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

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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.

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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.