Obstetric Emergencies

Pre-eclampsia with Severe Features / Severe Pre-eclampsia

IN REVIEWv4🇮🇳 India-firstPENDING CLINICAL VERIFICATION⚡ Acute Severe Hypertension (>=160/110)

PE plus severe-range BP, neurology, hepatic/renal/haematological involvement or pulmonary oedema. Stabilise with MgSO4 + antihypertensives, steroids if <34+6, then deliver ≥34 wks (expectancy 24–33+6 only in expert centres with intensive surveillance).

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.

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

First 15 minutes: Help called · MgSO4 decision made · BP agent running · bloods incl. coags in lab · CTG running · fluid restriction documented · delivery plan being formed

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

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

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

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

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

Fluid strategy: Restrict maintenance to ~80 mL/h (or 1 mL/kg/h) unless losses; NEVER chase oliguria with repeated boluses without reviewing lungs — pulmonary oedema kills in this disease.

If MgSO4 unavailable: diazepam 10 mg IV for seizure only (inferior — arrange supply urgently)
Nicardipine/esmolol infusions in ICU settings where available

④ Drug treatment detail (3 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

Betamethasone — antenatal courseWHOsummary checked

Dose12 mg IM, then 12 mg IM 24 hours later

RouteIM

FrequencyTwo doses, 24 h apart

DurationOne 24 mg course. Consider only ONE repeat course under NICE criteria; not routine weekly courses

PreparationConfirm product strength: for 6 mg/mL, 12 mg = 2 mL; volumes differ by formulation. Use the obstetric IM preparation

Max dose24 mg/course; NICE permits no more than 2 courses in total under its repeat-course criteria

Indication: Imminent preterm birth within the guideline gestational window; do not delay urgent maternal/fetal delivery
NICE offers at 24+0–33+6 weeks, considers 34+0–35+6; individual discussion at 22+0–23+6. Repeat: <34 weeks, prior course >7 days ago and very high risk of birth in 48 h.

Monitoring

Glucose monitoring and an insulin-adjustment plan in diabetes; assess infection and timing of birth

Contraindications: Do not delay lifesaving delivery to complete steroids; do not use a blanket “infection contraindication” without senior assessment

Dexamethasone — antenatal alternativeWHOsummary checked

Dose6 mg IM every 12 h for four doses

RouteIM

FrequencyEvery 12 hours, four doses

Duration24 mg total over 36 h; ONE course, subject to the same repeat-course restrictions

PreparationCheck the injectable product: if 4 mg/mL, 6 mg = 1.5 mL; other strengths require recalculation. Give IM for this antenatal regimen

Max doseFour 6 mg doses = 24 mg/course; do not combine with a full betamethasone course

Indication: Alternative fetal-lung-maturation course when appropriate

Monitoring

Maternal glucose, infection assessment and birth timing; diabetes team plan

Contraindications: Do not prolong an unsafe pregnancy to finish the course

Definitive treatment

DELIVERY IS THE DEFINITIVE TREATMENT
≥34 weeks: deliver after maternal stabilisation (FOGSI: severe PE delivered after 34 completed weeks)
<34 weeks: expectant management ONLY if mother stable AND fetus viable AND facility has HDU/ICU + NICU 24/7 — otherwise deliver after steroids (48 h benefit window) if stable enough
24–33+6 weeks: individualised (no trial evidence base — FOGSI explicitly notes this)
≤24 weeks: immediate delivery generally better option (FOGSI)
Indications for IMMEDIATE birth regardless of gestation: uncontrollable BP, eclampsia, pulmonary oedema, DIC, abruptio, non-reassuring fetal state, ruptured membranes/labour, HELLP with multiorgan dysfunction

Monitoring

Domain	Expectant-management schedule (intensive)
BP	Hourly (continuous arterial line in ICU if unstable)
Neuro obs + reflexes	Hourly
Labs (platelets/LFT/creatinine)	Minimum daily; q12h if deteriorating
MgSO4 toxicity	Before each dose: reflexes, RR ≥12, UO ≥25 mL/h
Fluid balance	Hourly urine; daily weight
Fetus	Daily CTG; UA Doppler ± DV 2–3×/wk; growth q1–2 wk

Response assessment

BP in target band on stable regimen
Labs plateau/improving
No seizure activity
Reassuring fetal parameters

Treatment failure

Rising BP needs → add second class agent
Lab deterioration or symptom evolution → abandon expectancy, deliver
Seizure despite MgSO4 → reload per eclampsia protocol (additional 2 g IV if reflexes absent logic — see eclampsia module)

Second-line treatment

ICU-level vasodilator infusions (nicardipine) where available
Plasmapheresis rarely for catastrophic HELLP/TTP confusion — haematology consult

Rescue treatment

Intracranial haemorrhage: emergent CT, neurosurgical referral, keep SBP <160 then 130–150, correct coagulopathy, deliver once salvageable. Pulmonary oedema: CPAP where available, frusemide 40–80 mg IV, stop fluids, expedite birth.

