A quality improvement intervention to optimize the management of severe hypertension during pregnancy and postpartum

IF 2.5 4区医学 Q2 OBSTETRICS & GYNECOLOGY

Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health Pub Date : 2025-02-17 DOI:10.1016/j.preghy.2025.101192

Marie-Julie Trahan , Marianne Plourde , Ana Clouatre , Karen Wou , Antonina Pavilanis , Ruth-Lynn Fortune , Sabrina Haas , Jennifer Pepin , Sophia Kapellas , Anne-Maude Morency , Ginette Aucoin , Alexandria Flannery , Pierre-Olivier Monast , Noura Hassan , Maral Koolian , Thiphavone Oudanonh , Nisha Almeida , Eva Suarthana , Stella S. Daskalopoulou , Isabelle Malhamé

{"title":"A quality improvement intervention to optimize the management of severe hypertension during pregnancy and postpartum","authors":"Marie-Julie Trahan , Marianne Plourde , Ana Clouatre , Karen Wou , Antonina Pavilanis , Ruth-Lynn Fortune , Sabrina Haas , Jennifer Pepin , Sophia Kapellas , Anne-Maude Morency , Ginette Aucoin , Alexandria Flannery , Pierre-Olivier Monast , Noura Hassan , Maral Koolian , Thiphavone Oudanonh , Nisha Almeida , Eva Suarthana , Stella S. Daskalopoulou , Isabelle Malhamé","doi":"10.1016/j.preghy.2025.101192","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><div>Severe hypertension (two systolic blood pressure [BP] values ≥ 160 mm Hg or diastolic BP values ≥ 110 mm Hg, 15–60 min apart) is a modifiable cause of maternal morbidity and mortality. We aimed to assess the impact of a quality improvement (QI) intervention to optimize the management of severe hypertension during pregnancy and postpartum.</div></div><div><h3>Study design</h3><div>We developed and implemented a QI intervention for severe hypertension management at a Canadian tertiary care center and conducted a quasi-experimental pre- and post-intervention cohort study. Pregnant and postpartum patients with a hypertensive disorder of pregnancy (HDP) between 2020 and 2022 were identified, and pre- and post-intervention cohorts were constructed.</div></div><div><h3>Main outcome measures</h3><div>Severe hypertension management was assessed according to quality indicators, including time-to-target BP within 60 min and use of appropriate antihypertensive therapy.</div></div><div><h3>Results</h3><div>Among 697 patients with HDP, 134 (19 %) experienced severe hypertension (pre-intervention: n = 56; post-intervention: n = 78). Immediate release oral nifedipine was the most frequently used medication to treat severe hypertension episodes (63 %). Median time-to-target BP was 49.5 min pre-intervention (interquartile range [IQR] 28.0–69.8) vs. 33.5 min (IQR 19.8–65.2) post-intervention (p = 0.102). Time-to-target BP within 60 min was achieved in 64 % of patients pre- vs. 74 % post-intervention (p = 0.209), meeting our pre-established institutional target. Appropriate antihypertensive administration increased from 55 % pre-intervention to 76 % post-intervention (p = 0.014).</div></div><div><h3>Conclusion</h3><div>Developing and implementing a QI intervention resulted in achievement of our institutional target for time-to-severe hypertension resolution and increased use of appropriate antihypertensive medications. Standardized protocols and QI interventions can optimize severe hypertension management to reduce severe maternal morbidity.</div></div>","PeriodicalId":48697,"journal":{"name":"Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health","volume":"39 ","pages":"Article 101192"},"PeriodicalIF":2.5000,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S221077892500008X","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"OBSTETRICS & GYNECOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Objective

Severe hypertension (two systolic blood pressure [BP] values ≥ 160 mm Hg or diastolic BP values ≥ 110 mm Hg, 15–60 min apart) is a modifiable cause of maternal morbidity and mortality. We aimed to assess the impact of a quality improvement (QI) intervention to optimize the management of severe hypertension during pregnancy and postpartum.

