Clinical factors associated with readmission for postpartum hypertension in women with pregnancy-related hypertension: a nested case control study

Hirshberg, Adi; Levine, Lisa D.; Srinivas, Sindhu K.

doi:10.1038/jp.2015.209

Cited by 28 publications

(21 citation statements)

References 14 publications

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“…Hypertensive disorders of pregnancy are strongly associated with severe cardiovascular morbidity during delivery hospitalisations. 38 Moreover, women with hypertensive disorders of pregnancy have previously been shown to be at increased risk for postpartum hypertensive urgency, [39][40][41][42] heart failure 43,44 and stroke. 45,46 Our findings therefore strengthen the evidence that women with hypertensive disorders of pregnancy require enhanced peripartum cardiovascular care.…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular severe maternal morbidity in pregnant and postpartum women: development and internal validation of risk prediction models

Malhamé

Danilack

Raker

et al. 2020

BJOG

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Objectives To develop and internally validate risk prediction models identifying women at risk for cardiovascular severe maternal morbidity (CSMM). Design A retrospective cohort study. Setting An obstetric teaching hospital between 2007 and 2017. Population A total of 89 681 delivery hospitalisations. Methods We created and evaluated two models, one predicting CSMM at delivery (delivery model) and the other predicting CSMM postpartum following discharge from delivery hospitalisation (postpartum CSMM). We assessed model discrimination and calibration and used bootstrapping for internal validation. Main outcome measures Cardiovascular severe maternal morbidity comprised the following confirmed conditions: pulmonary oedema/acute heart failure, myocardial infarction, aneurysm, cardiac arrest/ventricular fibrillation, heart failure/arrest during surgery or procedure, cerebrovascular disorders, cardiogenic shock, conversion of cardiac rhythm and difficult‐to‐control severe hypertension. Results The delivery model contained 11 variables and 3 interaction terms. The strongest predictors were gestational hypertension, chronic hypertension, multiple gestation, cardiac lesions or valvular heart disease, maternal age ≥40 years and history of poor pregnancy outcome. The postpartum model comprised eight variables. The strongest predictors were severe pre‐eclampsia, non‐Hispanic Black race/ethnicity, chronic hypertension, gestational hypertension, non‐severe pre‐eclampsia and maternal age ≥40 years at delivery. The delivery and postpartum models had an area under the receiver operating characteristic curve of 0.87 (95% CI 0.85–0.89) and 0.85 (95% CI 0.80–0.90), respectively. Both models were adequately calibrated and performed well on internal validation. Conclusions These tools may help providers to identify women at highest risk of CSMM and enable future prevention measures. Tweetable abstract Risk assessment tools for cardiovascular severe maternal morbidity were developed and internally validated.

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Section: Discussionmentioning

confidence: 99%

Cardiovascular severe maternal morbidity in pregnant and postpartum women: development and internal validation of risk prediction models

Malhamé

Danilack

Raker

et al. 2020

BJOG

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“…1 In 2009, 27% of obstetric readmissions were due to hypertensive disease. 2 Maternal blood pressure peaks 3–6 days after delivery, when patients have already been discharged home.…”

Section: Summary Of Problemmentioning

confidence: 99%

“…Task Force on Hypertension in Pregnancy guidelines have been established by the American College of Obstetricians and Gynecologists for management of maternal hypertension in labor and delivery, but these do not address management during the postpartum period. 1 Postpartum hypertension not only significantly impacts health care costs but also contributes to maternal morbidity including stroke and mortality. 3 …”

Section: Summary Of Problemmentioning

confidence: 99%

“…In a study conducted by Hirshberg et al, several labor, delivery and postpartum factors, such as demographics, mode of delivery, length of labor, severity of hypertensive disease, use of magnesium sulfate, fluid balance, initiation of antihypertensive medication and postpartum blood pressure prior to discharge, were examined to determine their association with hospital readmission. 1 Interestingly, readmitted patients were noted to have longer lengths of labor and were less likely to be initiated on antihypertensive therapy prior to discharge.…”

Section: Summary Of Evidencementioning

confidence: 99%

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What Clinical Interventions Have Been Implemented to Prevent or Reduce Postpartum Hypertension Readmissions? A Clin-IQ

O'Meara¹,

Lepic²

2016

Journal of Patient-Centered Research and Reviews

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A literature review was conducted to determine what clinical interventions have been studied and implemented to prevent and/or reduce postpartum hypertension readmissions. Appropriate verbal and printed educational materials should be given to the patient prior to discharge with use of the “teach back” method. Patients and health care providers within the multidisciplinary team should be educated on the warning signs and symptoms of worsening hypertensive disease and when to appropriately involve the obstetrician. The use of text messaging may be useful in preventing hospital readmissions by increasing patient follow-up and compliance and appropriately managing patients in the postpartum period. Treating postpartum patients with furosemide may decrease blood pressure and prevent postpartum hypertension and the need for antihypertensive therapy.

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“…HDP are a leading cause of postpartum readmission (PPR), accounting for approximately 30% of PPR 3 . Prior studies report that 2.5-5.7% of patients with HDP experience PPR 3,5 . PPR has multiple deleterious effects: it represents poor hypertensive control that predisposes women to medical complications, it disrupts typical postpartum recovery, and it has significant financial implications.…”

Section: Introductionmentioning

confidence: 99%

Factors associated with postpartum readmission for hypertensive disorders of pregnancy

Bruce¹,

Anderson²,

Stark³

2021

American Journal of Obstetrics & Gynecology MFM

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Clinical factors associated with readmission for postpartum hypertension in women with pregnancy-related hypertension: a nested case control study

Cited by 28 publications

References 14 publications

Cardiovascular severe maternal morbidity in pregnant and postpartum women: development and internal validation of risk prediction models

Cardiovascular severe maternal morbidity in pregnant and postpartum women: development and internal validation of risk prediction models

What Clinical Interventions Have Been Implemented to Prevent or Reduce Postpartum Hypertension Readmissions? A Clin-IQ

Factors associated with postpartum readmission for hypertensive disorders of pregnancy

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