Identification of factors associated with delayed treatment of obstetric hypertensive emergencies

摘要: Background Obstetric hypertensive emergency is defined as having systolic blood pressure ≥160 mm Hg or diastolic ≥110 Hg, confirmed 15 minutes apart. The American College of Obstetricians and Gynecologists recommends that acute-onset, severe hypertension be treated with first line-therapy (intravenous labetalol, intravenous hydralazine oral nifedipine) within 60 to reduce risk maternal morbidity death. Objective Our objective was identify barriers lead delayed treatment obstetric emergency. Study Design A retrospective cohort study performed compared women who were appropriately vs those delay in first-line therapy. We identified 604 patients discharge diagnoses chronic hypertension, gestational preeclampsia using International Classification Diseases–10 codes antihypertensive usage a pharmacy database at 1 academic institution from January 2017 through June 2018. Of these, 267 (44.2%) experienced the intrapartum period 2 days delivery; results 213 used for analysis. evaluated characteristics, presenting symptoms circumstances, timing emergency, age presentation, administered medications. Chi square, Fisher’s exact, Wilcoxon rank-sum, sample t-tests compare groups. Univariable logistic regression applied determine predictors treatment. Multivariable model also performed; C-statistic Hosmer Lemeshow goodness-of-fit test assess fit. result considered statistically significant P Results women, 110 (51.6%) had 103 (48.4%) minutes. Patients 3.2 times more likely have an initial nonsevere range timely (odds ratio, 3.24; 95% confidence interval, 1.85–5.68). Timeliness associated presence absence symptoms; without 2.7 2.68; 1.50–4.80). emergencies occurred overnight between 10 pm 6 am 2.72; 1.27–5.83). Delayed association race, white being 1.8 1.79; 1.04–3.08). Conclusion Initial range, symptoms, presentation overnight, complaint labor increasing are Quality improvement initiatives target these should instituted improve