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26: Postpartum hypertensive disorders of pregnancy: Discharge diagnosis and interval to readmission

      Objective

      Postpartum hypertension can be related to preexisting hypertensive disorders of pregnancy (HDP) or occur de novo during the postpartum period. Recently, there has been an increase in rates of readmission for HDP. The two aims of this study were (1) to examine risk factors for hospital readmission based on the timing of presentation for readmission (2) and to evaluate differences in outcomes for these women.

      Study Design

      We conducted a prospective cohort study of women readmitted with postpartum hypertension at a large, urban university hospital from September 2016 to July 2019. Some of the data abstracted from medical records included maternal demographics, pregnancy outcomes, readmission symptoms and blood pressures (BP). Timing of presentation for readmission was categorized as follows: 0-3 days, 4-7 days and ³ 8 days. Univariate analysis was performed to evaluate clinical data between women readmitted with HDP based on the timing of presentation and presence or absence of diagnosis prior to discharge (p< 0.05).

      Results

      One hundred sixty-four patients met the inclusion criteria. Of these, 53 (32.3%) were readmitted within 3 days, 53 (32.3%) within 4-7 days and 58 (35.4%) at >/=8 days or after discharge. Significant differences were seen between race/ethnicity, multifetal gestation, gestational age and birth weight (Table 1). Sixty percent of patients readmitted for postpartum hypertension had no diagnosis of HDP prior to discharge. Of these, 19 (30.7%) presented with severe symptoms (i.e. headache, visual changes) and 31 (50.0%) had elevated BPs on readmission.

      Conclusion

      The presence of postpartum preeclampsia in patients with no HDP highlights the need for patient and family counseling on signs and symptoms prior to discharge, regardless of preexisting disease. Further studies are needed to increase access points of care in the postpartum period for evaluation and better risk stratification for those who are at a higher risk of readmission.
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