347: Factors associated with postpartum complications after cesarean delivery in patients with hypertensive diseases

Abstract

Our objective was to determine the factors associated with post-cesarean maternal and neonatal adverse outcomes in patients with HTN, and the impact of a practice change towards early discharge. Retrospective cohort of singleton women who delivered via cesarean delivery (CD) at a single university hospital. Women with chronic hypertension, gestational hypertension or preeclampsia before or during the delivery admission (HTN group) were compared with those without HTN (control group). Our primary maternal outcome was a composite of maternal hospital readmission, ER visits, or unexpected clinic visits within 6 weeks after delivery. Secondary outcomes included individual components of the composite outcome. Neonatal outcomes included a composite of hospital readmission, ER visits, or unexpected clinic visits. Univariable and multivariable logistic regression analyses were performed and a P<0.05 was considered statistically significant. Women in the HTN group (N=214) were older, heavier, more likely to be African American, diabetic, deliver at an earlier GA, and have longer hospital length of stay (LOS) after CD, compared with the control group (n=1,120). The maternal primary and secondary outcomes were higher in the HTN group (Table). The primary neonatal outcome was not different between the two groups, however neonates of HTN mothers had more NICU admissions, hypoglycemia and need for readmission. After adjusting for variables found to be different on univariable analysis, we did not find an association between LOS after CD and the primary maternal outcome (aOR 0.99, 95% CI 0.98-1.01, p=0.3) or primary neonatal outcome (aOR 0.98, 95% CI 0.96-1.01, p=0.2). GA at delivery was the only factor associated with the primary maternal outcome (aOR 0.75, 95% CI 0.62-0.91, p=0.004). Among women in the HTN group 89 (41.6%) were discharged before 48 hours, and had similar maternal and neonatal outcomes compared with those discharged > 48 hours (maternal primary outcome: aOR 1.0, 95% CI 0.54 - 1.85, p=0.98) or neonatal primary outcome (aOR 1.0, 95%CI 0.99-1.01, P=0.81). Pregnant women with HTN have higher rates of post-CD complications, but keeping them longer in the hospital post-cesarean did not improve maternal or neonatal adverse outcomes.