(307) Identifying new onset postpartum hypertension in a low risk population using remote blood pressure monitoring

Thursday, February 9, 2023

10:30 AM – 12:00 PM

Objective: To identify incidence of new onset postpartum hypertensive disorders of pregnancy (HDP) in a low risk obstetric population undergoing remote blood pressure monitoring

Study Design: This retrospective cohort study examined clinical and healthcare utilization outcomes among 316 low-risk patients enrolled in remote blood pressure monitoring as part of a bidirectional text messaging program for postpartum support between September 2021 and May 2022. Patients with singleton pregnancy and no diagnosis of chronic hypertension or HDP antenatally or during delivery hospitalization were eligible for inclusion. The primary outcome was incidence of new onset postpartum HDP post-delivery hospitalization, defined by ACOG guidelines. Secondary outcomes included severity of HDP, chief complaint leading to diagnosis (blood pressures vs symptoms), hospital readmission, emergency department utilization, and postpartum visit attendance.

Results: Of 316 patients, nine patients (2.9%) were diagnosed with HDP after discharge from delivery hospitalization (Table 2). Four patients were diagnosed due to blood pressures identified through remote monitoring. Four patients (1.2%) were readmitted postpartum, all for HDP by blood pressure and symptom criteria (median 8 days postpartum). Five patients were diagnosed with HDP but not readmitted (median 6 days postpartum). There were no significant clinical differences between patients with and without postpartum HDP or between patients with and without postpartum readmission (data not shown).

Conclusion: In a cohort of low risk obstetric patients undergoing remote blood pressure monitoring, 2.9% developed new onset HDP after discharge from delivery hospitalization. 44% of cases were diagnosed due to blood pressures from remote monitoring. Remote blood pressure monitoring in low risk patients may identify postpartum HDP at higher than expected rates. Increasing accurate diagnosis of postpartum HDP is essential to reducing maternal morbidity and mortality and improving counseling and management for future pregnancies.

Primary & Presenting Author(s)

Natasha R. Kumar, MD
Dr.
Hospital of University of Pennsylvania
Philadelphia, Pennsylvania, United States

Coauthor(s)

HT
Hunter Terry, MD
OBGYN Resident
Hospital of University of Pennsylvania
Philadelphia, Pennsylvania, United States
KL
Kirstin Leitner, MD
University of Pennsylvania
Philadelphia, Pennsylvania, United States
Sindhu K. Srinivas, MD, MSCE
Professor, Vice Chair for Quality and Safety, Physician Lead, Women's Health Service Line Penn Medicine
Perelman School of Medicine, University of Pennsylvania
Philadelphia, Pennsylvania, United States
AH
Adi Hirshberg, MD
Hospital of the University of Pennsylvania
Philadelphia, Pennsylvania, United States