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

Abstract

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.

Emergency department visits for postpartum hypertension

“…O’Meara and Lepic reviewed the literature on interventions to reduce postpartum readmissions for hypertension and found no reliable evidence to guide management, although postnatal furosemide was noted to show potential in reduction of severity of postpartum hypertension. 4,5 Therefore, we recommend that future studies should focus on interventions, such as antihypertensive medications or furosemide in addition to close monitoring, to investigate protocols that better manage the immediate postpartum care in these women to decrease readmission.…”

“…2,3 Antenatal management and delivery timing for pregnancies complicated by hypertension have been a frequent focus of clinical research, but there is no evidence-based standard for postpartum surveillance that might prevent postpartum hypertension. 4,5 …”

Furosemide for postpartum blood pressure control in patients with hypertensive disorders

“…Hypertension affects approximately 10 % of pregnancies and causes a significant proportion of maternal morbidity and mortality [1] , [2] . Hypertension in the postpartum period requiring hospital readmission comprises a considerable number of obstetrical readmissions and overall hospital readmission rates [3] , [4] . Hypertension and hypertensive urgency can increase in the postpartum period due to postpartum fluid dynamics and changes in sodium balance in the setting of pre-eclampsia.…”