Hypertension during pregnancy accounts for nearly 7% of all maternal deaths. At Twistle, we look at barriers to care, and how digital engagement tools can help.

Maternal mortality in the United States

The United States may spend the most of any nation on healthcare overall, but that doesn’t mean the outcomes are better.

In fact, we have the dismal status of ranking last for maternal mortality and morbidity among developed countries. More than half of maternal deaths occur after the day of delivery and one-fifth of those happen between 7 and 42 days postpartum.1

Gaps in detection and management of postpartum hypertension

Hypertensive disorders of pregnancy (HDP) complicate approximately 10% of pregnancies nationally. About one-third of eclampsia (part of HDP) occurs postpartum with almost half of those presenting about 48 hours after delivery. While overall rates of HDP related mortality have declined in the US, it accounts for almost 7% of all maternal deaths. And most of these HDP related deaths occur after birth with 41% occurring > 48 hours postpartum.2 Black, American Indian, and Alaska Native (AI/AN) women are 2-3 times more likely to die from pregnancy related causes compared to white women. Among both black and AI/AN women, hypertensive disorders of pregnancy account for a significant proportion of maternal deaths.

Barriers to Care

Caring for a new baby while recovering from a delivery is a lot of work. Between 10% to 40% of women do not attend their postpartum visits which usually take place 2-6 weeks after discharge from the hospital. A woman has to contend with a myriad of factors during the postpartum period – including her own physical and emotional well being as well as that of her baby. Access to care is impeded by multiple factors including transportation, childcare issues and work and family obligations. Women with HDP are coping with all these elements in addition to an evolving potentially dangerous medical condition.

Leverage Technology to Reduce Barriers to Care

At Twistle we are solving this problem. Patient engagement technology is rapidly changing how new mothers experience care after giving birth.

While delivering the baby puts women with HDP on the path to recovery, the process takes several days during which time close monitoring is necessary, but it does not have to be done in the hospital. HDP are a complex set of disorders that require a multifaceted medical approach. One of these facets should include leveraging technology for antenatal and postpartum surveillance. This is an opportunity to reach more women and improve their access to care. Improving healthcare outcomes by recognizing worsening blood pressures – especially in the postpartum period – requires timely and effective access to care. Digital health which encompasses mobile health, health information technology, wearable devices, telehealth and telemedicine, and personalized medicine can bridge some gaps and bring healthcare to the patient.

Technology can be a powerful tool to reach women who might otherwise not get integral post-delivery care. Digital health can bridge some gaps in care and bring healthcare to the patient.

Rameet Singh, MD, MPH FACOG

Medical Director, Twistle

Patient Engagement Technology at Work

Patient engagement which spans several if not all of the categories in digital health is necessary to guide/drive or ‘engage’ the patient in their health. Patient engagement involves interventions to increase a patient’s knowledge, skills, ability and motivation to manage her own health and care. Engaging patients in this way has the potential to improve health outcomes, better patient care and lower costs. Twistle’s patient engagement platform connects patients to their health care team through multiple channels including text messaging, a mobile app, the patient portal or the home telephone. This engagement can automate health provider tasks like gathering blood pressure readings, and providing education and reminders. The Pew Research Center reports that 79% of American women own a smartphone. In addition, 65% of women in more developed countries download maternity-related apps to their smartphone during pregnancy. Some studies suggest that engaging with apps may require certain age, education or socioeconomic levels. Text-based engagement can supersede these. During pregnancy women are more motivated to engage around their health care. Technology can therefore be used to reach women who might otherwise not get integral post-delivery care.

With digital engagement, medical teams can monitor new mothers remotely, sending them information and providing care via their smartphone, removing the logistical burden of making an appointment and getting to the doctor’s office. Prompts and questions can be delivered in the patient’s preferred language and in a way that is easy to access and understand. This close connection ensures medical teams can intervene right away when needed.

With bi-directional communication, patients can monitor themselves from home, and avoid the inconvenience of having to leave their newborn for something like a simple blood pressure check especially during a pandemic. Women receive reminders on when and how to take their blood pressure and submit their readings. Normal blood pressures generate automated text replies to patients providing reassurance and abnormal readings can be escalated to clinical staff for additional intervention and management.

We can help!

Twistle’s postpartum hypertension digital engagement and remote monitoring program is improving outcomes for women with hypertensive disorders of pregnancy. We saw:

  • 203% increase in hypertension screening
  • 55% decrease in 30-day readmissions
  • 91% patient engagement rates

If you’re interested in reading about a real world use case using our technology, read how ChristianaCare significantly improved detection and management of postpartum hypertension.

 

1 Petersen EE, Davis NL et al. Vital signs: pregnancy-related deaths, United States, 2011-2015, and strategies for prevention, 13 states, 2013-2017. MMWR Morb Mortal Wkly Rep 2019;68:423-9. doi: 10.15585/mmwr.mm6818e1
2 Von Dadelszen P, Magee LA. Preventing deaths due to the hypertensive disorders of pregnancy. Best Pract Res Clin Obstet Gynaecol. 2016;36:83-102
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