(609) Survey of current management practices for gestational hypertension and preeclampsia in the postpartum period

Objective:
To assess postpartum management practices for hypertensive disorders of pregnancy (HDP) among maternal-fetal medicine specialists.

Study Design:
An 18-item survey on the clinical management of postpartum HDP (gestational hypertension and preeclampsia) was designed and validated through six cognitive interviews with general OB and MFMs. The revised survey was disseminated to SMFM members via email and SMFM’s Surveys of Interest webpage.

Results:
379 SMFM members completed the survey, with 95.2% from the U.S. and 77.2% working in academic or mixed academic-community settings (Table 1). The most common blood pressure (BP) thresholds for initiating antihypertensive therapy postpartum were ≥140 mmHg (54.9%) and ≥150 mmHg (33.2%) for systolic BP, and ≥90 mmHg (57.3%) and ≥100 mmHg (34.6%) for diastolic BP. Most respondents (68.5%) preferred to see at least two elevated BPs before initiating therapy. Respondents used similar BP thresholds for dose escalation. 46.4% reported that their workplace has formal guidelines for postpartum HDP management. 68.3% believed that evidence-based recommendations for antihypertensive therapy initiation endorsed by a professional society would be “very useful”, and only 24.6% reported being “satisfied” or “highly satisfied” with the available guidance. For postpartum BP monitoring, 40.6% have access to a remote BP monitoring system, and of these 47.3% enroll 75-100% of their patients in the system. 73.4% of those without remote BP monitoring reported prescribing BP cuffs at discharge from the delivery admission. Regarding magnesium sulfate administration during postpartum readmissions, 19.5% reported routinely administering it, and 65.5% indicated that administration depended on the presence of neurologic symptoms, lab abnormalities, or persistent severe-range BPs. If indicated, 54.2% would administer magnesium sulfate up to two weeks postpartum, while 28.9% would do so up to 6 weeks postpartum (Table 2).

Conclusion:
This survey highlighted the variation in postpartum HDP management, underscoring the need for standardization of postpartum HDP care.