Adverse Maternal Consequences Associated with Prolonged Acute-Onset Severe Systolic Hypertension during Pregnancy & Early Postpartum: Pitfalls in Practice & Lessons Learned
OBJECTIVE:To determine the types of major maternal-perinatal morbidity associated
with prolonged, acute-onset severe systolic hypertension during pregnancy and
postpartum.METHODS: A medicolegal database retaining only medical record data was created
from all cases involving women with medical/hypertensive disorders of pregnancy
evaluated by the first author between 1986-2015. Case files of women that
experienced severe systolic hypertension (SSH) sustained for many hours to days
were identified for study. RESULTS: Sixty six pregnant/postpartum women
met study criteria. Stroke secondary to intracranial hemorrhage or thrombosis
(65.2) and acute pulmonary edema (33%) were the leading causes of maternal
morbidity and mortality, most often antepartum as a component of early-onset
preeclampsia (≤34 weeks). Eclampsia, abruptio placenta and
injury to heart, liver and/or kidneys were other frequent co-morbidities. Seven
postpartum women developed sudden new-onset postpartum SSH and suffered a
stroke 4-13 days after delivery. Maternal mortality (54.6%) and morbidity as persistent
disability (24.2%) were high in this cohort. CONCLUSION: Failure to
rapidly respond, reduce and sustain at a safe level acute-onset SSH poses a
significant threat to the wellbeing of mothers and babies, before and in the
weeks following delivery. Systems to implement safe practices to identify and
emergently treat severe maternal
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