title: Clinical factors associated with readmission for postpartum hypertension in women with pregnancy-related hypertension: a nested case control study.
abstract: To evaluate the association between mode of delivery and length of labor on readmission for postpartum hypertension in women with pregnancy-related hypertension.
  
  
  
  Nested case control study within a cohort of 99 women with pregnancy-related hypertension who delivered at our institution between 2005 and 2009. Data were abstracted for clinical and labor information. Mode of delivery and length of labor were compared between women with previously diagnosed pregnancy-related hypertension readmitted within 4 weeks post partum (25 cases) and those not readmitted (74 controls). Categorical and continuous variables were compared using χ(2) and T-tests, respectively. Multivariable logistic regression controlled for confounders.
  
  
  
  Hypertension readmission was not associated with mode of delivery (cases: 10(40%) spontaneous vaginal delivery, 15(60%) cesarean delivery; controls: 38(51%) spontaneous vaginal delivery, 36(49%) cesarean delivery, P=0.33). Length of labor appeared longer in cases, with a trend toward significance (median: 15.5 [7,28] h vs 10.75 [5.8,15.9] h, P=0.12) and was significantly associated with readmission after controlling for delivery mode, induction and parity (adjusted odds ratio=1.06 [1 to 1.12], P=0.048). Readmitted patients were less likely to have initially been started on antihypertensive medications after controlling for age, race and chronic hypertension (adjusted odds ratio=0.23 [0.06 to 0.88], P=0.03).
  
  
  
  Postpartum readmission for hypertension in women with known pregnancy-related hypertension is not associated with mode of delivery, appears increased in those with longer length of labor and decreased in those initially started on antihypertensive medications. This provides targets for future research to continue to improve transitions of care and reduce preventable readmissions.
authors.affiliation: Department of Obstetrics and Gynecology, Maternal and Child Health Research Program, Hospital of the University of Pennsylvania, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
authors.forename: A
authors.initials: A
authors.lastname: Hirshberg
authors.affiliation: Department of Obstetrics and Gynecology, Maternal and Child Health Research Program, Hospital of the University of Pennsylvania, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
authors.forename: L D
authors.initials: LD
authors.lastname: Levine
authors.affiliation: Department of Obstetrics and Gynecology, Maternal and Child Health Research Program, Hospital of the University of Pennsylvania, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
authors.forename: S K
authors.initials: SK
authors.lastname: Srinivas
mesh_terms: D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D036861:Delivery, Obstetric / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000201:enzymology / Q000628:therapy; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D011314:Preventive Health Services / Q000379:methods; D011644:Puerperal Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D018570:Risk Assessment; D012307:Risk Factors; D013223:Statistics as Topic; D014481:United States / Q000453:epidemiology
chemical_list: D000959:Antihypertensive Agents