Study of Feasibility of Blood Pressure Monitoring in Postpartum Women by Teleconsultation in COVID 19 Pandemic Situation

The Journal of Obstetrics and Gynecology of India https://doi.org/10.1007/s13224-021-01580-0 ORIGINAL ARTICLE Study of Feasibility of Blood Pressure Monitoring in Postpartum Women by Teleconsultation in COVID 19 Pandemic Situation Sonali S. Deshpande1 · Shrinivas N. Gadappa1 · Swati A. Badgire1 · Apurva S. Sholapure1 · Mayura S. Kamble1 · Himani S. Baxy1 Received: 24 May 2021 / Accepted: 7 October 2021 © Federation of Obstetric & Gynecological Societies of India 2022 Abstract Purpose of the Study To study the feasibility of blood pressure monitoring and to assess the feasibility of antihypertensive dose adjustment in postpartum women by teleconsultation in COVID 19 pandemic situation. Methods This was a descriptive longitudinal study conducted in the Department of OBGY, GMCH, Aurangabad between the study periods November 2020 to April 2021 with a sample size of 60. The feasibility of blood pressure monitoring in postpartum women by teleconsultation was measured by recruitment and retention through 12 weeks postpartum. The feasibility of anti-hypertensive dose adjustment through teleconsultation was measured by the number of women requiring hospital visit for uncontrolled blood pressure or those with warning signs and symptoms. The data were collected and analyzed. Results The feasibility of blood pressure monitoring in postpartum women by teleconsultation was 95.23%. During followup, the antihypertensive drug dose was required to be increased in 3 women. Not a single woman required hospital visit or hospital readmission either due to uncontrolled hypertension or warning signs/symptoms. This indicates that the feasibility of anti-hypertensive dose adjustment by teleconsultation was good. Conclusion We demonstrated feasibility and over all good satisfaction rate of Blood Pressure Monitoring in postpartum women by teleconsultation in COVID 19 pandemic situation and found that teleconsultation is a boon in management for postpartum hypertension to reduce readmissions and decrease maternal morbidity while ensuring social distancing and minimizing viral exposure. We recommend teleconsultation as a quality improvement initiative in maternity care. Keywords Teleconsultation · Postpartum · Blood pressure monitoring · Hypertensive disorders in pregnancy · COVID19 pandemic Introduction Hypertensive disorders of pregnancy (HDP) remain among the most significant and intriguing unsolved problems in obstetrics. In India, the prevalence of HDP was 7.8% with pre-eclampsia in 5.4% of the study population [1]. The majority of research has focused on antenatal management Dr. Sonali Deshpande, MD, is an Academic Professor & Unit Head of Obstetrics and Gynaecology at Govt. Medical College and Hospital, Aurangabad. She has been Master Trainer for BEmOC, CEmOC, SAB, Ipas. * Sonali S. Deshpande 1 Department of Obstetrics and Gynecology, Government Medical College and Hospital, Aurangabad, Maharashtra 431001, India of hypertension in pregnancy; therefore, there is very little information on how to best manage postpartum hypertension, regardless of type or severity to optimize maternal safety [2]. Postpartum, it is not uncommon for normotensive women to have a physiologic increase in blood pressure [3, 4]. Furthermore, in an observational study in hypertensive women with or without proteinuria, many of the women had an initial decrease in blood-pressure (BP) after delivery, followed by a rise to hypertensive levels between days 3 and 6 postpartum [4, 5]. This increase typically occurs after the woman is discharged from the hospital. The exact reason for exacerbation of hypertension between days 3 and 5 is not exactly known, but it can have serious consequences such as stroke and rarely death [4, 6].The American College of Obstetricians and Gynaecologists (ACOG) guidelines suggest blood pressure monitoring in the hospital or that equivalent outpatient 13 Vol.:(0123456789) S. S. Deshpande et al. surveillance be performed for at least 72 h postpartum and 7–10 days after childbirth or earlier in women with symptoms who had gestational hypertension, preeclampsia, or superimposed preeclampsia [7].Cost-effective interventions are needed to identify women at risk for severe postpartum hypertension, support optimal blood pressure follow-up, and self-management. Our institute is a tertiary care centre catering patient from 12 nearby districts. As majority of cases were referred from rural area, monitoring of blood pressure in postpartum women may be a difficult task especially in this pandemic era. Repeated follow-up visits in hospital may not be possible. At the same time, if the women were counselled regarding the importance of blood pressure monitoring and dose adjustment of antihypertensives in postpartum period, they may be ready for follow-up, but it will be difficult for them to get specialist care for solving their problem. There is emerging data on the feasibility and satisfaction of home blood pressure monitoring for postpartum women with a hypertension-related pregnancy disorder [8]. If she gets her blood pressure monitored at home and if conveyed her BP readings on telephone or WhatsApp to specialist, it will help her to have improved outcome. Keeping this in mind we conducted a study to investigate the feasibility of teleconsultation with blood pressure monitoring with digital BP apparatus at home for management of hypertension in postpartum women at risk of severe or exacerbation in hypertension after hospital discharge. Aims & Objectives • To study the feasibility of BP monitoring in postpartum women by teleconsultation in COVID 19 pandemic situation. • To assess feasibility of antihypertensive dose adjustment through telemedicine • To study the pattern of BP normalization at home. • To determine number of women requiring hospital visit for uncontrolled blood pressure or warning signs and symptoms. Material & Methods This was a descriptive longitudinal study conducted in the Department of OBGY, GMCH, Aurangabad between the study period November 2020 to April 2021. A sample size of 60 was estimated to achieve a desired precision in the estimated recruitment and consent rates to within a 95% confidence interval of ± 11% or 14% assuming 10% drop-out by Cochrane formula [9]. 13 Inclusion Criteria Women who underwent vaginal delivery with HDP without any complication and willing to participate in the study and having digital BP apparatus and mobile phone with WhatsApp application at home. Birth companion willing to record BP and inform obstetrician. Exclusion Criteria Postnatal women with eclampsia or HDP with complications, those not willing to participate in the study, women who underwent cesarean section, women readmitted to hospital for neonatal complication. After the permission of Institution Ethics Committee and after applying inclusion and exclusion criteria, women were recruited in the study. Informed valid consent was obtained after making her aware about the purpose (...truncated)