(136) Inpatient versus outpatient management of gestational hypertension or preeclampsia without severe features

Thursday, February 9, 2023

10:30 AM – 12:00 PM

Objective: To compare maternal and neonatal outcomes along with gestational latency, in patients diagnosed with a hypertensive disorder of pregnancy (HDP) (gestational hypertension or preeclampsia), without severe features managed inpatient versus outpatient setting.

Study Design: A retrospective, cohort study of patients with HDP without severe features before 37 weeks from 2014-2021. Patients were managed inpatient or outpatient at discretion of obstetric provider. Patients with initial presentation with severe features were excluded. The primary outcome was severe maternal morbidity (SMM) as defined by the 21 CDC maternal morbidity identifiers. Secondary outcomes included maternal ICU admission, development of severe features, placental abruption, time from diagnosis to delivery, preterm birth < 37 weeks, low birthweight ( < 2500g), 5-minute Apgar score < 7, and stillbirth.

Results: A total of 279 patients met the inclusion criteria with 236 (84.6%) being managed outpatient and 43 (15.4%) being managed inpatient. In univariate analysis, SMM rates were higher in inpatient compared to outpatient group (14.0% vs. 2.3%, p=0.001). Maternal ICU admission was higher in the inpatient management group (7.0% vs. 0.4%, p< 0.001). Frequencies of placental abruption and development of severe features did not differ between the groups. Time from diagnosis to delivery was longer in the outpatient compared to inpatient group (13d vs. 3d, p< 0.001). Low birth weight and preterm birth were more frequent in the inpatient group (Table 1). In multivariate analyses, controlling for gestational age at HDP diagnosis, HDP type, twin gestation, maternal diabetes, BMI, and residential distance from the hospital, SMM did not differ between the groups (aOR 0.17, 95% CI 0.02-1.78) Secondary outcomes did not differ between outpatient and inpatient management groups (Table 2).

Conclusion:

Outpatient management of gestational hypertension or preeclampsia without severe features was not associated with adverse maternal or neonatal outcomes.

Primary & Presenting Author(s)

Blake Neuburg, MD
Resident Physician
Medical College of Wisconsin
Milwaukee, Wisconsin, United States

Coauthor(s)

MG
Meghan Gallagher, BS
Medical College of Wisconsin
Milwaukee, Wisconsin, United States
AP
Amy Y. Pan, PhD
Medical College of Wisconsin
Milwaukee, Wisconsin, United States
Anna Palatnik, MD
Medical College of Wisconsin
Milwaukee, Wisconsin, United States