The ACOG Hypertension in Pregnancy guidelines recommend monitoring blood pressure (BP) at 72 hours and 7–10 days postpartum in women with a hypertensive disease of pregnancy. We investigated a bidirectional text messaging system as an alternative to in-person follow up.
We performed a series of rapid cycle interventions in a cohort of women with CHTN, GHTN, or preeclampsia who delivered between September and December of 2014. Patients were given electronic BP cuffs and education prior to discharge. Standard texts were sent twice a day for 7 days post discharge reminding patients to send BPs. Standard responses were sent by the study obstetrician based on a management algorithm. Patients were also instructed to follow up with the usual care postpartum HTN clinic. Ability to meet ACOG guidelines was defined as the number of patients who texted BPs on post-discharge days 1 or 2 and days 5, 6, or 7.
We enrolled 32 patients. Six (19%) returned for their scheduled usual care office BP check. We received at least one BP from 27/32 (84%) patients. Nearly 63% (20/32) texted BPs on 5 of the 7 days. 27/32 (84%) texted at least one BP reading on day 1 or 2, and 21/32 (66%) texted at least one BP on day 5, 6, or 7 (P=.001 vs usual care). Two patients required medications for elevated BPs and none were readmitted for HTN.
Remote BP monitoring via text messaging is an effective, patient centered method for postpartum HTN surveillance. Further testing is needed prior to widespread adoption within the broader obstetric community.