How Do Hypertension in Pregnancy Practice Guidelines Change Hypertension Management in a Single Academic Center? [28F

Abstract

INTRODUCTION: In November 2013, the American College of Obstetricians and Gynecologists released the “Hypertension in Pregnancy” guidelines. Hypertensive disorders are a major source of perinatal morbidity and mortality. Our objective was to assess whether these guidelines affected hypertension management at our institution. METHODS: We performed a secondary analysis of a retrospective cohort study on postpartum hypertension from deliveries from 07/09 to 07/16. Inclusion criteria were the presence of a documented hypertensive disorder. Exclusion criteria were discharge home on antihypertensive medication. Study variables include: gestational age at time of induction, delivery method, antihypertensive treatment, maximum systolic/diastolic blood pressures < 24 and 24-72 hours postpartum, rates of attendance to blood pressure check and postpartum visit. Chi-square test was used for categorical variables and Student T-test was used for continuous variables. “Pre-Guidelines” (7/09-10/13) and “Post-Guidelines” (2/13-7/16) were chosen to allow for policy change within our institution. RESULTS: 470 deliveries were pre-guidelines and 237 deliveries post-guidelines. There are increased rates post-guidelines of intrapartum IV antihypertensive treatment (9.8% vs 3.2%, P<.001) and increased attendance to a postpartum blood pressure check post-guidelines (24.1% vs 15.4%, P<.01). There was no difference in all other variables studied. CONCLUSION: Post-guidelines, our institution noted a statistically significant increase in IV intrapartum antihypertensive therapy and postpartum blood pressure checks within two weeks of delivery. There were no statistically significant differences in the time of induction, delivery method, or antihypertensive treatments despite these guideline changes. Further research needs to be done to study the implications of these guideline changes in respect to perinatal morbidity and mortality.