The burden of postpartum hypertension complications on urgent care utilization; a retrospective single centre study.

Abstract

Objective: Hypertensive disorders of pregnancy can cause significant maternal morbidity including during the postpartum period. The aim of this study was to determine the burden of postpartum hypertension complications on urgent care utilization. Secondary outcomes were to assess common presentations of postpartum hypertension, uptake of SOGC guideline recommendations for postpartum hypertension management, and whether the reason for presentation was associated with early discontinuation of antihypertensive medications following delivery.

Methods: A single centre cohort study of patients returning to an urgent care setting with postpartum hypertension concerns over two-time periods (July-December 2021 and July-December 2023) was undertaken. Data were abstracted via chart review. Demographic and presentation characteristics of participants were characterized using descriptive statistics. Proportions were compared using a Chi square test and continuous variables were compared using the student's t-test or Wilcoxon rank-sum test.

Results: During the study period, 132 of 1535 (9%) postpartum patient presentations in an urgent care setting were for hypertension-related concerns, with stable rates over the two-time periods. 99 (75%) clinical presentations were for symptomatic hypertension, with median presentation occurring on postpartum day 5 (IQR 4-7). 32 (24%) were diagnosed with new postpartum preeclampsia and 91 (69%) were diagnosed with worsening of their antenatally diagnosed hypertensive disorder of pregnancy. Rates of readmission decreased over the two study periods from 24% to 8% (P = 0.01). Reinitiation of medications stopped prior to discharge after delivery occurred in 18 (14%).

Conclusion: Hypertension contributes to a significant burden of postpartum urgent care presentations. Enhanced discharge planning and development of a postpartum follow-up program may reduce this burden on urgent care settings.