Risk factors for postpartum readmission for preeclampsia or hypertension before delivery discharge among low-risk women: a case-control study

Stamilio, David M.; Beckham, A. Jenna; Boggess, Kim; Jelovsek, J. Eric; Venkatesh, Kartik K.

doi:10.1016/j.ajogmf.2021.100317

Cited by 27 publications

(32 citation statements)

References 20 publications

(15 reference statements)

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“…A self-constructed, well-structured, closed-ended questionnaire was developed by a review of related literature. 8 , 18 , 19 The developed questionnaire was pre-tested and administered to each participant to obtain information on socio-demographic data; maternal lifestyle factors such as smoking and alcohol consumption before and during pregnancy, contraceptive use (defined as use of combined oral pills, progesterone only pill, injectable contraceptives and barrier methods of birth control prior to conception), pain medication use, change of partner, physical activity (defined as at most 30 min of moderate-intensity aerobic activity daily), educational status, antenatal attendance, family history of HTN, residence, ethnicity, marital, and occupational status. A complete present and past obstetric history such as personal and family history of preeclampsia or eclampsia, systolic and DBP, infant birth weight, and pregnancy characteristics (gravidity, singleton/multiple gestation, gestational age at diagnosis of preeclampsia or eclampsia and at delivery, mode of delivery, antihypertensive treatment) were also obtained.…”

Section: Methodsmentioning

confidence: 99%

Risk factors for the development of new-onset and persistent postpartum preeclampsia: A case–control study in Ghana

Fondjo

Amoah

Tashie

et al. 2022

Womens Health (Lond Engl)

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Background: Postpartum preeclampsia has been implicated in increasing hospital re-admissions, maternal morbidity, and mortality worldwide. The knowledge of the risk factors of postpartum preeclampsia would be helpful in formulating strategies to aid in the prevention, early diagnosis, and timely treatment of this disorder. Thus, this study aimed to identify the risk factors associated with the development of new-onset postpartum preeclampsia and persistent postpartum preeclampsia in the Ghanaian setting. Methods: This case–control study was conducted at the Obstetrics and Gynecology units of Komfo Anokye Teaching Hospital and the Kumasi Regional Hospital, both located in the Ashanti Region of Ghana. A total of 65 postpartum preeclamptic women (33 new-onset postpartum preeclampsia and 32 persistent postpartum preeclampsia) and 65 normotensive postpartum mothers were recruited from 48 h to 6 weeks post-delivery. Questionnaires were administered to assess the socio-demographic, lifestyle, obstetric characteristics, and past medical history of the study participants. Results: Physical inactivity ( p < 0.0001), infrequent antenatal visits ( p < 0.0001), analgesic use ( p < 0.0001), and cesarean delivery ( p = 0.021) were significantly associated with both the new-onset postpartum preeclampsia and persistent postpartum preeclampsia. Contraceptive use was significantly associated with the development of new-onset postpartum preeclampsia ( p < 0.0001) while women with low-birthweight babies are also at high risk of developing persistent postpartum preeclampsia ( p < 0.0001). Conclusion: Physical inactivity, infrequent antenatal visits, analgesic use, contraceptive use, and cesarean delivery are major predisposing risk factors for the development of postpartum preeclampsia. Screening using these risk factors, close monitoring and follow-up observation of women after delivery would be beneficial in identifying and managing postpartum preeclampsia.

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Section: Methodsmentioning

confidence: 99%

Risk factors for the development of new-onset and persistent postpartum preeclampsia: A case–control study in Ghana

Fondjo

Amoah

Tashie

et al. 2022

Womens Health (Lond Engl)

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“… 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.…”

Section: Resultsmentioning

confidence: 99%

“… 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.…”

Section: Introductionmentioning

confidence: 99%

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

Griffin

Black

Deeb

et al. 2022

AJOG Global Reports

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“…Novel research utilizing machine learning has led to the development of risk prediction models for women with HDP that may help individualize care in the postpartum period. Risk factors for postpartum readmission for HDP have previously been identified using a variety of retrospective study designs; these include antecedent HDP, advanced maternal age, multiparity, elevated body mass index, and longer length of labor [ 17 – 19 , 61 ]. More recently, researchers have produced risk prediction models using machine learning that identify readmissions for complications of HDP with reasonable accuracy [ 52 ••].…”

Section: Paradigm Shifts In Management Of Postpartum Hypertensionmentioning

confidence: 99%

Best Practices for Managing Postpartum Hypertension

Kumar

Hirshberg

Srinivas

2022

Curr Obstet Gynecol Rep

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Purpose of Review Patients remain at risk for persistent and de novo postpartum hypertension related to pregnancy. This review aims to summarize the current definitions, clinical practices, and novel systems innovations and therapies for postpartum hypertension. Recent Findings Recent changes to the definitions of hypertension outside of pregnancy have not yet impacted definitions or management of hypertensive disorders of pregnancy (HDP), though research examining the implications of these new definitions on risks of developing HDP and the resultant sequelae is ongoing. The administration of diuretics has been shown to reduce postpartum hypertension among women with HDP. Widespread implementation of telemedicine models and remote assessment of ambulatory blood pressures has increased data available on postpartum blood pressure trajectories, which may impact clinical management. Additionally, policy changes such as postpartum Medicaid extension and an increasing emphasis on building bridges to primary care in the postpartum period may improve long-term outcomes for women with postpartum hypertension. Prediction models utilizing machine learning are an area of ongoing research to assist with risk assessment in the postpartum period. Summary The clinical management of postpartum hypertension remains focused on blood pressure control and primary care transition for cardiovascular disease risk reduction. In recent years, systemic innovations have improved access through implementation of new care delivery models. However, the implications of changing definitions of hypertension outside of pregnancy, increased data assessing blood pressure trajectories in the postpartum period, and the creation of new risk prediction models utilizing machine learning remain areas of ongoing research.

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Risk factors for postpartum readmission for preeclampsia or hypertension before delivery discharge among low-risk women: a case-control study

Cited by 27 publications

References 20 publications

Risk factors for the development of new-onset and persistent postpartum preeclampsia: A case–control study in Ghana

Risk factors for the development of new-onset and persistent postpartum preeclampsia: A case–control study in Ghana

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

Best Practices for Managing Postpartum Hypertension

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