Postpartum Preeclampsia
Conditions
Brief summary
The aim of this study is to assess the effect of a lower treatment threshold for antihypertensive medication and tighter blood pressure control, using remote blood pressure monitoring, on reducing Emergency Room visits for our postpartum patients with hypertensive disease.
Detailed description
The aim of this study is to assess the effect of lower treatment threshold for initiating antihypertensive medication and tighter blood pressure control, using remote blood pressure monitoring, on reducing Emergency Room visits for our postpartum patients with hypertensive disease. The investigators will study and compare two cohorts of patients. The first is a retrospective cohort, including patients delivered at Robert Wood Johnson University Hospital and Cooperman Barnabas Medical Center. The second is a prospective cohort that will enroll patients immediately postpartum who are eligible for our treatment protocol.
Interventions
OTHERTight postpartum blood pressure control
The standard of care for patients with pregnancy induced hypertension is to start antihypertensive therapy if blood pressures are consistently over 150/100 mm Hg. There is no established standard of care for titrating blood pressure medication in the postpartum period for those with chronic hypertension and the approach to these patients varies by institution. The intervention in this study will be to start antihypertensive medications at a lower blood pressure cutoff, which is commonly used in the non-pregnant patient population to more tightly control blood pressure. Remote patient monitoring may be considered standard of care. The blood pressure targets chosen for this study are considered to be standard of care for non-pregnant people.
Sponsors
Rutgers, The State University of New Jersey
Study design
Allocation
NON_RANDOMIZED
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
The investigators will study and compare two cohorts of patients. The first is a retrospective cohort, including patients delivered at Robert Wood Johnson University Hospital and Cooperman Barnabas Medical Center. The second is a prospective cohort that will enroll patients immediately postpartum who are eligible for our treatment protocol.
Eligibility
Sex/Gender
FEMALE
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Chronic hypertension, gestational hypertension, or preeclampsia. * Delivery of a neonate after 20 weeks during their current hospitalization * Able to consent * 18 years old or above * English or Spanish speaking * Planning to follow up with a physician associated with Robert Wood Johnson University Hospital or Cooperman Barnabas Medical Center * Ability to follow directions
Exclusion criteria
* Any medical condition that the providers feel is a contraindication to the MOPP algorithm. * Planning to follow up with an outside institution. * Unwillingness to take blood pressure at home.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Postpartum Emergency Department visits for hypertensive disorders | Six weeks from date of delivery | Any patient that returns to the Emergency Department for hypertensive disorders |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of acute postpartum complications of preeclampsia | 6 weeks from date of delivery | Postpartum complications include stroke, seizure, thrombocytopenia, elevated liver enzymes, liver rupture, kidney injury. |
| Lab abnormalities because of preeclampsia | 6 weeks from date of delivery | Rate of lab abnormalities including acute kidney injury (creatinine \>1.1 mg/dL), transaminitis (liver function tests \> 2x upper limit of normal), or thrombocytopenia (platelet count \< 100,000 uL) |
| Blood pressure at the postpartum visit | 6 weeks from date of delivery | Measurement of blood pressure value at 6 week postpartum visit |
| Breastfeeding rates at 6 weeks postpartum | 6 weeks from date of delivery | Rates of exclusive breastfeeding at 6 week postpartum visit. |
| Postpartum readmissions for hypertensive disorders | 6 weeks form date of delivery | Any patient that is readmitted to the hospital for hypertensive disorders. |
| Composite maternal cardiovascular and other morbidity | One year from delivery | Death, any new heart failure, stroke or encephalopathy, myocardial ischemia or angina, pulmonary edema, ICU admission/ intubation, encephalopathy, or renal failure. |
| Short-term cardiovascular disease | One year from delivery | The effect of aggressive postpartum preeclampsia on incidents of cardiovascular diseases, which include coronary heart disease (acute myocardial infarction, ischemic heart disease, hypertensive heart disease, and congestive heart failure), and stroke (ischemic and hemorrhagic strokes). |
| Socioeconomic factors | One year from delivery | The impact of race/ethnicity and insurance status on primary and secondary outcomes. |
| Compliance with follow up at postpartum visits | 6 weeks from date of delivery | If patient shows up to postpartum visit or not |
Countries
United States
Outcome results
None listed