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Observational Study
. 2018 Apr:12:183-188.
doi: 10.1016/j.preghy.2017.11.003. Epub 2017 Nov 21.

Early warning system hypertension thresholds to predict adverse outcomes in pre-eclampsia: A prospective cohort study

Hannah L Nathan  1 , Paul T Seed  2 , Natasha L Hezelgrave  3 , Annemarie De Greeff  4 , Elodie Lawley  5 , John Anthony  6 , David R Hall  7 , Wilhelm Steyn  8 , Lucy C Chappell  9 , Andrew H Shennan  10
Affiliations
Observational Study

Early warning system hypertension thresholds to predict adverse outcomes in pre-eclampsia: A prospective cohort study

Hannah L Nathan et al. Pregnancy Hypertens. 2018 Apr.

Abstract

Objectives: To evaluate the association between blood pressure (BP) measurements and adverse outcomes in women with pre-eclampsia.

Study design: A prospective cohort study of women with pre-eclampsia admitted to three South African tertiary facilities. BP was measured using the CRADLE Vital Signs Alert (VSA), incorporated with a traffic light early warning system; green: systolic BP <140 mmHg and diastolic BP <90 mmHg, yellow: systolic BP 140-159 and/or diastolic BP 90-109 mmHg (but neither is above the upper threshold), red: systolic BP ≥160 mmHg and/or diastolic BP ≥110 mmHg.

Main outcome measures: Maternal: death, eclampsia, stroke, kidney injury; process measures: magnesium sulfate use, Critical Care Unit (CCU) admission; perinatal: stillbirth, neonatal death, preterm delivery.

Results: Of 1547 women with pre-eclampsia (including 42 twin pregnancies), 33.0% of women triggered a red light on admission and 78.6% at their highest BP. Severe hypertension and adverse outcomes were common across yellow and red categories. Comparing admission red to yellow lights, there was a significant increase in kidney injury (OR 1.74, CI 1.31-2.33, trend test p = .003), magnesium sulfate use (OR 3.40, CI 2.24-5.18, p < .001) and CCU admission (OR 1.50, CI 1.18-1.91, p < .001), but not for maternal death, eclampsia, extended perinatal death or preterm delivery.

Conclusion: The CRADLE VSA, with integrated traffic light early warning system, can identify women who are hypertensive, at increased risk of severe pre-eclampsia complications and in need of escalation of care. Women who triggered a red light were at increased risk of kidney injury, magnesium sulfate use and CCU admission.

Keywords: Blood pressure; Early warning system; Hypertension; Pre-eclampsia.

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Figures

Fig. 1
Fig. 1
Flow diagram of participants.
Fig. 2
Fig. 2
Absolute difference in maternal outcomes (panel A), process outcomes (panel B), perinatal outcomes (panel C) at increasing systolic BP (‘highest’ during admission) from 140 mmHg and the area under the receiver operating characteristic curve (AUROC) values for the performance of highest SBP to predict outcomes, with incidence (%) of outcomes shown above.
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