801 Hypertensive disorders of pregnancy in a pandemic: care delivery, outcomes, and lessons learned

Abstract

To investigate outcomes in hypertensive disorders of pregnancy (HDP) with regard to shifting care models during the COVID-19 pandemic. We retrospectively compared women with complete records and without a major fetal anomaly diagnosed with HDP at a tertiary care center during the COVID-19 pandemic (April 2020) to women meeting the same criteria one year prior (April 2019). In the setting of a high regional COVID case load, women were offered virtual care, home BP monitoring was encouraged, and those with HDP had expedited discharges home with close follow up by phone from medical student volunteers on postpartum days 3, 5, and 7. The primary outcome was severity of HDP subtype at presentation. Secondary outcomes included diagnosis/delivery gestational age, NICU admission, time from last prenatal care visit to delivery, diagnosis site, and postpartum readmission. 229 women met criteria for analysis, 119 (52.0%) delivering pre-COVID and 110 (48.0%) during COVID. Individuals delivering in the two time periods had similar demographics and major co-morbidities, though patients had more in-person prenatal and postpartum visits before the pandemic (P<0.01, Table 1). There was no difference in the distribution of HDP severity, diagnosis site, or diagnosis timing across timepoints (Table 2). Likewise, there was no difference in the site of prenatal visit or time from last prenatal care visit to delivery. Gestational ages at delivery and NICU admission rates were also similar between timepoints. However, the post-partum readmission rate was higher in peri-pandemic time, with 4.2% needing readmission pre-COVID compared to 17.3% peri-COVID. Though changes in prenatal care did not affect the severity of women’s HDP presentation during the COVID pandemic, there were higher rates of postpartum readmission for HDP management. This may be due to truncated in-hospital monitoring periods, increased surveillance from medical student follow up, or difficulty managing blood pressure as an outpatient postpartum. These findings may help providers critically evaluate care models for HDP.View Large Image Figure ViewerDownload Hi-res image Download (PPT)