Management of Postpartum Preeclampsia

Rutgers, The State University of New Jersey392 enrolled

Overview

The aim of this study is to assess the effect of a lower treatment threshold for antihypertensive medication and tighter blood pressure control, using remote blood pressure monitoring, on reducing Emergency Room visits for our postpartum patients with hypertensive disease.

The aim of this study is to assess the effect of lower treatment threshold for initiating antihypertensive medication and tighter blood pressure control, using remote blood pressure monitoring, on reducing Emergency Room visits for our postpartum patients with hypertensive disease. The investigators will study and compare two cohorts of patients. The first is a retrospective cohort, including patients delivered at Robert Wood Johnson University Hospital and Cooperman Barnabas Medical Center. The second is a prospective cohort that will enroll patients immediately postpartum who are eligible for our treatment protocol.

Study Type

INTERVENTIONAL

Allocation

NON_RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Enrollment

392

Conditions

Postpartum Preeclampsia

Interventions

Tight postpartum blood pressure controlOTHER

The standard of care for patients with pregnancy induced hypertension is to start antihypertensive therapy if blood pressures are consistently over 150/100 mm Hg. There is no established standard of care for titrating blood pressure medication in the postpartum period for those with chronic hypertension and the approach to these patients varies by institution. The intervention in this study will be to start antihypertensive medications at a lower blood pressure cutoff, which is commonly used in the non-pregnant patient population to more tightly control blood pressure. Remote patient monitoring may be considered standard of care. The blood pressure targets chosen for this study are considered to be standard of care for non-pregnant people.

Eligibility

Sex: FEMALEMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Chronic hypertension, gestational hypertension, or preeclampsia. * Delivery of a neonate after 20 weeks during their current hospitalization * Able to consent * 18 years old or above * English or Spanish speaking * Planning to follow up with a physician associated with Robert Wood Johnson University Hospital or Cooperman Barnabas Medical Center * Ability to follow directions Exclusion Criteria: * Any medical condition that the providers feel is a contraindication to the MOPP algorithm. * Planning to follow up with an outside institution. * Unwillingness to take blood pressure at home.

Locations (2)

Cooperman Barnabas Medical Center

Livingston, New Jersey, United States

Robert Wood Johnson Medical School

New Brunswick, New Jersey, United States

Outcomes

Primary Outcomes

Postpartum Emergency Department visits for hypertensive disorders

Any patient that returns to the Emergency Department for hypertensive disorders

Time frame: Six weeks from date of delivery

Secondary Outcomes

Postpartum readmissions for hypertensive disorders

Any patient that is readmitted to the hospital for hypertensive disorders.

Time frame: 6 weeks form date of delivery

Number of acute postpartum complications of preeclampsia

Postpartum complications include stroke, seizure, thrombocytopenia, elevated liver enzymes, liver rupture, kidney injury.