174: Effect of a post-birth warning signs education protocol on postpartum follow-up in women with hypertension

Post-birth warning sign instructions are now distributed per hospital protocol prior to discharge to provide women with hypertensive disorders of pregnancy education on when to seek additional care in the postpartum (PP) period. Our objective was to determine if implementation of this protocol correlated with improved PP follow-up at an urban, academic institution. A retrospective cohort study was conducted on women who delivered at a tertiary care center. Women were included if diagnosed with a hypertensive disorder of pregnancy (gestational hypertension, preeclampsia/eclampsia, chronic hypertension) and if discharged from the hospital in the puerperium between March-August 2017 or March-August 2018. A policy was implemented in February 2018 that required staff to provide verbal and written post-birth hypertensive warning sign instructions. Patient attendance at the PP blood pressure (BP) appointment (3-10 days PP), PP visit, and rates of PP readmission for hypertension or emergency department (ED) visits for hypertension were compared before and after implementing the protocol. 125 women were in the pre-intervention group and 253 were in the post-intervention group. The pre-intervention group had a higher rate of a history of a hypertensive disorder (previous pregnancy) (37.6 vs 27.3%, p=0.044), but other demographics were similar. The rates of gestational hypertension, chronic hypertension, and preeclampsia/eclampsia were similar. The median duration of postpartum hospitalization was the same between the groups (2 days). Attendance at the PP BP visit (50.4 vs 51.4%, p=0.91), PP visit (63.2 vs 62.9%, p=1.00), and rates of readmission or ED visit for hypertension were similar (Table). Despite the implementation of a patient education protocol for hypertensive women, the overall rate of PP follow-up was still low. In this cohort of high-risk women, it is clear that additional interventions need to be implemented to improve PP follow-up and continued care. Improved follow-up could decrease rates of postpartum maternal morbidity and mortality.