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Obstetric Quality and Safety

Poster Session 1

(312) Assessing Immediate-Acting Antihypertensive Therapy on Severely Elevated Peripartum Blood Pressures Through Balancing Measures

Tuesday, February 13, 2024

10:30 AM – 12:00 PM

Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

Primary & Presenting Author(s)

Patrick Schneider, MD

The Ohio State University
Columbus, OH, United States

Coauthor(s)

AM

Anna Muraveva, PhD

Government Resources Center for the Ohio Colleges of Medicine
Columbus, OH, United States
MM

Michelle Menegay, PhD

Government Resources Center for the Ohio Colleges of Medicine
Columbus, OH, United States
HK

Hallie Kerr, MPH

Ohio Department of Health
Columbus, OH, United States
Justin R. Lappen, MD

Division Director - Maternal Fetal Medicine Associate Professor - Obstetrics/Gynecology and Reproductive Biology Cleveland Clinic Lerner College of Medicine, Case Western Reserve University
Cleveland Clinic Foundation
Cleveland, OH, United States

Objective: The timely treatment of severely elevated peripartum blood pressures (BP) within 60 minutes of identification is advocated as a strategy to decrease severe morbidity and mortality from hypertensive disorders of pregnancy. However, concerns about too rapidly decreasing BP results in delays in care as providers do not want to potentially induce hypotension or changes in the fetal status.

Study Design: As part of a state-wide quality improvement initiative, 29 hospitals submitted data on an initial severely elevated BP episode, defined as a systolic BP (SBP) ≥160 or diastolic BP (DBP) ≥110 occurring sequentially and 15 minutes apart, and subsequent management of the episode. BPs following treatment were collected to assess the response to immediate-acting antihypertensive therapy with the next three BPs collected at 15-minute intervals. The primary measure was fetal heart rate (FHR) changes within 1 hour of the initial severely elevated BP (among pregnant patients) with secondary measure assessing whether hypotension (SBP < 90 or DBP < 60) occurred among pregnant or postpartum patients.

Results: Overall, 3,230 pregnant or postpartum patients were treated for a severe hypertensive event. Mean initial SBP was 170.9mmHg and mean initial DBP was 96.1mmHg. Following BP treatment and normalization, the mean SBP and DBP decreased to 145.1 and 83.1, respectively. A small proportion of patients (13.8%) had mean arterial pressure (MAP) decrease of ≥30% following treatment. Among 2,396 pregnant patients, those with a MAP decrease of ≥30% (compared to those with MAP decrease of < 30%) were more likely to require intervention for FHR changes (8.5% vs. 4.3%, p=.001). Patients with MAP decrease of ≥30% had higher rates of hypotension compared to those with MAP decrease of < 30% (42.3% vs. 1.6%), p< .001).

Conclusion:

MAP decreases of ≥30% were associated with FHR changes requiring intervention and hypotension. These findings suggest that strategies towards effective BP control should be cognizant of how rapidly and profoundly BP is decreased to avoid potential harm.