Study design

We developed and implemented a QI intervention for severe hypertension management at a Canadian tertiary care center and conducted a quasi-experimental pre- and post-intervention cohort study. Pregnant and postpartum patients with a hypertensive disorder of pregnancy (HDP) between 2020 and 2022 were identified, and pre- and post-intervention cohorts were constructed.

Main outcome measures

Severe hypertension management was assessed according to quality indicators, including time-to-target BP within 60 min and use of appropriate antihypertensive therapy.

Results

Among 697 patients with HDP, 134 (19 %) experienced severe hypertension (pre-intervention: n = 56; post-intervention: n = 78). Immediate release oral nifedipine was the most frequently used medication to treat severe hypertension episodes (63 %). Median time-to-target BP was 49.5 min pre-intervention (interquartile range [IQR] 28.0–69.8) vs. 33.5 min (IQR 19.8–65.2) post-intervention (p = 0.102). Time-to-target BP within 60 min was achieved in 64 % of patients pre- vs. 74 % post-intervention (p = 0.209), meeting our pre-established institutional target. Appropriate antihypertensive administration increased from 55 % pre-intervention to 76 % post-intervention (p = 0.014).

Conclusion

Developing and implementing a QI intervention resulted in achievement of our institutional target for time-to-severe hypertension resolution and increased use of appropriate antihypertensive medications. Standardized protocols and QI interventions can optimize severe hypertension management to reduce severe maternal morbidity.

查看原文本刊更多论文

妊娠期和产后重度高血压的质量改善干预优化管理

目的重度高血压（两次收缩压≥160 mm Hg或舒张压≥110 mm Hg，间隔15-60分钟）是产妇发病和死亡的可改变原因。我们的目的是评估质量改善（QI）干预对优化妊娠期和产后重度高血压管理的影响。研究设计：我们在加拿大一家三级保健中心开发并实施了一种QI干预措施，用于治疗严重高血压，并进行了一项准实验的干预前和干预后队列研究。确定2020年至2022年间妊娠期高血压疾病（HDP）的孕妇和产后患者，并构建干预前和干预后队列。根据质量指标评估重度高血压管理，包括60分钟内血压到达目标时间和使用适当的降压治疗。结果697例HDP患者中，134例（19%）发生重度高血压(干预前：n = 56；干预后：n = 78)。立即释放口服硝苯地平是治疗严重高血压发作最常用的药物（63%）。干预前（四分位数间距[IQR] 28.0 ~ 69.8）至靶血压的中位时间为49.5 min，干预后（四分位数间距[IQR] 19.8 ~ 65.2）为33.5 min （p = 0.102）。干预前和干预后分别有64%和74%的患者达到了60分钟内血压到达目标时间（p = 0.209），达到了我们预先设定的机构目标。适当的降压治疗从干预前的55%增加到干预后的76% （p = 0.014）。结论：制定和实施QI干预措施，实现了我们的机构目标，即高血压时间到严重程度的解决，并增加了适当抗高血压药物的使用。标准化方案和QI干预可以优化严重高血压管理，以降低严重孕产妇发病率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Pregnancy Hypertension-An International Journal of Womens Cardiovascular Health OBSTETRICS & GYNECOLOGYPERIPHERAL VASCULAR-PERIPHERAL VASCULAR DISEASE

CiteScore

4.90

自引率

0.00%

发文量

127

期刊介绍： Pregnancy Hypertension: An International Journal of Women''s Cardiovascular Health aims to stimulate research in the field of hypertension in pregnancy, disseminate the useful results of such research, and advance education in the field. We publish articles pertaining to human and animal blood pressure during gestation, hypertension during gestation including physiology of circulatory control, pathophysiology, methodology, therapy or any other material relevant to the relationship between elevated blood pressure and pregnancy. The subtitle reflects the wider aspects of studying hypertension in pregnancy thus we also publish articles on in utero programming, nutrition, long term effects of hypertension in pregnancy on cardiovascular health and other research that helps our understanding of the etiology or consequences of hypertension in pregnancy. Case reports are not published unless of exceptional/outstanding importance to the field.