TITLE:
Adverse Maternal Consequences Associated with Prolonged Acute-Onset Severe Systolic Hypertension during Pregnancy & Early Postpartum: Pitfalls in Practice & Lessons Learned
AUTHORS:
James Nello Martin Jr., James Martin Tucker
KEYWORDS:
Severe Systolic Hypertension Acute Pulmonary Edema Maternal Morbidity & Mortality Maternal Safety
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.11 No.5,
May
27,
2021
ABSTRACT: OBJECTIVE: To determine the types of major maternal-perinatal morbidity associated
with prolonged, acute-onset severe systolic hypertension during pregnancy and
postpartum. METHODS: A medicolegal database retaining only medical record data was created
from all cases involving women with medical/hypertensive disorders of pregnancy
evaluated by the first author between 1986-2015. Case files of women that
experienced severe systolic hypertension (SSH) sustained for many hours to days
were identified for study. RESULTS: Sixty six pregnant/postpartum women
met study criteria. Stroke secondary to intracranial hemorrhage or thrombosis
(65.2) and acute pulmonary edema (33%) were the leading causes of maternal
morbidity and mortality, most often antepartum as a component of early-onset
preeclampsia (≤34 weeks). Eclampsia, abruptio placenta and
injury to heart, liver and/or kidneys were other frequent co-morbidities. Seven
postpartum women developed sudden new-onset postpartum SSH and suffered a
stroke 4 - 13 days after delivery. Maternal mortality (54.6%) and morbidity as persistent
disability (24.2%) were high in this cohort. CONCLUSION: Failure to
rapidly respond, reduce and sustain at a safe level acute-onset SSH poses a
significant threat to the wellbeing of mothers and babies, before and in the
weeks following delivery. Systems to implement safe practices to identify and
emergently treat severe maternal hypertension are needed.