Emergency department visits for postpartum hypertension

Brousseau, E. Christine; Danilack, Valery A.; Cai, Fei; Matteson, Kristen A.

doi:10.1080/10641955.2017.1299171

Cited by 9 publications

(6 citation statements)

References 10 publications

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“…16 In the United States, women with postpartum hypertensive diseases of pregnancy presented very early after delivery, around the first week to 10 days. 17 18 While rare, postpartum preeclampsia and eclampsia can occur 6 weeks after the pregnancy ends or later, and one study found that all of the mothers with late-onset preeclampsia were readmitted within 3 weeks of delivery. These women were more likely to be over 40 years of age, Black or Latinx, have higher BMI and gestational diabetes.…”

Section: Resultsmentioning

confidence: 99%

Care of the Postpartum Patient in the Emergency Department: A Systematic Review with Implications for Maternal Mortality

Mitchell

Haddock

Husainy³

et al. 2021

Am J Perinatol

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Objective Approximately one-third of maternal deaths occur postpartum. Little is known about the intersection between the postpartum period, emergency department (ED) use, and opportunities to reduce maternal mortality. The primary objectives of this systematic review are to explore the incidence of postpartum ED use, identify postpartum disease states that are evaluated in the ED, and summarize postpartum ED use by race/ethnicity and payor source. Study Design We searched PubMed, Embase, Cumulative Index of Nursing and Allied Health Literature (CINAHL), ClinicalTrials.gov, Cochrane CENTRAL, Social Services Abstracts, and Scopus from inception to September 19, 2019. Each identified abstract was screened by two authors; the full-text manuscripts of all studies deemed to be potential candidates were then reviewed by the same two authors and included if they were full-text, peer-reviewed articles in the English language with primary patient data reporting care of a female in the ED in the postpartum period, defined as up to 1 year after the end of pregnancy. Results A total of 620 were screened, 354 records were excluded and 266 full-text articles were reviewed. Of the 266 full-text articles, 178 were included in the systematic review; of these, 108 were case reports. Incidence of ED use by postpartum females varied from 4.8 to 12.2% in the general population. Infection was the most common reason for postpartum ED evaluation. Young females of minority race and those with public insurance were more likely than whites and those with private insurance to use the ED. Conclusion As many as 12% of postpartum women seek care in the ED. Young minority women of lower socioeconomic status are more likely to use the ED. Since approximately one-third of maternal deaths occur in the postpartum period, successful efforts to reduce maternal mortality must include ED stakeholders. Systematic Review Registration CRD42020151126. Key Points

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Section: Resultsmentioning

confidence: 99%

Care of the Postpartum Patient in the Emergency Department: A Systematic Review with Implications for Maternal Mortality

Mitchell

Haddock

Husainy³

et al. 2021

Am J Perinatol

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“…The incidence of hypertension-related cardiovascular morbidities, such as obstetric hypertensive emergency, stroke, and heart failure, is highest during the postpartum period [41][42][43][44][45][46]. Moreover, preeclampsia at the time of delivery is the strongest risk factor for postpartum readmission with cardiovascular morbidity within 6 weeks postpartum [47], and hypertension is a leading cause of hospital readmission and healthcare resource utilization during the postpartum period [41,48,49]. Thus, strategies to optimize postpartum BP management are needed.…”

Section: Discussionmentioning

confidence: 99%

The use of loop diuretics in the context of hypertensive disorders of pregnancy: a systematic review and meta-analysis

Malhamé

Dong

Syeda

et al. 2022

Journal of Hypertension

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Aims: Addressing volume expansion may improve the management of hypertension across the pregnancy continuum. We conducted a systematic review to summarize the evidence on the use of loop diuretics in the context of hypertensive disorders during pregnancy and the postpartum period.Methods and results: Medline, Embase, Cochrane library, ClinicalTrials.gov, and Google Scholar were searched for original research articles published up to 29 June 2021. Of the 2801 results screened, 15 studies were included: eight randomized controlled trials, six before-after studies, and one cohort study. Based on random effects meta-analysis of before-after studies, antepartum use of loop diuretics was associated with lower DBP [mean difference À17.73 mmHg, (95% confidence intervals À34.50 to À0.96); I 2 ¼ 94%] and lower cardiac output [mean difference À0.75 l/min, (À1.11 to À0.39); I 2 ¼ 0%], with no difference in SBP, mean arterial pressure, heart rate, or total peripheral resistance. Meta-analysis of randomized controlled trials revealed that postpartum use of loop diuretics was associated with decreased need for additional antihypertensive patients [relative risk 0.69, (0.50-0.97); I 2 ¼ 14%], and an increased duration of hospitalization [mean difference 8.80 h, (4.46-13.14); I 2 ¼ 83%], with no difference in the need for antihypertensive therapy at hospital discharge, or persistent postpartum hypertension.Conclusion: Antepartum use of loop diuretics lowered DBP and cardiac output, while their postpartum use reduced the need for additional antihypertensive medications. There was insufficient evidence to suggest a clear benefit. Future studies focusing on women with hypertensive pregnancy disorders who may most likely benefit from loop diuretics are required.

