Cedars-Sinai investigators have developed a new initiative to improve the speed of treatment for women suffering from severe pregnancy-related hypertension. This is one of the leading causes and consequences of pregnancy-related deaths.
Nearly 95% of patients with confirmed severe hypertension were treated under the new protocol. It was detailed in The Joint Commission Journal on Quality and Patient Safety. This speedy treatment decreases maternal stroke risk and other morbidities, as opposed to the current national standard for treating pregnant hypertension patients within 30-60 minutes of diagnosis.
Researchers also discovered that although Black, Asian, and Hispanic women were more likely to develop severe pregnancy-related hypertension than white women, race and ethnicity didn’t play any role in the treatment timeliness.
“We are constantly looking to develop strategies to decrease both severe maternal morbidity and mortality, while identifying ways of narrowing the racial disparity gap,” said John Ozimek, DO, the director of Labor & Delivery and the Maternal-Fetal Care Unit at Cedars-Sinai and first author of the study. “One of the ways that we can minimize, or at least decrease risk of complication from severe hypertension, is by recognizing and treating it quickly.”
Hypertensive disorders of pregnancy include chronic hypertension, gestational hypertension, preeclampsia-eclampsia, and chronic hypertension with superimposed preeclampsia. These are all significant causes of severe maternal morbidity and account for approximately 7% in pregnancy-related deaths in the U.S. Black women have a three-fold higher rate of pregnancy-related deaths than white women.
Cedars-Sinai’s team sought to address these issues and improve the timely treatment for severe hypertension.
The team worked with nurses, doctors, and residents to create a standard protocol for diagnosing and treating severe pregnancy-related hypertension. This was intended to eliminate any obstacles.
An automated monthly report was created that identified women who suffered severe hypertension during labor and delivery. To determine if each case had received treatment within 30 minutes, the records were reviewed. These rates were also compared based on race and ethnicity.
Between April 1, 2019 and March 31, 2021 there were 12,069 deliveries in Cedars-Sinai. 684 women experienced severe hypertension at least once. 441 women had severe hypertension and 441 received treatment. 417 (94.6%) were treated quickly.
Patients who are not treated within 30 minutes of the deadline were most likely to have refused to take their medication, delayed notification to the healthcare provider, and/or antihypertensive drugs temporarily withheld while they were being evaluated for concurrent morbidity. The majority of cases met the national criteria and were treated without delay.
Investigators also discovered that black, Asian, and Hispanic women were more likely to develop severe hypertension and need treatment than white women. In this particular parameter, however, race or ethnicity did not contribute to delays in treatment.
“The fact that Black women were more likely to experience hypertension than white women was not unexpected, and we know that is due to a variety of complex factors,” said Ozimek, who is also an assistant professor of Obstetrics and Gynecology. “But what we saw was timeliness of treatment for severe hypertension didn’t differ between the groups, which is so important.”
Said Sarah Kilpatrick, MD, PhD, chair of the Department of Obstetrics and Gynecology at Cedars-Sinai and senior author of the paper, “The really big point we want to drive home is that we now have this automated program that other institutions can duplicate to be able to audit their own timeliness of treatment of women with severe hypertension and identify ways to improve severe maternal morbidity and mortality within their own systems.”