790 Association between mean arterial pressure and postpartum readmission for preeclampsia with severe features

Abstract

To evaluate the relationship between mean arterial pressure (MAP) during delivery hospitalization and postpartum readmission for preeclampsia with severe features. This is a single-institution retrospective case-control study. Cases were defined as adult parturients readmitted for preeclampsia with severe features between January 1, 2012 and June 30, 2019. Controls were matched one-to-one by delivery date, maternal age, and gestational age at delivery. The primary objective was to evaluate the relationship between MAP during the index hospitalization and risk of readmission, and to establish MAP thresholds to identify the population at highest risk of readmission. We calculated MAP at a single time point at admission, 24 hours postpartum, discharge, and readmission. We also evaluated risk of readmission by age, race/ethnicity, body mass index and comorbidities. Chi-squared tests, multivariate logistic regression, and receiver operator curve analyses were performed. 348 women met criteria for inclusion, including 174 subjects in each study group. After adjusting for other covariates, MAP at admission and 24-hours postpartum were associated with increased odds of readmission (aOR 1.4 per 10mmHg increase in MAP, p<0.001; aOR 1.6 per 10mmHg increase in MAP, p<0.001, respectively), as were African-American race and hypertensive disorders of pregnancy (Table 1). Admission MAP greater than 99.5mmHg and 24-hour postpartum MAP greater than 91.5mmHg conferred highest risk of readmission and predicted readmission with a sensitivity of 79% and a specificity of 79% (Figure 1). Admission and 24-hour postpartum MAP may be useful screening markers to identify women at higher risk for postpartum readmission for preeclampsia with severe features who may otherwise be missed by standard clinical approaches. These women would likely benefit from closer outpatient postpartum surveillance.View Large Image Figure ViewerDownload Hi-res image Download (PPT)