Most expectant-management charts record the current antihypertensive dose. Very few record how many times it has been changed, or over how many days. The second is the one that tells the next person on the ward round whether this pregnancy is stable or sliding.
It costs one line in the notes: drug, dose, date of each change, and any intravenous push given for severe hypertension. At handover it turns a static number into a direction of travel, which is what the decision to continue or deliver actually depends on.
Do the same with the protein. A single 24-hour figure is a data point; two, a week apart, are a trend — and today's evidence says both the rate of antihypertensive change and the level of proteinuria carry maternal prognostic weight.
- Keep a running escalation count at the top of the expectant-management sheet
- Log intravenous antihypertensive pushes by date, not just as 'given'
- Hand over the trajectory, not the current reading
- Repeat quantified proteinuria rather than relying on the admission value
Why it matters
Handover on these women is usually a snapshot when the decision needs a trend.
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