Division of Maternal-Fetal Fetal Medicine, Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, New York.
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, California.
Am J Perinatol. 2022 May;39(7):699-706. doi: 10.1055/s-0041-1739429. Epub 2021 Nov 12.
This study aimed to characterize risk for postpartum complications based on specific hypertensive diagnosis at delivery.
This retrospective cohort study used the 2010 to 2014 Nationwide Readmissions Database to identify 60-day postpartum readmissions. Delivery hospitalizations were categorized based on hypertensive diagnoses as follows: (1) preeclampsia with severe features, (2) superimposed preeclampsia, (3) chronic hypertension, (4) preeclampsia without severe features, (5) gestational hypertension, or (6) no hypertensive diagnosis. Risks for 60-day readmission was determined based on hypertensive diagnosis at delivery. The following adverse outcomes during readmissions were analyzed: (1) stroke, (2) pulmonary edema and heart failure, (3) eclampsia, and (4) severe maternal morbidity (SMM). We fit multivariable log-linear regression models to assess the magnitude of association between hypertensive diagnoses at delivery and risks for readmission and associated complications with adjusted risk ratios (aRR) as measures of effect.
From 2010 to 2014, 15.7 million estimated delivery hospitalizations were included in the analysis. Overall risk for 60-day postpartum readmission was the highest among women with superimposed preeclampsia (6.6%), followed by preeclampsia with severe features (5.2%), chronic hypertension (4.0%), preeclampsia without severe features (3.9%), gestational hypertension (2.9%), and women without a hypertensive diagnosis (1.5%). In adjusted analyses for pulmonary edema and heart failure as the outcome, risks were the highest for preeclampsia with severe features (aRR = 7.82, 95% confidence interval [CI]: 6.03, 10.14), superimposed preeclampsia (aRR = 8.21, 95% CI: 5.79, 11.63), and preeclampsia without severe features (aRR = 8.87, 95% CI: 7.06, 11.15). In the adjusted model for stroke, risks were similarly highest for these three hypertensive diagnoses. Evaluating risks for SMM during postpartum readmission, chronic hypertension and superimposed preeclampsia were associated with the highest risks.
Chronic hypertension was associated with increased risk for a broad range of adverse postpartum outcomes. Risk estimates associated with chronic hypertension with and without superimposed preeclampsia were similar to preeclampsia with severe features for several outcomes.
· Chronic hypertension was associated with increased risk for a broad range of adverse outcomes.. · Close postpartum follow-up is required if hypertension is present at delivery.. · The majority of readmissions occurred within 10 days after delivery hospitalization discharge..
本研究旨在根据分娩时特定的高血压诊断来描述产后并发症的风险。
本回顾性队列研究使用 2010 年至 2014 年全国再入院数据库来确定产后 60 天的再入院。分娩住院治疗根据高血压诊断分类如下：(1)伴有严重特征的子痫前期，(2)重叠子痫前期，(3)慢性高血压，(4)无严重特征的子痫前期，(5)妊娠期高血压，或(6)无高血压诊断。基于分娩时的高血压诊断来确定 60 天再入院的风险。分析了再入院期间的以下不良结局：(1)中风，(2)肺水肿和心力衰竭，(3)子痫，以及(4)严重产妇发病率（SMM）。我们拟合了多变量对数线性回归模型，以评估分娩时高血压诊断与再入院风险和相关并发症之间的关联程度，调整后的风险比（aRR）作为效应的度量。
2010 年至 2014 年，分析中包括了估计的 1570 万次分娩住院治疗。在 60 天产后再入院风险方面，重叠子痫前期（6.6%）的女性风险最高，其次是伴有严重特征的子痫前期（5.2%）、慢性高血压（4.0%）、无严重特征的子痫前期（3.9%）、妊娠期高血压（2.9%）和无高血压诊断的女性（1.5%）。在肺水肿和心力衰竭作为结局的调整分析中，严重特征子痫前期（aRR=7.82，95%置信区间[CI]：6.03，10.14）、重叠子痫前期（aRR=8.21，95%CI：5.79，11.63）和无严重特征子痫前期（aRR=8.87，95%CI：7.06，11.15）的风险最高。在中风的调整模型中，这些三种高血压诊断的风险也同样最高。评估产后再入院时 SMM 的风险，慢性高血压和重叠子痫前期与最高风险相关。
慢性高血压与广泛的不良产后结局风险增加相关。慢性高血压伴或不伴重叠子痫前期的风险估计与严重特征子痫前期的某些结局相似。
·慢性高血压与广泛的不良结局风险增加相关。·如果分娩时存在高血压，则需要进行密切的产后随访。·大多数再入院发生在分娩住院治疗出院后 10 天内。
