Postnatal Hypertension Management and Discharge Documentation: A Retrospective Clinical Audit at a UK University Hospital

BackgroundPostnatal hypertension requires timely blood pressure surveillance, treatment review, safety netting, and communication between maternity and community services.This audit assessed postnatal hypertension care and discharge documentation against local Trust standards at Princess Royal University Hospital. MethodsA retrospective case-note audit included women with postnatal hypertension who delivered between April and September 2025.For audit eligibility, postnatal hypertension was defined as a pregnancy-related or chronic hypertensive disorder identified through prespecified Epic diagnosis filters and requiring postnatal surveillance.The clinical blood pressure threshold used for the audit was systolic blood pressure of at least 140 mmHg and/or diastolic blood pressure of at least 90 mmHg from birth through six weeks postpartum.Of 150 identified notes, 148 were included after exclusion of one pre-viable birth before 24+0 weeks and one immediate post-delivery transfer to another Trust.Statistical analyses were performed using R version 4.3.3(R Foundation for Statistical Computing, Vienna, Austria).Exploratory comparisons across pregnancyinduced hypertension, pre-eclampsia, and chronic hypertension/superimposed pre-eclampsia used Kruskal-Wallis tests for continuous variables and Pearson chi-square statistics with Monte Carlo p-values for categorical variables. ResultsMedian maternal age was 34.0 years (IQR 30.0-37.0);76/148 women (51.4%) had pregnancy-induced hypertension, 50/148 (33.8%) had pre-eclampsia, and 22/148 (14.9%) had chronic hypertension or superimposed pre-eclampsia.A valid discharge blood pressure was recorded in 146/148 records (98.6%); 118/146 (80.8%) were below 140/90 mmHg.Blood-pressure parameter plans, two-week general-practitioner review, and clear discharge communication were documented in 27/148 (18.2%), 34/147 (23.1%), and 16/148 (10.8%) records, respectively.Documentation of a blood pressure parameter plan (Pearson chi-square=8.551,p=0.014) and clear discharge communication (Pearson chi-square=8.349,p=0.013) differed across hypertensive disorder groups.Any postnatal antihypertensive was documented in 109/148 records (73.6%); medication documentation differed across groups (Pearson chi-square=12.669,p=0.001).Community rereferral for raised blood pressure occurred in 12/148 records (8.1%); any documented readmission occurred in 14/148 (9.5%). ConclusionsDischarge blood pressure documentation, safety netting, and breastfeeding drug safety advice were high, but documentation of individualized blood pressure plans, early general practitioner review, and clear discharge communication were low.An electronic discharge template and prospective re-audit are appropriate quality-improvement interventions.