The incidence of pregnancy-related maternal death in the United States has more than doubled from 7.2 per 100,000 live births in 1987 to 16.9 per 100,000 in 2016. According to NPR and ProPublica, American mothers die of pregnancy-related complications more than in any other developed country and the U.S. is also the only country in which the rate of maternal deaths is rising. Maternal mortality due to cardiovascular disease accounted for more than one-third of the cases in CDC studies from 2011 to 2016.
Researchers at the University of Pittsburgh School of Medicine and the Magee-Womens Research Institute (MWRI) developed a telemedicine blood pressure monitoring program for postpartum women who are diagnosed with a hypertensive disorder. As outlined in a recent study published in Obstetrics & Gynecology, the group from Pitt and MWRI enrolled 499 postpartum patients diagnosed with preeclampsia, eclampsia, or chronic, gestational, or postpartum hypertension. The women went home with automatic blood pressure cuffs and instructions on how to use them.
During the first week after discharge, an automated nursing call center-managed system integrated with the patients’ electronic health records prompted them to record and report their blood pressure readings and heart rate once a day for five days. If patients reported extremely high readings, the system directed them to go to the emergency department. The program algorithms informed the patients’ healthcare teams and prompted increased monitoring frequency when the reports showed abnormal but less dangerous readings. The system automatically canceled pre-scheduled one-week follow-up appointments for patients with normal readings.
In 2018, the American College of Obstetricians and Gynecologists (ACOG) recommended postpartum checkups, starting within three weeks of birth. The ACOG reported that only 66% of new mothers diagnosed with hypertension disorders returned for checkups within six weeks. According to the Pitt-MWRI group, 88% of the patients in its study went for checkups.
The authors of the study cited scalability as a major advantage of the telemedicine program for hypertensive postpartum moms. The team also reported high satisfaction rates and an increased sense of ownership on the part of patients in the home blood pressure monitoring study.
