Amro Farah H, Smith Kim C, Hashmi Syed S, Barratt Michelle S, Carlson Rachel, Sankey Kristen Mariah, Bartal Michal Fishel, Blackwell Sean C, Chauhan Suneet P, Sibai Baha M
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston.
Division of Community & General Pediatrics, Department of Pediatrics, McGovern Medical School, The University of Texas Health Science Center at Houston.
JAMA Netw Open. 2024 Jun 3;7(6):e2416844. doi: 10.1001/jamanetworkopen.2024.16844.
Innovative approaches are needed to address the increasing rate of postpartum morbidity and mortality associated with hypertensive disorders.
To determine whether assessing maternal blood pressure (BP) and associated symptoms at time of well-child visits is associated with increased detection of postpartum preeclampsia and need for hospitalization for medical management.
DESIGN, SETTING, AND PARTICIPANTS: This is a pre-post quality improvement (QI) study. Individuals who attended the well-child visits between preimplementation (December 2017 to December 2018) were compared with individuals who enrolled after the implementation of the QI program (March 2019 to December 2019). Individuals were enrolled at an academic pediatric clinic. Eligible participants included birth mothers who delivered at the hospital and brought their newborn for well-child check at 2 days, 2 weeks, and 2 months. A total of 620 individuals were screened in the preintervention cohort and 680 individuals were screened in the QI program. Data was analyzed from March to July 2022.
BP evaluation and preeclampsia symptoms screening were performed at the time of the well-child visit. A management algorithm-with criteria for routine or early postpartum visits, or prompt referral to the obstetric emergency department-was followed.
Readmission due to postpartum preeclampsia. Comparisons across groups were performed using a Fisher exact test for categorical variables, and t tests or Mann-Whitney tests for continuous variables.
A total of 595 individuals (mean [SD] age, 27.2 [6.1] years) were eligible for analysis in the preintervention cohort and 565 individuals (mean [SD] age, 27.0 [5.8] years) were eligible in the postintervention cohort. Baseline demographic information including age, race and ethnicity, body mass index, nulliparity, and factors associated with increased risk for preeclampsia were not significantly different in the preintervention cohort and postintervention QI program. The rate of readmission for postpartum preeclampsia differed significantly in the preintervention cohort (13 individuals [2.1%]) and the postintervention cohort (29 individuals [5.6%]) (P = .007). In the postintervention QI cohort, there was a significantly earlier time frame of readmission (median [IQR] 10.0 [10.0-11.0] days post partum for preintervention vs 7.0 [6.0-10.5] days post partum for postintervention; P = .001). In both time periods, a total of 42 patients were readmitted due to postpartum preeclampsia, of which 21 (50%) had de novo postpartum preeclampsia.
This QI program allowed for increased and earlier readmission due to postpartum preeclampsia. Further studies confirming generalizability and mitigating associated adverse outcomes are needed.
需要创新方法来应对与高血压疾病相关的产后发病率和死亡率不断上升的问题。
确定在儿童健康检查时评估产妇血压（BP）及相关症状是否与产后先兆子痫的检测增加以及医疗管理住院需求增加相关。
设计、设置和参与者：这是一项前后质量改进（QI）研究。将实施前（2017年12月至2018年12月）参加儿童健康检查的个体与QI项目实施后（2019年3月至2019年12月）登记的个体进行比较。个体在一家学术儿科诊所登记。符合条件的参与者包括在该医院分娩并在2天、2周和2个月时带新生儿进行儿童健康检查的生母。干预前队列共筛查了620人，QI项目筛查了680人。数据于2022年3月至7月进行分析。
在儿童健康检查时进行血压评估和先兆子痫症状筛查。遵循一种管理算法，该算法包含常规或产后早期就诊标准，或迅速转诊至产科急诊科的标准。
因产后先兆子痫再次入院。对分类变量使用Fisher精确检验进行组间比较，对连续变量使用t检验或Mann-Whitney检验。
干预前队列中有595人（平均[标准差]年龄，27.2[6.1]岁）符合分析条件，干预后队列中有565人（平均[标准差]年龄，27.0[5.8]岁）符合条件。干预前队列和干预后QI项目的基线人口统计学信息，包括年龄、种族和族裔、体重指数、初产情况以及与先兆子痫风险增加相关的因素，差异均无统计学意义。产后先兆子痫的再次入院率在干预前队列（13人[2.1%]）和干预后队列（29人[5.6%]）中差异有统计学意义（P = 0.007）。在干预后QI队列中，再次入院的时间框架明显更早（干预前产后中位数[四分位间距]为10.0[10.0 - 11.0]天，干预后为7.0[6.0 - 10.5]天；P = 0.
