1181: Factors associated with attendance at the postpartum blood pressure visit in pregnancies complicated by hypertension

Abstract

The ACOG recommends that women with hypertensive disorders of pregnancy have a blood pressure (BP) evaluation no later than 7-10 days after delivery. The objective of this study was to identify the factors that are associated with patient attendance at the postpartum (PP) BP follow-up visit. This was a retrospective cohort study of postpartum women who had a hypertensive disorder of pregnancy over a 12-month study period. This was derived from a separate study that evaluated PP follow-up rates after implementing a protocol that required specific post-birth warning sign instructions to be provided to these women. Women were identified by delivery records and rates of follow-up were extracted from the medical record. Characteristics of women who attended a clinic visit 3-10 days after delivery for BP evaluation were compared to women who did not return for the visit. 193 women attended the PP BP visit compared to 185 who did not. Those who returned were older, delivered at an earlier gestational age, and were more likely to have the diagnosis of preeclampsia (OR 2.05) or severe features (OR 1.78). They were also more likely to have taken an antihypertensive agent during pregnancy, received magnesium sulfate, received furosemide postpartum, delivered via cesarean, or had an Emergency Room visit due to hypertension. They were also more likely to return for a PP visit. These women were less likely to be African-American (OR 0.54) (Table). Although women with hypertensive disorders of pregnancy are at increased risk of postpartum complications, those who returned for a shorter-interval visit to evaluate blood pressure had significantly more complicated pregnancies and increased interventions than those who did not return. African American women, who have the highest rates of maternal morbidity and mortality nationwide, had the lowest rate of PP BP follow-up, which is a concerning trend. Effective interventions to increase follow-up for all hypertensive women are needed. It is important to properly counsel women with hypertension on the importance of PP follow-up.