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The purpose of this study is observe outcomes before and after a change in clinical practice in the threshold for management of severe hypertension in pregnancy and the post-partum period. Outcomes will be observed for 10 months under the current (traditional) clinical blood pressure threshold for acute treatment of hypertension, which is >= 160 millimeters of mercury (mmHg) systolic blood pressure (SBP). This will be followed by one month of education about rationale for the new SBP threshold of >= 180 mmHg and change of clinical guidelines. Then, there will be 10 months of observation after adopting the updated clinical threshold for acute antihypertensive treatment (>= 180 SBP).
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Traditional clinical blood pressure threshold of SBP >= 160 mmHg for acute treatment of hypertension |
| ||
| Updated clinical blood pressure threshold of SBP >= 180 mmHg for acute treatment of hypertension |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Clinical blood pressure threshold of SBP >= 160 mmHg for acute treatment of hypertension | Procedure | Patients are treated for hypertension if SBP >= 160 mmHg. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Number of patients with Congestive Heart Failure/Pulmonary Edema, hemorrhagic or ischemic Stroke, Acute Kidney Injury (creatinine > 1.5mg/dL), and/or or Myocardial Ischemia. | The primary outcome is a composite outcome, and will be reported as number of patients who have Congestive Heart Failure/Pulmonary Edema, hemorrhagic or ischemic Stroke, Acute Kidney Injury (creatinine > 1.5mg/dL), and/or Myocardial Ischemia. | during the time of delivery hospitalization (about 2 days to 3 months) |
| Measure | Description | Time Frame |
|---|---|---|
| Number of patients with non-reassuring fetal heart rate tracing (NR-FHRT) requiring caesarean delivery | at the time of delivery | |
| Number of patients with Apgar score < 7 at 5 min | The Apgar score indicates the status of the newborn infant immediately after birth. Apgar score ranges from 0-10, with a higher score indicating a better outcome. |
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Inclusion Criteria:
Exclusion Criteria:
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Any individual > 20 weeks' gestation in triage or admitted at Children's Memorial Hermann Hospital (CMHH) in Houston, Texas and with blood pressure with >= 160/110 mmHg
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| Name | Affiliation | Role |
|---|---|---|
| Kristen Cagino, MD | The University of Texas Health Science Center, Houston | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| UT Houston | Houston | Texas | 77004 | United States |
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| Clinical blood pressure threshold of SBP >= 180 mmHg for acute treatment of hypertension | Procedure | Patients are treated for hypertension if SBP >= 180 mmHg. |
|
| 5 minutes after birth |
| Number of patients with eclampsia | during the time of delivery hospitalization (about 2 days to 3 months) |
| Number of patients with placental abruption | during the time of delivery hospitalization (about 2 days to 3 months) |
| Number of patients with posterior reversible encephalopathy syndrome (PRES) | during the time of delivery hospitalization (about 2 days to 3 months) |
| Number of patients with hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome | during the time of delivery hospitalization (about 2 days to 3 months) |
| ID | Term |
|---|---|
| D046110 | Hypertension, Pregnancy-Induced |
| ID | Term |
|---|---|
| D011248 | Pregnancy Complications |
| D005261 | Female Urogenital Diseases and Pregnancy Complications |
| D000091642 | Urogenital Diseases |
| D006973 | Hypertension |
| D014652 | Vascular Diseases |
| D002318 | Cardiovascular Diseases |
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