Postpartum Arterial Hypertension Management in Patients with Severe Preeclampsia. The Experience of a High Specialty Hospital of Mexico City

Background: The management of postpartum hypertension is a priority in severe preeclampsia (SP) to reduce short and long term complications. This study aimed to analyze the results of the management of postpartum arterial hypertension in patients with SP of a high specialty hospital of Mexico City.

Methods: An observational, longitudinal, retrospective and analytical study was carried out in a series of 91 pregnant women with SP admitted to the Intensive Care Unit (ICU) from May 1 to September 30, 2019 with termination of pregnancy and postpartum stay in the same hospital. Systolic blood pressure (SBP), diastolic blood pressure (DBP) and antihypertensive management were compared on admission (prepartum, baseline measurement) and on days 1, 3 and 7 postpartum. Statistical analysis: descriptive statistics, Student t test and two-way ANOVA test with the statistical program SPSS version 20.

Results: Age 30.91±6.69 years, parity 2 and pregnancy of 32.48±4.21 weeks. SBP gradually decreased, at the end of the study the changes had statistical significance (baseline measurement 163.08±16.52, vs day 1 133.78±22.11 P=.150, vs day 3 131.56±21.07 P=0.051, vs day 7 125.02±17.79 P=0.007). DBP also decreased, but at the end of the study the changes were not significant (baseline measurement 100.29±13.06, vs day 1 82.02±13.88 P=.61, vs day 3 80.87±11.98 P=.11, day 7 78.02±10.78 P=.14. At the beginning, the combination of two to five oral drugs was necessary, but in the end the number of drugs was reduced. Blood pressure was controlled (<140/90 mmHg) in 87.92% (n=80), and 12.08% (n=11) continued with uncontrolled hypertension (≥140/90 mmHg). Stay in the ICU was 2.33±2.12 days, hospital stay 7.23±3.69 days and mortality 0%.

Conclusion: SBP was significantly improved, but not DBP. Polypharmacy was necessary in most cases. A significant number of patients did not have adequate blood pressure control.