019 · updated 17 April 2023 · checked 2026-10-18 · verified-live
Open source ↗

Scope: additional clinical-detail explanation for hdp-postpartum. Checked the assessment, management-decision and follow-up statements in that section against this source. This does not certify all pre-existing regimens, calculations or recommendations in the module. Targeted medication audit: Table…

MSF — Labetalol oral
· checked 2026-10-17 · verified-live
Open source ↗

100 mg twice daily with increments, divided higher dosing, 2400 mg/day limit and beta-blocker cautions.

Milpharm / emc — Enalapril 5 mg tablets — SmPC
· checked 2026-10-17 · verified-live
Open source ↗

Hypertension initial 5 mg with volume/renal caution, 40 mg/day maintenance ceiling, creatinine/potassium and pregnancy/feeding warnings. NICE NG133 supplies the separately cited postpartum recommendation.

NICE — Postnatal care — NG194
· checked 2026-10-18 · verified-live
Open source ↗

Maternal/newborn transfer assessment, first void and effective feeding, handover, support/safeguarding, first midwife visit within 36 hours after transfer, postnatal danger symptoms. Full recommendations page read.

India MoHFW / NHM — District Hospital Standard Operating Procedures — LaQshya
· checked 2026-10-18 · verified-live
Open source ↗

Normal-delivery discharge not less than 48 hours: full primary SOP PDF normal-delivery/discharge passages read. Corroborated by NHM CEmONC 2024 Part 1, chapter 8. This does not define a universal post-caesarean or complicated-case stay.

WHO — WHO recommendations on quality postnatal care — official recommendation summary
· checked 2026-10-18 · verified-live
Open source ↗

Official WHO summary read: at least 24-hour facility care after birth; additional contacts at 48–72 hours, 7–14 days and week 6; individual assessment/support. Summary facts only, not a claim that the full 242-page PDF was reviewed.

RCOG — Laparoscopy — recovering well
· checked 2026-10-18 · verified-live
Open source ↗

Full primary patient recovery page read: pain control, wounds, activity/VTE, urinary/bowel and infection warning signs, adult support and no driving/important decisions during the first 24 hours after general anaesthesia. Used as general recovery/handover principles, not operation-specific discharge…

NICE — Acutely ill adults in hospital — CG50
· checked 2026-10-18 · verified-live
Open source ↗

Full primary recommendations read, focusing on critical-care-to-ward transfer: structured written handover, shared plan, monitoring, rehabilitation and receiving-team capability. Step-down is distinct from home discharge; no universal organ-support discharge cutoff is asserted.