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Clinical Guideline: Hypertenson in Pregnancy

PowerPoint presentation: Hypertension in Pregnancy

Hypertension complicates approximately 10% of pregnancies.  It is associated with an increased risk for fetal morbidity (12% of preterm deliveries), maternal morbidity (stroke, renal failure, heart failure, eclampsia) and is one of the most common etiologies for maternal mortality (12-13%).  The American College of Obstetricians and Gynecologist published recommendations from their Task Force on Hypertension in Pregnancy in November 2013.  The following guideline is based primarily on recommendations from the ACOG Task Force.

Get Ready Get Set Go!!

For those of you requiring IRB approval - click here

It’s officially time to get to work.  The expert team has determined the needed baseline data for our work on NAS.  There are 3 separate parts of baseline data that is required to move forward in the NAS initiative.  We will be collecting:

  • Unit Level Data
  • Administration Level Data
  • Patient Level Data.  

Click here to view/download the baseline data collection form

Click here to download the Data Dictionary 

Unit Level Data:  Every team should have completed the Unit Snap Shot that details current practices related to NAS.  If you have not already done so please click here and complete as soon as possible.

Administration Level Data:  There are 3 pieces of administrative data that need to be collected.  Please collect the following data for the time period August 2012-August 2013.  Please email this data to Tammy Haithcox

  • Total number of admissions or hospital births:  Provides us with denominator data
  • Total number of infants with ICD-9 code:  779.5.  This code is for NAS that includes antenatal exposure to opiates with subsequent withdrawal syndrome requiring pharmacologic treatment.  Numerator data for percentage of opiate-exposed infants care for within you facility
  • Total number of infants with ICD-9 code:  760.72.  This code is for opiate-exposure without the criteria of postnatal treatment for NAS.  Numerator data for percentage of infants who are exposed to opiates cared for within your facility.

Patient Level Data:  This data will be entered into Delphi, the database for all initiatives. (Data Collectors:  Please click here for instructions of how to obtain access to Delphi to submit data.)  

  • Each facility will complete the PQCNC NAS Data Collection Sheet on the last 10 patients they have scored for NAS.  We may not be able to get all of the questions answered retrospectively but will ask that you complete as much as possible.  
  • Please indicate for these ten patients whether parents were in a drug treatment program or if they were referred to one during their hospital stay.

Outstanding Prerequisites:  If your team has not completed the following please do so before Jan 7th.

Next Call Wednesday, December 18th, 12:00 pm

Conference Call Number  832-551-5100 access code 222655#

Materials to review: Charter (availalble in the 'Results' column) and Toolkits (last 2 resources in the list)

Agenda To Follow

OBJECTIVE: Given the increasing rates of labor induction and cesarean delivery, and efforts to reduce early term births, we examined recent trends in methods and timing of delivery.

STUDY DESIGN: We identified delivery methods and medical indications for delivery from administrative hospital discharge data for 231 691 deliveries in 2006 and 213 710 deliveries in 2010 from 47 specialty care member hospitals of the National Perinatal Information Center/Quality Analytic Services. In a subset of 17 hospitals, we examined trends by gestational age.

RESULT: From 2006 to 2010, there was an 11% increase in labor induction and a 6% increase in cesarean delivery, largely due to repeat cesareans. There was a 4 per 100 reduction in early term births (37 to 38 weeks), mostly due to a decline in non-medically indicated interventional deliveries.

CONCLUSION: We report a shift in deliveries at 38 weeks, which we believe may be attributed to efforts to actively limit nonmedically indicated early term deliveries.

 

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