INTRODUCTION: In November 2013, the American College of Obstetricians and Gynecologists released the “Hypertension in Pregnancy” guidelines. Hypertensive disorders are a major source of perinatal morbidity and mortality. Our objective was to assess whether these guidelines affected hypertension management at our institution. METHODS: We performed a secondary analysis of a retrospective cohort study on postpartum hypertension from deliveries from 07/09 to 07/16. Inclusion criteria were the presence of a documented hypertensive disorder. Exclusion criteria were discharge home on antihypertensive medication. Study variables include: gestational age at time of induction, delivery method, antihypertensive treatment, maximum systolic/diastolic blood pressures < 24 and 24-72 hours postpartum, rates of attendance to blood pressure check and postpartum visit. Chi-square test was used for categorical variables and Student T-test was used for continuous variables. “Pre-Guidelines” (7/09-10/13) and “Post-Guidelines” (2/13-7/16) were chosen to allow for policy change within our institution. RESULTS: 470 deliveries were pre-guidelines and 237 deliveries post-guidelines. There are increased rates post-guidelines of intrapartum IV antihypertensive treatment (9.8% vs 3.2%, P<.001) and increased attendance to a postpartum blood pressure check post-guidelines (24.1% vs 15.4%, P<.01). There was no difference in all other variables studied. CONCLUSION: Post-guidelines, our institution noted a statistically significant increase in IV intrapartum antihypertensive therapy and postpartum blood pressure checks within two weeks of delivery. There were no statistically significant differences in the time of induction, delivery method, or antihypertensive treatments despite these guideline changes. Further research needs to be done to study the implications of these guideline changes in respect to perinatal morbidity and mortality.
Psychophysical and physiological studies have demonstrated selectivity for spectral modulation frequency in the auditory system, suggesting that auditory perception of complex spectra might be based on spectral modulation channels. However, an early study [Liu and Eddins (2008)] reported that vowel identification was significantly reduced by filtering in spectral modulation frequency domain, although there was no significant correlation between spectral modulation detection thresholds and vowel identification. The latter result may have been due to the small number of listeners (n = 5) in the previous study. Using a larger number of listeners, the present study measured spectral modulation transfer functions and vowel identification performance with and without spectral modulation filtering in 11 normal-hearing listeners. Vowel identification performance was significantly correlated with spectral modulation detection thresholds at 0.5 cyc/oct (i.e., higher spectral modulation detection thresholds associated with poorer vowel identification scores). In addition, average spectral modulation detection thresholds were significantly correlated with the change in vowel identification associated with filtering in the spectral modulation domain. Both of these results highlight the relation between the perception of sinusoidal spectral modulation and vowel identification.
INTRODUCTION: Hypertensive disease of pregnancy is a leading cause of maternal mortality. The primary objective of our study was to identify associations between demographics and persistent postpartum hypertension, and secondary outcome to identify postpartum blood pressures predicting persistent hypertension. METHODS: We performed a retrospective electronic chart review of women with hypertensive disorders of pregnancy, delivered from 7/1/09-7/1/16. Exclusion criteria were anti-hypertensive medication upon discharge and no recorded blood pressure within 12 weeks postpartum. Study variables included maternal demographics, the three highest systolic and diastolic values <24 and 24-72 hours postpartum, and postpartum outpatient values. Chi-square and student’s T-test were used for analysis of patient demographics. A receiver operating characteristic analysis was performed to identify blood pressure values which would predict persistent hypertension. RESULTS: 591 women met study criteria. Women with persistent hypertension were significantly more likely to be multiparous (p= 0.008) and obese (p=0.016) with a trend towards increased maternal age (p=0.05). Systolic and diastolic pressures 24-72 hours after delivery were significantly associated with continued postpartum hypertension (p<0.001). No specific systolic or diastolic value within 72 hours postpartum could reliably predict persistent hypertension. CONCLUSION: Persistent postpartum hypertensive disease is more likely in multiparous, obese women, with a trend towards increasing age. Although elevated blood pressures 24 to 72 hours postpartum are significantly associated with persistent hypertension, there is no specific systolic or diastolic value above which persistence can be accurately predicted from our study. This stresses the importance of close follow up for women with hypertensive disorders of pregnancy.
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