RESUMO
BACKGROUND: Hypertensive disorders of pregnancy are increasing in prevalence and a leading cause of early postpartum readmissions. Stricter blood pressure target goals for treatment of hypertension during pregnancy have recently been proposed, however, the treatment goals for management of postpartum hypertension are less well established. OBJECTIVE: We sought to evaluate the clinical factors associated with early postpartum readmissions for hypertensive disease and to evaluate blood pressure thresholds associated with these readmissions. STUDY DESIGN: We conducted a retrospective cohort study of women delivering at a tertiary care center between January 2018 and May 2022 who experienced a hospital readmission for postpartum hypertension or new onset postpartum preeclampsia. Charts were reviewed for clinical and sociodemographic data. Patients with early readmission (<72 hours after discharge) were compared with patients readmitted after 3 days of initial discharge. Data were analyzed using chi-square, Student t test, Mann-Whitney U test, and logistic regression where appropriate. The P value <.05 was considered significant. RESULTS: During the study period, 23,372 deliveries occurred. Postpartum readmission due to worsening of a known diagnosis of hypertension or new onset postpartum preeclampsia occurred in 1.1% and 0.49% respectively. Patients with early readmission were more likely to have hypertensive disorders of pregnancy as the indication for delivery. Among patients readmitted, 93% had 2 or more systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg, and 73% had blood pressure of either systolic between 130 and 139 mmHg or diastolic between 80 and 89 mmHg within 24 hours before initial discharge. Only 27 patients met criteria (blood pressure ≥160/110 mmHg on >1 vitals check during their hospitalization) to be started on antihypertensives before initial delivery discharge; of those 25 (93%) were discharged with a new prescription for an antihypertensive. After controlling for confounding variables, predischarge blood pressure between 130-140 mmHg/80-90 mmHg (adjusted odds ratio, 2.4 [1.5-4.0]) was associated with an increased likelihood of early readmission. CONCLUSION: Patients with delivery for hypertensive disorders of pregnancy and predischarge blood pressure ≥140/90 mmHg were less likely to have an early readmission within 3 days of initial discharge, however, patients with predischarge blood pressure 130-139 mmHg/80-89 mmHg were more likely to have an early readmission for hypertensive disorders of pregnancy and postpartum preeclampsia. Further research is indicated to evaluate interventions to prevent postpartum readmission in patients at high risk for persistent hypertension or new onset postpartum preeclampsia.
RESUMO
Cystic fibrosis (CF) is the most common genetic disease in the United States (US) and, with the development of newer therapeutics, there is increased fertility among women with CF. We present a series of pregnant patients taking novel CF transmembrane conductance regulator (CFTR) modulators and summarize pertinent clinical considerations. All women conceived within four months after starting elexacaftor-ivacaftor-tezacaftor. Pulmonary function was stable before and during pregnancy. One patient developed transaminitis necessitating discontinuation of the medication mid-trimester. All patients delivered healthy neonates between 36-38 weeks of gestation with uncomplicated postpartum courses. No birth defects were encountered. Given that newly introduced CFTR modulators may increase fertility among CF patients, contraception counseling, pulmonary function monitoring, liver function monitoring, and multi-disciplinary care are important pillars of management.
RESUMO
Despite multiple efforts to reduce the use of illicit drugs, the epidemic of addiction continues to be a significant public health issue. Through its easy availability, the number of people afflicted with this addiction continues to rise, including women of childbearing age. Secondarily, any health care crisis that occurs in this age group of women will have potential implications in pregnancy, infancy, and childhood. The use of cocaine alone or in conjunction with other illicit drugs, combined with the normal physiological cardiovascular changes in pregnancy, leads to a myriad of pathophysiological changes, thereby placing the life of the pregnant cocaine user, as well as the health status of their unborn fetus and neonate at risk for adverse outcomes. As more data are available, the long-term physical, mental, and developmental sequelae for children exposed to cocaine in utero prove that this public health crisis has serious implications. The pregnancy-specific maternal, fetal, and neonatal risks of cocaine use during the antepartum period are reviewed.
