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CC BY-NC-ND 4.0 · AJP Rep 2018; 08(04): e212-e218
DOI: 10.1055/s-0038-1673632
Case Report
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Safe Motherhood Initiative: Early Impact of Severe Hypertension in Pregnancy Bundle Implementation

Lynn L. Simpson
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, New York
,
Burton Rochelson
2   Division of Maternal-Fetal Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
,
Cande V. Ananth
3   Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York, New York
,
Peter S. Bernstein
4   Division of Maternal-Fetal Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
,
Mary D'Alton
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, New York
,
Cynthia Chazotte
4   Division of Maternal-Fetal Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
,
Jessica A. Lavery
3   Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York, New York
,
Kristin Zielinski
5   American College of Obstetricians and Gynecologists District II, Albany, New York
,
for the Safe Motherhood Initiative Severe Hypertension in Pregnancy Work Group› Author Affiliations
Further Information

Publication History

17 April 2018

21 August 2018

Publication Date:
11 October 2018 (online)

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Abstract

Objective To describe the implementation and early results of the American College of Obstetricians and Gynecologists District II Safe Motherhood Initiative's Severe Hypertension in Pregnancy bundle on the timely treatment of severe hypertension in New York State obstetric hospitals.

Methods This is a retrospective comparative study of two time periods during voluntary implementation of the Severe Hypertension in Pregnancy bundle in New York State's obstetric hospitals. The main outcome measure was the administration of an appropriate antihypertensive agent within 1 hour of the second elevated value for all pregnant or postpartum patients with severe hypertension.

Results Of the 117 obstetric hospitals participating in the Safe Motherhood Initiative, 111 (94.9%) submitted data included in this analysis. During the study period, 80 of the 111 (72.0%) hospitals reported implementing the hypertension bundle. Overall, 2.4% of pregnant women were diagnosed with severe hypertension, and 60 to 65% of patients were treated within an hour of the second elevated value. Although not statistically significant, a greater numbers of patients were treated within an hour of the second elevated value in the second time period compared with the first in most obstetric hospitals (overall 64.8 vs. 60.8%; p = 0.33).

Conclusion There were increasing numbers of patients receiving timely treatment of severe hypertension during early implementation of a Severe Hypertension in Pregnancy bundle in New York State obstetric hospitals. However, bundle implementation requires significant financial and human resources and the long-term impact on maternal morbidity and mortality in our state remains uncertain.

Precis There was a tendency toward more timely treatment of severe hypertension following implementation of a Severe Hypertension in Pregnancy bundle in New York obstetric hospitals.

Keywords

severe hypertension - bundle implementation - safe motherhood - timely treatment

* Author names for this group are provided in Appendix A.


Note

This work is supported by Merck for Mothers, American College of Obstetricians & Gynecologists District II's Safe Motherhood Initiative, and participating New York State obstetric hospitals.