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“…P ostpartum hypertension is the cause of 15-20% of postpartum readmissions and emergency department (ED) visits in the United States. [1][2][3] Hypertensive disorders of pregnancy complicate about 10% of pregnancies and are associated with significant risks during pregnancy and postpartum, including stroke and seizure. [4][5][6] Postpartum readmission for hypertension indicates poor control and can be associated with complications.…”

Section: Resultsmentioning

confidence: 99%

Standardized Clinical Assessment and Management Plan to Reduce Readmissions for Postpartum Hypertension

Mei

Corry-Saavedra

Nguyen

et al. 2023

Obstetrics &Amp; Gynecology

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OBJECTIVE: To evaluate the effect of a postpartum hypertension standardized clinical assessment and management plan on postpartum readmissions and emergency department (ED) visits. METHODS: We conducted a prospective cohort study of patients with postpartum hypertension (either chronic hypertension or hypertensive disorders of pregnancy) who delivered at a single tertiary care center for 6 months after enacting an institution-wide standardized clinical assessment and management plan (postintervention group). Patients in the postintervention group were compared with patients in a historical control group. The standardized clinical assessment and management plan included 1) initiation or uptitration of medication for any blood pressure (BP) higher than 150/100 mm Hg or any two BPs higher than 140/90 mm Hg within a 24-hour period, with the goal of achieving normotension (BP lower than 140/90 mm Hg) in the 12 hours before discharge; and 2) enrollment in a remote BP monitoring system on discharge. The primary outcome was postpartum readmission or ED visit for hypertension. Multivariable logistic regression was used to evaluate the association between standardized clinical assessment and management plan and the selected outcomes. A sensitivity analysis was performed with propensity score weighting. A planned subanalysis in the postintervention cohort identified risk factors associated with requiring antihypertensive uptitration after discharge. For all analyses, the level of statistical significance was set at P<.05. RESULTS: Overall, 390 patients in the postintervention cohort were compared with 390 patients in a historical control group. Baseline demographics were similar between groups with the exception of lower prevalence of chronic hypertension in the postintervention cohort (23.1% vs 32.1%, P=.005). The primary outcome occurred in 2.8% of patients in the postintervention group and in 11.0% of patients in the historical control group (adjusted odds ratio [aOR] 0.24, 95% CI 0.12–0.49, P<.001). A matched propensity score analysis controlling for chronic hypertension similarly demonstrated a significant reduction in the incidence of the primary outcome. Of the 255 patients (65.4%) who were compliant with outpatient remote BP monitoring, 53 (20.8%) had medication adjustments made per protocol at a median of 6 days (interquartile range 5–8 days) from delivery. Non-Hispanic Black race (aOR 3.42, 95% CI 1.68–6.97), chronic hypertension (aOR 2.09, 95% CI 1.13–3.89), having private insurance (aOR 3.04, 95% CI 1.06–8.72), and discharge on antihypertensive medications (aOR 2.39, 95% CI 1.33–4.30) were associated with requiring outpatient adjustments. CONCLUSION: A standardized clinical assessment and management plan significantly reduced postpartum readmissions and ED visits for patients with hypertension. Close outpatient follow-up to ensure appropriate medication titration after discharge may be especially important in groups at high risk for readmission.

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Emergency department visits for postpartum hypertension

Cited by 9 publications

References 10 publications

Care of the Postpartum Patient in the Emergency Department: A Systematic Review with Implications for Maternal Mortality

Care of the Postpartum Patient in the Emergency Department: A Systematic Review with Implications for Maternal Mortality

The use of loop diuretics in the context of hypertensive disorders of pregnancy: a systematic review and meta-analysis

Standardized Clinical Assessment and Management Plan to Reduce Readmissions for Postpartum Hypertension

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