(776) Assessment of the Impact of Hemodynamic-aligned Antihypertensive Therapy in Postpartum Management of Preeclampsia

This is a retrospective cohort study of patients with PEC with severe features who delivered at our institution and received a postpartum echo, excluding patients with cardiomyopathy. Antihypertensive choice and decision to order echo were provider dependent. CO and SVR were calculated retrospectively from the echo in collaboration with cardiology. Concordance was defined as patients with high CO ( >6L/min) initiated on labetalol and high SVR ( >1200 dyn.s.cm⁵) initiated on nifedipine. Patients initiated on the opposite medication were grouped as discordant. The primary outcome was time to optimal BP control, defined as the period from the start of BP medication to when no titration was needed. Chi-squared & Fisher’s exact tests were used for categorical variables, and Mann-Whitney U test for continuous variables.

Results: Of the 145 patients, 83 (58%) received concordant therapy. Maternal demographics were similar between groups (Table 1). No patients were on magnesium sulfate during the echo. Most patients had high SVR (74%) vs high CO (26%). Of those with high SVR, 56% were on nifedipine. Overall, 51% of patients received Labetalol and 48% received Nifedipine. There was no difference in the median time to optimal BP control (2 days for both groups, p=0.4). The median postpartum length of stay was 3 days for both groups (p >0.9) (Table 2).

Conclusion: Our study revealed majority of patients with PEC had high SVR, with Nifedipine initiation aligning with most hemodynamic profiles. Although time to optimal BP control did not differ, prospective studies are needed to explore the benefits of hemodynamic aligned therapy in PEC.