Society for Maternal-Fetal Medicine Special Statement: Quality metric for timely postpartum follow-up after severe hypertension

      Hypertensive disorders of pregnancy are a leading cause of maternal morbidity and mortality. Because postpartum exacerbation of severe hypertension is common, the American College of Obstetricians and Gynecologists recommends that patients with severe hypertension during the childbirth hospitalization be seen within 72 hours after discharge. In this statement, the Society for Maternal-Fetal Medicine proposes a uniform metric reflecting the rate of timely postpartum follow-up of patients with severe hypertension. The metric is designed to be measured using automated calculations based on billing codes derived from claims data. The metric can be used in quality improvement projects to increase the rate of timely follow-up in patients with severe hypertension during the childbirth hospitalization. Suggested steps for implementing such a project are outlined.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Steegers E.A.
        • von Dadelszen P.
        • Duvekot J.J.
        • Pijnenborg R.
        Lancet. 2010; 376: 631-644
        • Khan K.S.
        • Wojdyla D.
        • Say L.
        • Gülmezoglu A.M.
        • Van Look P.F.
        WHO analysis of causes of maternal death: a systematic review.
        Lancet. 2006; 367: 1066-1074
        • GBD 2015 Maternal mortality collaborators
        Global, regional, and national levels of maternal mortality, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015.
        Lancet. 2016; 388: 1775-1812
        • Petersen E.E.
        • Davis N.L.
        • Goodman D.
        • et al.
        Vital signs: pregnancy-related deaths, United States, 2011-2015, and strategies for prevention, 13 states, 2013-2017.
        MMWR Morb Mortal Wkly Rep. 2019; 68: 423-429
        • Main E.K.
        • McCain C.L.
        • Morton C.H.
        • Holtby S.
        • Lawton E.S.
        Pregnancy-related mortality in California: causes, characteristics, and improvement opportunities.
        Obstet Gynecol. 2015; 125: 938-947
        • Morton C.H.
        • Seacrist M.J.
        • VanOtterloo L.R.
        • Main E.K.
        Quality improvement opportunities identified through case review of pregnancy-related deaths from preeclampsia/eclampsia.
        J Obstet Gynecol Neonatal Nurs. 2019; 48: 275-287
        • Al-Safi Z.
        • Imudia A.N.
        • Filetti L.C.
        • Hobson D.T.
        • Bahado-Singh R.O.
        • Awonuga A.O.
        Delayed postpartum preeclampsia and eclampsia: demographics, clinical course, and complications.
        Obstet Gynecol. 2011; 118: 1102-1107
        • Filetti L.C.
        • Imudia A.N.
        • Al-Safi Z.
        • Hobson D.T.
        • Awonuga A.O.
        • Bahado-Singh R.O.
        New onset delayed postpartum preeclampsia: different disorders?.
        J Matern Fetal Neonatal Med. 2012; 25: 957-960
      1. ACOG Committee Opinion No. 736: optimizing postpartum care.
        Obstet Gynecol. 2018; 131: e140-e150
        • Suresh S.C.
        • Duncan C.
        • Kaur H.
        • et al.
        Postpartum outcomes with systematic treatment and management of postpartum hypertension.
        Obstet Gynecol. 2021; 138: 777-787
        • Roth H.
        • LeMarquand G.
        • Henry A.
        • Homer C.
        Assessing knowledge gaps of women and healthcare providers concerning cardiovascular risk after hypertensive disorders of pregnancy-a scoping review.
        Front Cardiovasc Med. 2019; 6: 178
        • Iriye B.K.
        • Gregory K.D.
        • Saade G.R.
        • Grobman W.A.
        • Brown H.L.
        Quality measures in high-risk pregnancies: executive summary of a cooperative workshop of the Society for Maternal-Fetal Medicine, National Institute of Child Health and Human Development, and the American College of Obstetricians and Gynecologists.
        Am J Obstet Gynecol. 2017; 217: B2-B25
        • Society for Maternal-Fetal Medicine
        Telehealth: opportunities to increase access to quality health care and advance equitable maternal health.
        (Available at)
        • Hirshberg A.
        • Downes K.
        • Srinivas S.
        Comparing standard office-based follow-up with text-based remote monitoring in the management of postpartum hypertension: a randomised clinical trial.
        BMJ Qual Saf. 2018; 27: 871-877
        • Hoppe K.K.
        • Thomas N.
        • Zernick M.
        • et al.
        Telehealth with remote blood pressure monitoring compared with standard care for postpartum hypertension.
        Am J Obstet Gynecol. 2020; 223: 585-588
        • Hirshberg A.
        • Sammel M.D.
        • Srinivas S.K.
        Text message remote monitoring reduced racial disparities in postpartum blood pressure ascertainment.
        Am J Obstet Gynecol. 2019; 221: 283-285
        • Khosla K.
        • Suresh S.
        • Mueller A.
        • et al.
        Elimination of racial disparities in postpartum hypertension follow-up after incorporation of telehealth into a quality bundle.
        Am J Obstet Gynecol MFM. 2022; 4: 100580
        • Chan S.E.
        • Nowik C.M.
        • Pudwell J.
        • Smith G.N.
        Standardized postpartum follow-up for women with pregnancy complications: barriers to access and perceptions of maternal cardiovascular risk.
        J Obstet Gynaecol Can. 2021; 43: 746-755
        • Janssen M.K.
        • Demers S.
        • Srinivas S.K.
        • et al.
        Implementation of a text-based postpartum blood pressure monitoring program at 3 different academic sites.
        Am J Obstet Gynecol MFM. 2021; 3: 100446
        • Parati G.
        • Stergiou G.
        • O’Brien E.
        • et al.
        European Society of Hypertension practice guidelines for ambulatory blood pressure monitoring.
        J Hypertens. 2014; 32: 1359-1366
        • Baras Shreibati J.B.
        When low tech wins.
        N Engl J Med. 2021; 385: 581-583
        • American College of Obstetricians and Gynecologists
        Billing for care after the initial outpatient postpartum visit: the fourth trimester.
        (Available at)
        • National Quality Forum
        Measure evaluation criteria.
        (Available at)
        • The Joint Commission
        Provision of care, treatment, and services standards for maternal safety.
        (Available at) (Accessed May 19, 2022)
        • Deming W.E.
        The new economics for industry, government, education.
        MIT Press, Cambridge, MA1994
        • Agency for Healthcare Research and Quality
        Ways to approach the quality improvement process.
        (Available at)
        • Bernstein P.
        • Bradford W.
        • Gullo S.
        • et al.
        Implementing quality improvement projects toolkit.
        (Available at)