Article Text

PDF
Comparing standard office-based follow-up with text-based remote monitoring in the management of postpartum hypertension: a randomised clinical trial
  1. Adi Hirshberg,
  2. Katheryne Downes,
  3. Sindhu Srinivas
  1. Department of Obstetrics and Gynecology, Maternal Child Health Research Program, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr Adi Hirshberg, Department of Obstetrics and Gynecology, Maternal Child Health Research Program, University of Pennsylvania, Philadelphia, PA 19104, USA; Adi.Hirshberg{at}uphs.upenn.edu

Abstract

Background Monitoring blood pressure at 72 hours and 7–10 days post partum in women with hypertensive disorders is recommended to decrease morbidity. However, there are no recommendations as to how to achieve this.

Objective To compare the effectiveness of text-based blood pressure monitoring to in-person visits for women with hypertensive disorders of pregnancy in the immediate postpartum period.

Methods Randomised clinical trial among 206 postpartum women with pregnancy-related hypertension diagnosed during the delivery admission between August 2016 and January 2017. Women were randomised to 2 weeks of text-based surveillance using a home blood pressure cuff and previously tested automated platform or usual care blood pressure check at their prenatal clinic 4–6 days following discharge. The primary study outcome was a single recorded blood pressure in the first 10 days post partum. The ability to meet American Congress of Obstetricians and Gynecologists (ACOG) guidelines, defined as having a blood pressure recorded on postpartum days 3–4 and 7–10 was evaluated in the text message group. The study was powered to detect a 1.4-fold increase in a single recorded blood pressure using text messaging. All outcomes were analysed as intention to treat.

Results 206 women were randomised (103 in each arm). Baseline characteristics were similar. There was a statistically significant increase in a single blood pressure obtained in the texting group in the first 10 days post partum as compared with the office group (92.2% vs 43.7%; adjusted OR 58.2 (16.2–208.1), p<0.001). Eighty-four per cent of patients undergoing text-based surveillance met ACOG criteria for blood pressures at both recommended points.

Conclusions Text-based monitoring is more effective in obtaining blood pressures and meeting current clinical guidelines in the immediate postdischarge period in women with pregnancy-related hypertension compared with traditional office-based follow-up.

Trial registration number NCT03185455, Remote Surveillance of Postpartum Hypertension (TextBP), https://clinicaltrials.gov.

  • obstetrics and gynaecology
  • healthcare quality improvement
  • patient-centred care

Statistics from Altmetric.com

Footnotes

  • Funding The design and conduct of the study, collection, management, analysis, and interpretation of the data, and decision to submit the manuscript for publication were supported by two institutional funds.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval University of Pennsylvania IRB.

  • Provenance and peer review Not commissioned; externally peer reviewed.

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.