Poster Session 2
Adina R. Kern-Goldberger, MD, MPH, MSCE
Assistant Professor
Cleveland Clinic Lerner College of Medicine
Cleveland, Ohio, United States
Megan R. Ansbro, MD, PhD
Resident Physician
Cleveland Clinic Foundation
Cleveland, Ohio, United States
Antonio Bajan, BS
Cleveland Clinic Foundation
Cleveland, Ohio, United States
Elizabeth Raiff, MPH
Research Program Manager
Cleveland Clinic Ob/Gyn & Women’s Health Institute
Cleveland, Ohio, United States
Justin R. Lappen, MD
Division Director - Maternal Fetal Medicine
Associate Professor - Obstetrics/Gynecology and Reproductive Biology
Cleveland Clinic Lerner College of Medicine, Case Western Reserve University
Cleveland Clinic
Cleveland, Ohio, United States
Patients with preeclampsia are at increased risk for severe maternal morbidity (SMM). Elucidating risk for specific sub-types of SMM can inform interventions to improve maternal outcomes. This study describes the incidence of SMM indicators in patients with hypertensive disorders of pregnancy (HDP).
Study Design:
This retrospective cohort study included all deliveries > 20 weeks across a multi-hospital academic health system from 1/1/2022-6/30/2024. Patient clinical information was extracted from the electronic health record and patients were classified as having gestational hypertension/mild preeclampsia (gHTN), severe preeclampsia (SPEC, inclusive of superimposed preeclampsia), or no HDP during the delivery admission. Patient characteristics classified according to OBCMI components and outcomes, including SMM sub-types, were compared in univariable analyses using chi2 by hypertensive disorder of pregnancy status.
Results:
28,812 patients were included: 5,495 with gHTN (19.1%) and 2,432 with SPEC (8.4%). Patient co-morbidities classified according to OB-CMI components were different across groups for every condition except coronary artery disease, congenital heart disease, and autoimmune disease (Table 1). There were significant differences in incidence of preterm birth, cesarean delivery, ICU admission, extended postpartum length of stay (>5 days), and readmission, as well as non-transfusion SMM, which ranged from 1.0% in patients without HDP to 1.8% in patients with gHTN and 9.1% in patients with SPEC (Table 2). Renal failure was the most frequent SMM indicator for all groups, occurring in 4.7% of patients with SPEC. Eclampsia was the second most common indicator in patients with SPEC, followed by disseminated intravascular coagulation (Table 2).
Conclusion:
SMM sub-types have differential incidence based on HDP status. The high rate of renal failure in patients with SPEC could be an important target for care improvement or may reflect over-coding of mild kidney injury, correction of which is an equally important quality target to accurately capture SMM.
