Corlin Tiffany, Raghuraman Nandini, Rampersad Roxane M, Sabol Bethany A
Department of Obstetrics, Gynecology, and Women's Health, University of Minnesota, Minneapolis, MN (Drs Corlin and Sabol).
Department of Obstetrics and Gynecology, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO (Drs Raghuraman and Rampersad).
AJOG Glob Rep. 2023 Jul 8;3(3):100251. doi: 10.1016/j.xagr.2023.100251. eCollection 2023 Aug.
There has been an alarming and substantial increase in hypertensive disorders of pregnancy, which are a significant driver of maternal morbidity and mortality. The postpartum period is an especially high-risk time, with >50% of pregnancy-related deaths and significant morbidity occurring during this period. The American College of Obstetricians and Gynecologists suggests inpatient or equivalent monitoring of blood pressures in patients with hypertensive disorders of pregnancy for the immediate 72 hours postpartum and again within 7 to 10 days postpartum. Hypertensive disorders of pregnancy significantly contribute to healthcare costs through increasing admission lengths, rates of readmissions, the number of medications given, and laboratory studies ordered, and through the immeasurable impact on the patient and society. Telemedicine is an essential option for patients with barriers to accessing care, particularly those in remote areas with difficulty accessing subspecialty care, transportation, childcare, or job security. The implementation of these programs also has potential to mitigate racial inequities given that patients of color are disproportionately affected by the morbidity and mortality of hypertensive disorders of pregnancy. Remote blood pressure monitoring programs are generally acceptable, with high levels of satisfaction in the obstetrical population without posing an undue burden of care. Studies have reported different, but encouraging, measures of feasibility, including rates of recruitment, consent, engagement, adherence, and retention in their programs. Considering these factors, the widespread adoption of postpartum blood pressure monitoring programs holds promise to improve the identification and care of this at-risk population. These immediate clinical effects are significant and can reduce short-term hypertension-related morbidity and even mortality, with the potential for long-term benefit with culturally competent, well-reimbursed, and widespread use of these programs. This clinical opinion aims to show that remote monitoring of postpartum hypertensive disorders of pregnancy is a reliable and effective alternative to current follow-up care models that achieves improved blood pressure control and diminishes racial disparities in care while simultaneously being acceptable to providers and patients and cost-saving to hospital systems.
妊娠高血压疾病的发生率出现了惊人的大幅上升，这是孕产妇发病和死亡的一个重要驱动因素。产后时期是一个特别高危的时段，超过50%的与妊娠相关的死亡和严重发病都发生在这一时期。美国妇产科医师学会建议，对患有妊娠高血压疾病的患者，在产后立即进行72小时的住院或同等水平的血压监测，并在产后7至10天再次进行监测。妊娠高血压疾病通过延长住院时间、再入院率、用药数量和所做实验室检查数量，以及对患者和社会造成的不可估量的影响，显著增加了医疗成本。对于那些获得医疗服务存在障碍的患者，尤其是那些在偏远地区难以获得专科医疗服务、交通不便、难以照顾孩子或工作缺乏保障的患者，远程医疗是一种必不可少的选择。鉴于有色人种患者受妊娠高血压疾病的发病率和死亡率影响尤为严重，实施这些项目还有助于缓解种族不平等问题。远程血压监测项目总体上是可接受的，产科人群的满意度较高，且不会带来过度的护理负担。研究报告了不同但令人鼓舞的可行性指标，包括项目的招募率、同意率、参与度、依从性和留存率。考虑到这些因素，产后血压监测项目的广泛采用有望改善对这一高危人群的识别和护理。这些直接的临床效果显著，可以降低短期高血压相关的发病率甚至死亡率，通过以具有文化胜任力、报销良好且广泛使用这些项目，有可能带来长期益处。本临床观点旨在表明，对产后妊娠高血压疾病进行远程监测是一种可靠且有效的替代当前随访护理模式的方法，它能够实现更好的血压控制，减少护理中的种族差异，同时为医疗服务提供者和患者所接受，并为医院系统节省成本。
