An Integrated Approach to the Hypertensive Disorders of Pregnancy

To institute a standardized protocol for the assessment, surveillance and management of women admitted with a hypertensive disorder of pregnancy and to monitor the effect of the protocol on health outcomes, resource utilization, place of care, and family/social disruption.

To institute a standardized protocol for the assessment, surveillance and management of women admitted with a hypertensive disorder of pregnancy and to monitor the effect of the protocol on health outcomes, resource utilization, place of care, and family/social disruption.

Research Summary

Seven to 10 percent of pregnancies are complicated by hypertensive (high blood pressure) disorders (HDP), particularly eclampsia. These disorders are the leading cause of maternal mortality in North America. The condition often results in premature delivery, requiring specialized intensive care for the newborn and increasing the risk of long term physical and developmental health problems. Hypertensive disorders also are responsible for nine percent of all patient transfers from a low risk birthing unit to a secondary or tertiary facility in BC, costing on average $15,000 per transfer. The incidence of HDPs continues to rise with the growing prevalence of risk factors such as advanced maternal age at first pregnancy, multiple births, and obesity.

The goal of this research project is to institute a standardized protocol for the assessment, surveillance and management of pregnant women admitted to hospital with an HDP. The research team will monitor the impact of the standardized protocol on health outcomes of the mother and baby, the utilization of health system resources and the degree to which family and social disruption caused by transfer and hospitalization is reduced.

The team expects that this research will contribute to better management of pregnant women with hypertensive disorders and better outcomes for them and their newborns. Further, they expect that their findings will also be useful in adapting this model to address other leading causes of prematurity, such as preterm labour, premature rupture of membranes, poor fetal growth, and bleeding behind the placenta (abruption).

Research Results

We introduced new guidelines through an active mechanism of engaging stakeholders, soliciting and incorporating feedback, and then presenting throughout the province to maximize buy-in. Using data collected by the BC Perinatal Database Registry since 2000/2001, we have been able to track the incidence of various adverse outcomes for mothers and babies for every woman diagnosed with a HDP in BC. We compared data for the five fiscal years before the new guidelines were introduced with data from the two years since their introduction.

Following the introduction of the new guidelines adverse maternal and fetal outcomes were less frequent (60% and 40%, respectively) across the province.  These results demonstrate that the active introduction of new evidence-based guidelines can alter adverse outcomes across a health system.

Through this participatory action research project, we created an expert research team of managers, researchers, and clinicians who were charged with identifying, on the basis of evidence and local information, how practices might be standardized to improve population well-being in the scenario of the HDP. The framework developed was seen as an improvement over historical methods of guideline implementation, and may have utility in other settings of increased perinatal risk.