(A) First and second trimester record.

Gestation	Signs and Symptoms	Actions	Severe Hypertension Protocol Applies at any Gestation	Postpartum Hemorrhage Protocol
Antepartum visit at 8–16 weeks gestation	□Body mass index (BMI)  > 25 kg/m2, if Asian  > 23 kg/m2 □Current systolic blood pressure (BP) > than 120 mm Hg: Record BP: --------/------- □History of miscarriage. □History of pre-pregnancy hypertension OR chronic kidney disease. □History of late-onset (34 weeks gestation or later) preeclampsia-eclampsia (PE-E) in a prior pregnancy. □Diabetes or dyslipidemia.	If yes to any signs and symptoms: □Order baseline PE-E blood and urine tests. □Start low-dose aspirin (120–160 mg/day at bedtime. lower doses may be ineffective)––continue until 37 weeks gestation. Check weekly adherence: □ 13, □ 14, □ 15, □ 16, □ 17, □ 18, □ 19, □ 20, □ 21, □ 22, □ 23, □ 24, □ 25, □ 26, □ 27, □ 28, □ 29, □ 30, □ 31, □ 32, □ 33, □ 34, □ 35, □ 36 □Start calcium supplementation (1.5 g/day)––continue until 37 weeks gestation. Check weekly adherence: □ 13, □ 14, □ 15, □ 16, □ 17, □ 18, □ 19, □ 20, □ 21, □ 22, □ 23, □ 24, □ 25, □ 26, □ 27, □ 28, □ 29, □ 30, □ 31, □ 32, □ 33, □ 34, □ 35, □ 36 □Ascertain maternal smoking (Ask). □ Yes, smoker □ No, nonsmoker If yes: □ Smoking cessation intervention □ Advise □ Assess □ Assist □ Arrange □Start First Line Intervention.	Systolic blood pressure (SBP)  ≥160 mm Hg  Or Diastolic blood pressure (DBP)  ≥110 mm Hg for > 15 min. Administer 1)Labetalol 20 mg iv. over 2 min, except if asthmatic or in heart failure. a)If BP still severe in 10 min, give 40 mg labetalol iv. b)If BP still severe in 10 min, give 60 mg labetalol iv. c)If BP still severe in 10 min, give 80 mg labetalol iv. d)If BP still severe in 10 min, consultation per protocol.	Insert institution Postpartum Hemorrhage protocol here. Check for: Transfusion availability □ Platelets □ Fresh frozen plasma □ Cryoprecipitate □ Packed red blood cells Check for: □ Cell saver applicability
Antepartum visit at 12–16 weeks gestation	□History of antiphospholipid antibody syndrome. □History of early-onset PE-E (onset at before 34 weeks gestation) in a prior pregnancy. □History of small for gestational age fetus inconsistent with parentage.	□Start unfractionated or low-molecular weight heparin. Check weekly adherence: □ 13, □ 14, □ 15, □ 16, □ 17, □ 18, □ 19, □ 20, □ 21, □ 22, □ 23, □ 24, □ 25, □ 26, □ 27, □ 28, □ 29, □ 30, □ 31, □ 32, □ 33, □ 34, □ 35, □ 36 □Use low-dose aspirin and calcium. Check □ above. □Ascertain maternal smoking (Ask). □ Yes, smoker □ No, nonsmoker If yes: □ Smoking cessation intervention □ Advise □ Assess □ Assist □ Arrange	Start hydralazine. Do not exceed 300 mg labetalol/24 h. 2)Hydralazine 5 mg iv. First line if pulse <60 bpm. Can give 250 mL normal saline bolus to reduce reflex tachycardia. a)If BP still severe in 20 min, give 10 mg hydralazine iv. b)If BP still severe in 20 min, give 20 mg labetalol iv. c)If BP still severe in 20 min, Give 40 mg labetalol iv.	Institute of Medicine weight gain guide Pre-pregnancy   Total BMI    Weight gain           lbs <18.5      28–40 18.5–24.9    25–35 25.0–29.9    15–25 ≥30.0      11–20
Antepartum visit after 16 weeks	□Singleton gestation. □Multiple gestation.	If multiple gestation: □Perinatology/maternal-fetal-medicine consultation ordered. □Perinatology/maternal-fetal-medicine consultation performed.	Consultation per protocol. 3)Oral nifedipine up to 90 mg daily.	Second and Third Trimester Weight Gain Rate BMI          lbs/week <18.5–24.9         1.0 25–29.9          0.6
Before 24 weeks	□ Severe PE-E.	□Consider pregnancy termination due to greater than 80% perinatal mortality and up to 71% maternal morbidity (Lowe et al., 2015). □Peridelivery thromboprophylaxis.	Short-acting is preferred. 4)Oral labetalol 200 mg.	1st Trimester Weight Gain All BMIs 1.1–4.4 lbs
□ Excessive	Interval weight gain	□Revisit First Line Intervention