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Multivariable risk model for postpartum re-presentation with hypertension: development phase.

Helen Elizabeth McDougall1,2, Grace Yuan2,3, Nadia Olivier2

  • 1Alfred Health, Melbourne, Victoria, Australia h.mcdougall@alfred.org.au.

BMJ Open Quality
|December 28, 2023
PubMed
Summary

Postpartum hypertension is a major cause of hospital readmission. A new risk model using discharge data can identify high-risk patients, enabling early interventions to prevent complications.

Keywords:
clinical decision-makinghospital medicinemachine learningobstetrics and gynecologyrisk management

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Area of Science:

  • Obstetrics and Gynecology
  • Cardiovascular Medicine
  • Health Informatics

Background:

  • Postpartum hypertension is a leading cause of hospital readmission and increases long-term cardiovascular risk.
  • Identifying at-risk patients is challenging, as many cases of postpartum hypertension arise de novo.
  • Early monitoring and management interventions can reduce complications and improve long-term blood pressure control.

Purpose of the Study:

  • To develop a predictive risk model for postpartum hypertension re-presentation.
  • To utilize data readily available at hospital discharge for risk assessment.
  • To identify women at risk for targeted interventions.

Main Methods:

  • A case-control study was conducted using retrospective data from 17,746 deliveries.
  • Multivariable analysis and bootstrapping were employed to identify and select key risk factors.
  • The model's discriminative ability was assessed using the C-statistic (0.90 in the training cohort).

Main Results:

  • Over 17,000 deliveries were analyzed, with 72 cases of postpartum hypertension re-presentation.
  • 51.4% of re-presentations were de novo postpartum hypertension.
  • Six factors, including pre-eclampsia, gestational hypertension, peak systolic blood pressure, aspirin use, and elective cesarean delivery, were selected for the model.

Conclusions:

  • The developed risk model uses readily available discharge data to predict postpartum hypertension re-presentation.
  • Further validation is needed, but the model shows promise for identifying at-risk women.
  • This tool can facilitate interventions to prevent postpartum hypertension and its associated complications.