Are There Predictable Blood Pressure Patterns After Delivery in Women With Preeclampsia? [20B]. (May 2017)

• Record Type: Journal Article
• Authors: Hirshberg, Adi; Sammel, Mary; Srinivas, Sindhu K.
• Is Part Of: Obstetrics and gynecology. Volume 129 (2017)Supplement 1
• Publication Date: 2017-05
• Subjects: Obstetrics -- Periodicals; Gynecology -- Periodicals; 618
• DOI: 10.1097/01.AOG.0000514290.80956.62
• Languages: English
• ISSNs: 0029-7844

Abstract

Abstract : INTRODUCTION: There is limited data on blood pressure(BP) patterns after delivery among women diagnosed with preeclampsia. We sought to investigate immediate postpartum BP trajectories and the impact of fluid balance on these patterns. METHODS: Prospective cohort of women with preeclampsia from 2005-2009. Group-based trajectories were created using latent-class models based on all individual BPs from delivery to 48 hours postpartum. Fluid balance was defined as input minus output from admission until 24 hours postpartum. Odd ratios were calculated for association between BP group, fluid balance, mode of delivery, length of labor, and disease severity. RESULTS: 96 women were evaluated. A model identifying four distinct patterns best fit the BP trajectories (class 1 (n=28):initial decrease in BP followed by rise at discharge, class 2(n=11):persistently elevated BPs, class 3(n=25):rising BPs until discharge, class 4(n=32):normal BP control). There was a statistically significant association between maternal age (p=0.0004) and initial weight(p=0.0005), parity(p=0.02), history of hypertension(p=0.035) or preeclampsia(0.024), and gestational age at delivery(p=0.018) with BP group. Women with a fluid balance greater than 500 cc and cesarean delivery after more than 12 hours of labor were more likely to be in group 3 vs 4(OR 3.97, p=0.03; OR 8.4, p=0.001). Severity of disease(p=0.36) was not associated with BP group. CONCLUSION: There are distinct patterns of BP immediately postpartum. Persistent hypertension is associated with age, chronic hypertension, fluid balance, length of labor, and mode of delivery. Future investigations should evaluate whether diuresis, as a modifiable factor, can alter patterns of BP and expedite resolution of hypertension in the postpartum period.