Hypertensive Disorders and Severe Obstetric Morbidity in the United States

Northrop Grumman, Civilian Agencies Group, Atlanta, Georgia, USA.
Obstetrics and Gynecology (Impact Factor: 5.18). 06/2009; 113(6):1299-306. DOI: 10.1097/AOG.0b013e3181a45b25
Source: PubMed


To examine trends in the rates of hypertensive disorders in pregnancy and compare the rates of severe obstetric complications for delivery hospitalizations with and without hypertensive disorders.
We performed a cross-sectional study using the 1998-2006 Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project. Logistic regressions and population-attributable fractions were used to examine the effect of hypertensive disorders on severe complications.
The overall prevalence of hypertensive disorders among delivery hospitalizations increased significantly from 67.2 per 1,000 deliveries in 1998 to 81.4 per 1,000 deliveries in 2006. Compared with hospitalizations without any hypertensive disorders, the risk of severe obstetric complications ranged from 3.3 to 34.8 for hospitalizations with eclampsia/severe preeclampsia and from 1.4 to 2.2 for gestational hypertension. The prevalence of hospitalizations with eclampsia/severe preeclampsia increased moderately from 9.4 to 12.4 per 1,000 deliveries (P for linear trend <0.001) during the period of study. However, these hospitalizations were associated with 38% of hospitalizations with acute renal failure and 19% or more of hospitalizations with ventilation, disseminated intravascular coagulation syndrome, pulmonary edema, puerperal cerebrovascular disorders, and respiratory distress syndrome. Overall, hospitalizations with hypertensive disorders were associated with 57% of hospitalizations with acute renal failure, 27% of hospitalizations with disseminated intravascular coagulation syndrome, and 30% or more of hospitalizations with ventilation, pulmonary edema, puerperal cerebrovascular disorders, and respiratory distress syndrome.
The number of delivery hospitalizations in the United States with hypertensive disorders in pregnancy is increasing, and these hospitalizations are associated with a substantial burden of severe obstetric morbidity.

Download full-text


Available from: Elena Kuklina,
  • Source
    • "HD increase the risk of severe complications by 3 to 25 times, e.g. placental abruption, thrombocytopenia, disseminated intravascular coagulation, acute pulmonary edema, cerebrovascular disorders and other conditions, in comparison to women without hypertension [3,5,6]. The contrast between low or very low maternal mortality ratios (MMR) in high-income countries, compared to low-income or middle-income countries with high MMR has been attributed to the quality of obstetric care, patient access to hospitalization, qualification of health professionals and structural resources, including the input and availability of intensive care units [7-9]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Hypertensive disorders represent the major cause of maternal morbidity in middle income countries. The main objective of this study was to identify the prevalence and factors associated with severe maternal outcomes in women with severe hypertensive disorders. This was a cross-sectional, multicenter study, including 6706 women with severe hypertensive disorder from 27 maternity hospitals in Brazil. A prospective surveillance of severe maternal morbidity with data collected from medical charts and entered into OpenClinica(R), an online system, over a one-year period (2009 to 2010). Women with severe preeclampsia, severe hypertension, eclampsia and HELLP syndrome were included in the study. They were grouped according to outcome in near miss, maternal death and potentially life-threatening condition. Prevalence ratios and 95% confidence intervals adjusted for cluster effect for maternal and perinatal variables and delays in receiving obstetric care were calculated as risk estimates of maternal complications having a severe maternal outcome (near miss or death). Poisson multiple regression analysis was also performed. Severe hypertensive disorders were the main cause of severe maternal morbidity (6706/9555); the prevalence of near miss was 4.2 cases per 1000 live births, there were 8.3 cases of Near Miss to 1 Maternal Death and the mortality index was 10.7% (case fatality). Early onset of the disease and postpartum hemorrhage were independent variables associated with severe maternal outcomes, in addition to acute pulmonary edema, previous heart disease and delays in receiving secondary and tertiary care. In women with severe hypertensive disorders, the current study identified situations independently associated with a severe maternal outcome, which could be modified by interventions in obstetric care and in the healthcare system. Furthermore, the study showed the feasibility of a hospital system for surveillance of severe maternal morbidity.
    Reproductive Health 01/2014; 11(1):4. DOI:10.1186/1742-4755-11-4 · 1.88 Impact Factor
  • Source
    • "Although rates of maternal mortality are low in the United States [US], evidence is accumulating that the country's rates of maternal morbidity during labor and delivery are high [1] and rates of severe obstetric complications are increasing (e.g., hypertension [2], pulmonary embolism [3]). In addition , it is well known that the US ranks behind most other developed countries in its rates of adverse birth outcomes, such as low birth weight [4], preterm birth [5] [6] [7], and infant mortality [4]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective. This study examined to what degree patient-centeredness-measured as an underlying ability of obstetrical nurses-influenced Medicaid patients' satisfaction with care in hospital obstetrical units. Design. Multigroup structural equation modeling design, using three cross-sectional random samples (n = 300 each) from the 2003 Press Ganey National Inpatient Database. Setting. Self-administered mail surveys. Participants. 900 Medicaid recipients recently discharged from inpatient hospital obstetrical units across the United States. Methods. Multigroup structural equation modeling was used to test the goodness of fit between a hypothesized model based on the Primary Provider Theory and patients' ratings of nurses. Results. The model fitted the data well, was stable across three random samples, and was sustained when compared to a competing model. The patient-centeredness of nurses significantly influenced overall patient satisfaction and explained 66% of its variability. When nurses' patient-centeredness increased by one standard deviation, patients' satisfaction increased by 0.80 standard deviation. Conclusion. This study offers a novel approach to the measurement of the patient-centeredness of nurses and a paradigm for increasing it and its influence on Medicaid patients' satisfaction in hospital obstetrical units.
    08/2013; 2013(4):563282. DOI:10.1155/2013/563282
  • Source
    • "The classification scheme of HDP proposed by the National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy includes preeclampsia/eclampsia, preeclampsia superimposed on chronic hypertension, gestational hypertension, and chronic hypertension [4]. Secular increases in chronic hypertension, gestational hypertension and preeclampsia (PE) [5] have occurred as a result of changes in maternal characteristics (such as maternal age and pre-pregnancy weight), whereas declines in eclampsia have followed widespread antenatal care and use of prophylactic treatments (such as magnesium sulfate) [6] [7]. HDP are associated with higher rates of maternal, fetal and infant mortality and severe morbidity, especially in cases of severe PE, eclampsia with or without association of hemolysis, elevated liver enzymes and low platelet syndrome (HELLP) [8] [9]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective To investigate the relationship between COMT G675A and MTHFR C677T polymorphisms and hypertension disorders of pregnancy (HDP) in a Mexican mestizo population. Design and methods This case-control study involved 194 HDP and 194 normoevolutive pregnant women. The polymorphisms were genotyped by real time PCR. Results Our results showed that the COMT AA genotype increases the risk to HDP (OR: 2.67; 95% CI 1.33–5.35), preeclampsia (OR: 2.69; 95% CI 1.00–7.22) and gestational hypertension (OR: 3.87; 95% CI 1.25–12.0). Furthermore, the double mutant genotype (COMTAA/MTHFRTT) potency the risk to HDP more than two times (OR: 5.21; 95% CI 1.12–24.3, p = 0.019). Conclusion Our work provides evidence that COMT 675AA genotype is a risk factor for HDP and that this risk is increased by the presence of MTHFR 677TT genotype in a Mexican mestizo population.
    Pregnancy Hypertension 01/2013; 4(1). DOI:10.1016/j.preghy.2013.11.002
Show more