Procedure / surgery

Anaesthesia: regional preferred if platelets >70–75×10⁹/L with normal coagulation (local policy); GA if coagulopathy/urgent — careful intubation BP surge attenuation (labetalol/remifentanil)
Surgical team aware of friable tissues/bleeding tendency
Active third-stage management mandatory

Escalation

HDU mandatory during acute control
ICU triggers: ventilatory support, vasopressors, dialysis, post-craniotomy, refractory seizures
Tertiary transfer BEFORE deterioration if local capability lacking and gestation allows expectancy

⑮ Complications & their management

Eclampsia

Dedicated algorithm (hdp-eclampsia/emergency hub)

HELLP

hdp-hellp module

Renal failure

Nephrology; dialysis if AEIOU indications

Liver rupture/infarction

Haemodynamic collapse + RUQ → CT angio, interventional radiology embolisation, surgery; massive transfusion

Post-treatment care

HDU/ward observation ≥24–48 h postpartum (risk persists)
MgSO4 continues 24 h after birth/last seizure
Thromboprophylaxis once haemostasis secure
Debrief + documentation; neonatal follow-up arranged
Postpartum review schedule as for PE

Diagnosis & assessment

Red flags:

Impending/actual eclamptic seizure
Uncontrolled BP despite two agents
Platelet fall + LFT rise (evolving HELLP)
Oliguria <25 mL/h despite fluids
Abnormal CTG/stillbirth risk
Stroke signs
Pulmonary oedema

Definition: Pre-eclampsia with ANY of: SBP ≥160/DBP ≥110 (confirmed), thrombocytopenia <100×10⁹/L, AST/ALT >×2 ULN with severe persistent RUQ/epigastric pain, renal insufficiency (creatinine >97 µmol/L or doubling), pulmonary oedema, new-onset cerebral/visual disturbances (FOGSI severe PE definition: BP >160/110 ± premonitory symptoms ± abnormal labs, or ≥140/90 WITH symptoms/lab abnormality).

Initial assessment

Call for senior obstetrician + anaesthetist; allocate 1:1 nursing
Left-lateral tilt if supine; continuous SpO₂, BP q10–15 min initially
Send full panel INCLUDING coagulation + group & save/crossmatch
Start MgSO4 if neurological signs/symptoms or imminent birth <30 wks (neuroprotection overlap)
Control BP to SBP 130–150/DBP 80–90 (rapid drops risk placental hypoperfusion)
Strict fluid balance; restrict maintenance fluids (pulmonary oedema risk)

Investigations

Test	Looking for
Coagulation profile + fibrinogen	DIC before regional anaesthesia/procedures
Group & save / crossmatch	Operative readiness
Serum urate, LDH, blood film	Haemolysis (HELLP evolution)
CT head if focal deficit/coma/atypical presentation	ICH vs eclampsia vs other

Algorithm

Entry pointSevere feature recognised

ActionHELP CALL + 1:1 care + IV access + bloods(coags!)

NextMgSO4 indicated? (neuro signs/symptoms/unit policy) ↓

DecisionMgSO4 indicated? (neuro signs/symptoms/unit policy)

YESPritchard loading 4g IV + 10g IM ↓NOBP ≥160/110 → labetalol IV / hydralazine IV / nifedipine PO to 130–150/80–90 ↓

ActionPritchard loading 4g IV + 10g IM

NextBP ≥160/110 → labetalol IV / hydralazine IV / nifedipine PO to 130–150/80–90 ↓

ActionBP ≥160/110 → labetalol IV / hydralazine IV / nifedipine PO to 130–150/80–90

Next<34+6 wks? → betamethasone course ↓

Action<34+6 wks? → betamethasone course

NextStable enough for expectancy <34 wks with HDU+NICU? ↓

DecisionStable enough for expectancy <34 wks with HDU+NICU?

NO / ≥34 wksDELIVER after stabilisation ↓YES 24–33+6Intensive surveillance; deliver at deterioration/34 wks ↓

OutcomeDELIVER after stabilisation

OutcomeIntensive surveillance; deliver at deterioration/34 wks

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 (15)

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…

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.

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.

WHO — Antenatal corticosteroids for improving preterm birth outcomes — 2022
· checked 2026-10-17 · verified-summary
Open source ↗

Recommendation 1.9/type-and-regimen evidence: IM dexamethasone or betamethasone total 24 mg; four 6 mg dexamethasone doses 12 hours apart or two 12 mg betamethasone doses 24 hours apart. NICE NG25 supplies gestational and repeat-course criteria.

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.