Pulse Pressure and Postepidural Complications in Women With Hypertensive Disorders of Pregnancy [33R

Abstract

INTRODUCTION: Normotensive women with narrow pulse pressure have increased risk of postepidural complications and benefit from additional fluid volume. We hypothesized that narrow pulse pressure in hypertensive women was associated with increased postepidural intervention. METHODS: Single-center prospective cohort study of women with singleton pregnancies and diagnosis of gestational hypertension (gHTN) or preeclampsia admitted for delivery between December 2016 and January 2018. Mean pulse pressure in the 3 hours prior to test dose was calculated (narrow defined as <45 mm Hg). Primary outcome was a composite of postepidural resuscitative measures including fluid bolus, vasopressors, supplemental oxygen, or intentional maternal position changes. Secondary outcomes included hypotension, defined as a decrease in blood pressure (BP) of 20% from baseline, or fetal heart rate (FHR) decelerations compared to 1 hour prior to epidural bolus. RESULTS: 67 women with hypertensive disorders of pregnancy were included, with 15 (22.4%) having a narrow pulse pressure. Average systolic and diastolic BP prior to epidural for those with narrow vs. normal pulse pressure was 125 ± 11 vs. 137 ± 10 mm Hg (P<.001) and 86 ± 11 vs. 81 ± 8 mm Hg (P=.05), respectively. No observed difference in the need for postepidural resuscitation 13.3 vs. 38.5% (P=.12) or any component of the composite outcome. No observed increased risk of systolic (RR 0.74 [95%CI 0.25-2.25]) or diastolic hypotension (RR 0.89 [95%CI 0.53-1.51]) with narrow pulse pressure, nor were abnormal FHR patterns more frequent (P=.72). CONCLUSION: Narrow pulse pressure was not predictive of postepidural complications or resuscitation in women with gHTN or preeclampsia.