An initiative developed by Cedars-Sinai investigators improves timeliness of treatment for women with severe pregnancy-related hypertension, one of the leading causes of pregnancy-related death.
According to the new treatment protocol, detailed in The Joint Commission Journal on Quality and Patient Safety, nearly 95% of patients were treated within 30 minutes of confirmed severe hypertension. Expediting treatment reduces the risk of stroke and other maternal morbidity compared to the current national standard of treating hypertensive pregnant patients within 30 to 60 minutes of confirmed diagnosis.
The investigators also found that while black, Asian, and Hispanic women were more likely than white women to have severe pregnancy-related hypertension, race and ethnicity did not play a role in timeliness of treatment.
“We are constantly striving to develop strategies to reduce serious maternal morbidity and mortality while identifying ways to close the racial disparity gap,” said John Ozimek, DO, director of obstetrics and maternal-fetal care at Cedars-Sinai and first author studies. “One of the ways we can minimize or at least reduce the risk of complications from severe hypertension is early recognition and treatment.”
Hypertensive disorders in pregnancy include chronic hypertension, gestational hypertension, preeclampsia-eclampsia, and chronic hypertension with superimposed preeclampsia. In the US, they all remain a significant cause of major maternal morbidity, accounting for approximately 7% of pregnancy-related deaths. And black women have a pregnancy-related death rate more than three times that of white women.
To help overcome some of these challenges, the team at Cedars-Sinai sought to improve early treatment of severe hypertension, which can specifically target and address interventions to potentially improve these outcomes.
Working with residents, physicians and nurses, the team created a standardized protocol for the diagnosis and treatment of severe pregnancy-related hypertension to help remove any barriers.
They then created an automated monthly report that identified women who experienced severe hypertension during labor and delivery. The record for each case was reviewed to determine whether the treatment lasted within 30 minutes. These rates were also compared by race and ethnicity.
From April 1, 2019 to March 31, 2021, 12,069 deliveries were made at Cedars-Sinai. A total of 684 women had at least one episode of severe hypertension. Of these women, 441 met criteria for and received treatment, with 417 (94.6%) treated on time.
For those not treated within 30 minutes, common reasons included patient refusal of medication, slight delay in notifying the health care provider, or temporarily withholding antihypertensives during evaluation and treatment of comorbidity. In most cases, the delay was minimal and still met the national criteria for treatment.
The investigators also found that black, Asian, and Hispanic women were more likely than white women to have severe hypertension requiring treatment. However, race and ethnicity did not play a contributing factor in treatment delay in this specific parameter.
“The fact that black women were more likely to have hypertension than white women was not unexpected, and we know that this is due to a number of complex factors,” said Ozimek, who is also an assistant professor of obstetrics and gynecology. “But what we saw was that the timeliness of treatment for severe hypertension did not differ between the groups, which is so important.”
Sarah Kilpatrick, MD, PhD, chair of the department of obstetrics and gynecology at Cedars-Sinai and lead author of the paper, said, “The really big point that we want to drive home is that we now have this automated program that can be replicated by other institutions. to be able to control their own timeliness of treatment of women with severe hypertension and to identify ways to improve severe maternal morbidity and mortality within their own systems.’
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