1044 Modifiable factors in the treatment of severe postpartum hypertension

Abstract

We sought to determine whether Time to Treatment (TTT) and Time to Resolution (TTR) of severe hypertension varies by shift and nurse to patient ratio in our postpartum units. We performed a retrospective cohort study of patients delivered between 1/2017-9/2019 at Magee-Womens Hospital of the University of Pittsburgh Medical Center (UPMC). Women with 2 or more severe range blood pressures (BP) sustained ≥15 minutes in the postpartum period were identified utilizing data collected by UPMC’s Clinical Analytics Department. TTT was defined as the time from the first severe range BP to administration of the first rapid-acting antihypertensive agent. TTR was defined as the time from the first severe range BP to BP<150/100 mmHg. We performed a univariate analysis using Student’s T-Test and Wilcoxon Rank Sum test to compare TTT and TTR by postpartum unit (high-risk; nurse to patient ratio 1:2 versus routine; nurse to patient ratio 1:5 couplets) and shift (day; 7am-7pm versus night; 7pm-7am). 302 women met inclusion criteria. In all, 152 (50.5%) were treated with rapid-acting antihypertensives. Median TTT was significantly longer on routine postpartum units compared to high-risk postpartum units (57 minutes [IQR 40-98] vs. 38 minutes [IQR 27-70]; p=0.0004). Similarly, TTR was longer in routine units compared to high-risk units (149 minutes [IQR 103-274] vs. 80 minutes [IQR 45-150]; p<0.001). TTT in routine and high-risk units was similar during the day shift (47 minutes [IQR 37-94] vs. 48 minutes [IQR 28-80]; p=0.3), however, during the night shift, TTT was significantly longer on routine units compared to high-risk units (66 minutes [IQR 47-102] vs. 36 minutes [IQR 25-62]; p=0.001). Despite clear recommendation from ACOG on treatment of severe range blood pressures, only half of women in our cohort were treated with rapid-acting antihypertensives. We identified significant delays in treatment that were exacerbated by time of day. Complications from HDP are among the leading causes of preventable severe maternal morbidity and our data identified areas amenable to improvement.