Postpartum Outcomes With Systematic Treatment and Management of Postpartum Hypertension

Abstract

OBJECTIVE: To test the ability of a hospital-wide, bundled quality-improvement initiative to improve postpartum maternal blood pressure control and adherence to postpartum follow-up among patients with hypertensive disorders of pregnancy. METHODS: This quality-improvement initiative consisted of a bundle of clinical interventions including health care professional and patient education, a dedicated nurse educator, and protocols for postpartum hypertensive disorders of pregnancy care in the inpatient, outpatient and readmission setting. We implemented this initiative in patients with hypertensive disorders of pregnancy starting in January 2019 at the University of Chicago. The study period was divided into four periods, which correspond to preintervention, distinct bundle roll outs, and postintervention. Our primary outcome was postpartum hypertension visit adherence. Secondary outcomes included blood pressure values and antihypertensive medication use in the immediate postpartum and outpatient postpartum time periods. We then stratified our outcomes by race to assess whether the effect size differed. RESULTS: A total of 926 patients who delivered between September 2018 and November 2019 were included. Postpartum hypertension visit adherence improved from preintervention period compared with the full implementation period (33.5% vs 59.4%, P<.001). Blood pressure in the first 24 hours postpartum decreased from preintervention compared with full implementation (preintervention median [interquartile range] systolic blood pressure 149 mm Hg [138, 159] vs 137 [131, 146] in postimplementation; P<.001). After implementation, fewer patients experienced a blood pressure of 140/90 mm Hg or higher at the first postpartum blood pressure check, when compared with preintervention (39.1% vs 18.5%, P=.004). The effect size did not differ by race. CONCLUSION: A bundled quality-improvement initiative for patients with hypertensive disorders of pregnancy was associated with improved postpartum visit adherence and blood pressure control in the postpartum period.

Observational database study on preeclampsia and postpartum medical care up to 7.5 years after birth

“…Only few interventional studies have been conducted on postpartum care. Riemer et al recently demonstrated that early postpartum aerobic endurance exercise can reduce arterial stiffness, as a predictor for CVD 27 , and implementing a structured, bundled management of postpartum care after PE was shown to improve blood pressure control during the first 6 weeks after birth 28 . Hypertension is a crucial risk factor for CVD that emerges after PE and accounts for substantially increased mortality 2 .…”

Preeclampsia pathophysiology and adverse outcomes during pregnancy and postpartum

“…In the postpartum period, there are tools that exist to aid in minimizing these adverse outcomes. Studies have illustrated that postpartum blood pressure monitoring in patients with chronic hypertension and HDP is a sustainable and important intervention for patients in the postpartum setting ( 83 , 84 ). One tertiary care center implemented a postpartum blood pressure monitoring program that included standardized education and assisted follow-up, illustrating a dramatic increase in postpartum visit attendance (33.5% vs. 59.4%, p < 0.001) with more patients reporting blood pressures of <140/90 (39.1% vs. 18.5%, p = 0.004) ( 84 ).…”

“…Studies have illustrated that postpartum blood pressure monitoring in patients with chronic hypertension and HDP is a sustainable and important intervention for patients in the postpartum setting ( 83 , 84 ). One tertiary care center implemented a postpartum blood pressure monitoring program that included standardized education and assisted follow-up, illustrating a dramatic increase in postpartum visit attendance (33.5% vs. 59.4%, p < 0.001) with more patients reporting blood pressures of <140/90 (39.1% vs. 18.5%, p = 0.004) ( 84 ). Importantly, when incorporating telemedicine, racial disparities in visit compliance were reduced, providing one mechanism through which health equity in the setting of postpartum care can be mitigated ( 85 ).…”

Society of Obstetricians and Gynaecologists Pakistan (SOGP) Hypertensive Disorders in Pregnancy Guidelines- 2022

“…Preconception care is recommended for all women with pre-existing hypertension to optimize BP control, general health and weight; assess for complications; review of medications; folic acid supplementation and patient education. 14 The guideline recommends early universal screening for HDP in all pregnant women at booking using automated/mercury BP monitors. 3 All women diagnosed to be hypertensive are offered screening for preeclampsia in first trimester by maternal characteristics, mean arterial BP measurement (MAP) and Uterine artery Pulsality Index (UTPI).…”