(806) MEWS Due to Severe Hypertension Prior to Delivery: Clinical Characteristics and Outcomes

Maternal early warning systems (MEWS) are used to identify individuals at risk for adverse outcomes related to severe hypertension (HTN). We aimed to describe the frequency, demographics, management, and adverse outcomes of MEWS for severe HTN.

Study Design:

A retrospective cohort study on the pragmatic management of MEWS for severe HTN from March to Dec 2022 at a level IV center. Individuals that triggered a MEWS antenatally or intrapartum for systolic BP > 160 or diastolic BP > 110 mm Hg were included and any subsequent MEWS were collected. Those with MEWS exclusively postpartum were excluded. MEWS were triggered after two sustained severe BPs prompting a provider to bedside within 30 minutes. Composite maternal adverse outcomes (CMAO) included eclampsia, stroke, pulmonary edema, acute kidney injury, myocardial ischemia, placental abruption, or death. Descriptive statistics were performed using N (%), mean (standard deviation [+ SD]) and median (interquartile range [IQR]). 95% confidence intervals (CI) were calculated for CMAO.

Results:

There were 3933 deliveries during the study period and 100 individuals (2.5%) who met inclusion criteria with a total of 541 MEWS—a median of 4 (IQR 2-8) per person. 52% were nulliparous, 21% had preeclampsia in a previous pregnancy, and 54% had chronic hypertension. Mean systolic BP and diastolic BP were 172 + 12 and 98 + 13 mm Hg, respectively. Symptoms occurred in only 15% of MEWS. The rate of CMAO was 8% (95% CI; 3-15%). In response to MEWS, acute antihypertensives were given in 41%, both acute and oral in 20%, and oral only in 7% of cases. 31% of all MEWS (n=170) were not treated. When evaluating adverse outcomes, only one (acute kidney injury) occurred after an untreated MEWS.  

Conclusion:

In our population, the likelihood of developing MEWS for severe HTN before delivery was 2.5% and adverse outcomes occurred in approximately 1 in 10. The majority of cases had no symptoms other than elevated BP. BPs were not treated in 31% of MEWS and only 1 out of 170 were associated with the development of CMAO.