Clinical Epidemiological Profile of De Novo Postpartum Hypertensive Disorder in BP Koirala Institute of Health Sciences, a Tertiary Care Center in Eastern Nepal

Abstract

Aim: To identify the incidence, clinical risk factors, and clinical course of women with de novo postpartum hypertensive disorder without prior antepartum or chronic hypertensive disorders. Methods: This is a retrospective cross-sectional study. Postpartum records of all pregnant women normotensive in the antepartum and prepregnancy period, delivered in this institute and women (within 6 weeks postpartum period) admitted with the diagnosis of new-onset postpartum hypertension in the reference time period (March 2020–May 2020) were evaluated. Women with an antenatal diagnosis of preeclampsia or chronic hypertension were excluded. Relevant information regarding demographic characteristics, history, pregnancy course, postpartum course, and significant morbidity was collected. The incidence of de novo postpartum hypertension (dPPHTN) was calculated. The medians were compared using the Wilcoxon rank-sum tests. The association between outcome variables and epidemiological and clinical variables was assessed using the Chi-square test. For follow-up of the course of HTN, patients with dPPHTN were inquired via telephone conversation regarding duration of treatment, adherence to home BP charting, and complications. Results: Among 1,080 women who were normotensive 54 women developed dPPHTN giving us the incidence of 4.9%. Cesarean delivery was found to have a statistically significant association with dPPHTN. No statistically significant association was found in terms of parity, family history of HTN in first-degree relatives, and multiple gestations in the development of dPPHTN. No statistically significant difference was found between the medians of maternal age, gestational age at delivery, and that of birth weight among the two groups. The median postpartum day of presentation was 1st postpartum day with range of 0–7th postpartum day. The majority (92%) of cases were asymptomatic and were detected upon routine inpatient blood pressure monitoring, 5% patients had headache as the presenting symptom, and 1 patient presented with seizure. Median (range) peak systolic and diastolic blood pressures were 140 (120–170) mm Hg and 100 (70–110) mm Hg, respectively. The median length of hospital stay was 2 days with range of 2–7 days. About 19 (35%) patients were discharged with daily home blood pressure charting instructions, and 35 (65%) were discharged on oral medications. Regarding follow-up, 17 (31.48%) patients could not be contacted, 15 (27.77%) patients complied with home BP charting and discontinued antihypertensive therapy after physician consultation with duration of use of antihypertensive ranging from 7 to 14 days, 21 (38.88%) were noncompliant and lost to follow-up, 1 (1.8%) patient developed chronic hypertension. Conclusion: De novo postpartum hypertension is an underrecognized disorder with potential serious maternal morbidity. Our study elucidates the need for the development and implementation of stringent postpartum surveillance and follow-up protocols in order to detect, manage, and prevent morbidity due to this disorder.