Advertisement

Society for Maternal-Fetal Medicine Special Statement: A quality metric for evaluating timely treatment of severe hypertension

Published:October 11, 2021DOI:https://doi.org/10.1016/j.ajog.2021.10.007
      Severe hypertension in pregnancy is a medical emergency. Although expeditious treatment within 30 to 60 minutes is recommended to reduce the risk of maternal death or severe morbidity, treatment is often delayed by >1 hour. In this statement, we propose a quality metric that facilities can use to track their rates of timely treatment of severe hypertension. We encourage facilities to adopt this metric so that future reports from different facilities will be based on a uniform definition of timely treatment.

      Key words

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

      Subscribe:

      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

      References

        • 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
        • 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
        • Judy A.E.
        • McCain C.L.
        • Lawton E.S.
        • Morton C.H.
        • Main E.K.
        • Druzin M.L.
        Systolic hypertension, preeclampsia-related mortality, and stroke in California.
        Obstet Gynecol. 2019; 133: 1151-1159
        • Martin J.N.
        • Thigpen B.D.
        • Moore R.C.
        • Rose C.H.
        • Cushman J.
        • May W.
        Stroke and severe preeclampsia and eclampsia: a paradigm shift focusing on systolic blood pressure.
        Obstet Gynecol. 2005; 105: 246-254
      1. Gestational hypertension and preeclampsia: ACOG Practice Bulletin, Number 222.
        Obstet Gynecol. 2020; 135: e237-e260
        • American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Obstetrics
        ACOG Practice Bulletin No. 203: chronic hypertension in pregnancy.
        Obstet Gynecol. 2019; 133: e26-e50
        • Kantorowska A.
        • Heiselman C.J.
        • Halpern T.A.
        • et al.
        Identification of factors associated with delayed treatment of obstetric hypertensive emergencies.
        Am J Obstet Gynecol. 2020; 223: 250.e1-250.e11
        • Deshmukh U.S.
        • Lundsberg L.S.
        • Culhane J.F.
        • et al.
        Factors associated with appropriate treatment of acute-onset severe obstetrical hypertension.
        Am J Obstet Gynecol. 2021; 225: 329.e1-329.e10
        • Shields L.E.
        • Wiesner S.
        • Klein C.
        • Pelletreau B.
        • Hedriana H.L.
        Early standardized treatment of critical blood pressure elevations is associated with a reduction in eclampsia and severe maternal morbidity.
        Am J Obstet Gynecol. 2017; 216: 415.e1-415.e5
        • King P.L.
        • Keenan-Devlin L.
        • Gordon C.
        • Goel S.
        • Borders A.
        Reducing time to treatment for severe maternal hypertension through statewide quality improvement.
        Am J Obstet Gynecol. 2018; : 218
        • Alliance for Innovation on Maternal Health
        Impact statements.
        (Available at:)
        • Mullan S.J.
        • Vricella L.K.
        • Edwards A.M.
        • et al.
        Pulse pressure as a predictor of response to treatment for severe hypertension in pregnancy.
        Am J Obstet Gynecol MFM. 2021; 3: 100455
        • 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
        • Sharma K.J.
        • Rodriguez M.
        • Kilpatrick S.J.
        • Greene N.
        • Aghajanian P.
        Risks of parenteral antihypertensive therapy for the treatment of severe maternal hypertension are low.
        Hypertens Pregnancy. 2016; 35: 123-128
        • Bailit J.L.
        • Gregory K.D.
        • et al.
        • Society for Maternal-Fetal Medicine (SMFM) Quality and Safety and Health Policy Committees
        Society for Maternal-Fetal Medicine (SMFM) Special Report: current approaches to measuring quality of care in obstetrics.
        Am J Obstet Gynecol. 2016; 215: B8-B16
        • Society for Maternal-Fetal Medicine
        SMFM scorecard 2020–2021.
        (Available at:)
        https://www.smfm.org/scorecard/2020
        Date: 2021
        Date accessed: September 28, 2021
        • The Joint Commission
        Provision of care, treatment, and services standards for maternal safety.
        (Available at:)
        • National Quality Forum
        Measure evaluation criteria. 2012.
        (Available at:)