Characteristics of Postpartum Patients Readmitted for Management of Hypertensive Disorders of Pregnancy [09M]

Abstract

INTRODUCTION: To identify risk factors of patients who are readmitted in the immediate postpartum period for management of hypertensive disorders. METHODS: Retrospective cohort study from 2012-2019 at a tertiary care academic center of all women with a diagnosis of hypertensive disorders during the delivery admission. Maternal characteristics for women readmitted within 30 days postpartum were compared to those not readmitted. RESULTS: Of 40,124 deliveries, 8361 were identified as having a hypertensive disorder (20.8%). 85 were subsequently readmitted for management of hypertension in the postpartum period (1%). Maternal age was significantly correlated with a higher rate of readmission (P<.001). No differences were noted among BMI, gestational age, race/ethnicity, chronic hypertension diagnosis, nulliparity, or multiple gestations. Readmitted patients showed a significantly higher rate of antihypertensive use during the delivery admission (1.33% vs 0.95%, P=.049) and those discharged on labetalol had a higher rate of readmission when compared to those discharged on nifedipine (1.51% vs 0.63%, P=.058). Patients with private insurance were more likely to be readmitted versus those with Medicaid insurance (1.25% vs 0.59%, P=.012). CONCLUSION: Women with hypertensive disorders discharged home on antihypertensive medication are more likely to be readmitted during the postpartum period and may benefit from increased vigilance during this time period. Further investigation is needed to determine the effect of insurance on readmission rate and if social determinants of health impact postpartum hypertension follow up visits. The use of nifedipine versus labetalol also warrants further investigation as there appears to be a trend towards improved blood pressure control with nifedipine.

Postpartum readmissions for hypertensive disorders in pregnancy during the COVID-19 pandemic

“… 5 , 16 During our study period, the readmission rate due to HDP was about 0.16%, which is lower than readmission rates from previous studies ranging from 0.4-9.3%. 2 , 6 Although the LOS between groups during the delivery admission were similar, an outpatient HDP management protocol for postpartum patients with HDP was continued after implementation of the early discharge policy to adhere with ACOG recommendations. It is important for healthcare institutions to implement an HDP outpatient HDP management protocol in accordance to ACOG recommendations as this is an essential component for early discharge policies.…”

“… 1 Previous studies have published postpartum readmission rates due to HDP ranging from 0.4% to 9.3%. 2 , 3 , 4 , 5 , 6 Severe maternal morbidities related to postpartum hypertension and preeclampsia include stroke, eclampsia, and death. 1 , 7 Between 2014-2017, HDP comprised 6.6% of pregnancy-related deaths.…”