Induction of labour versus conservative management for mild gestational hypertension at term

Bhageerathy, Pallipuram Seshadrinathan; Thomas, Vinotha; Regi, Annie; Jose, Ruby

doi:10.18203/2320-1770.ijrcog20160567

Cited by 3 publications

(12 citation statements)

References 9 publications

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“…9 Majority of the patients in the present study were from rural community (66.67% in group A and 76.67% in group B) and studied only till primary school (40% in group A and 38.33% in group B). The mean systolic pressure and diastolic pressure in both groups in the present study were comparable which was similar to the study conducted by Pallipuram et al 4 It was seen that in the present study, 30% patients from Group B underwent spontaneous onset of labor whereas none (0) from group A underwent spontaneous onset of labor which was significant statistically. The HYPITAT Trial8 showed that 53% patients in expectant group underwent spontaneous onset of labour as compared to 3% patients in induction group.…”

Section: Discussionsupporting

confidence: 91%

“…It was similar to the study of Pallipuram et al, and The HYPITAT trial which also reported increased progression to severe hypertension in conservative group in comparison to the induction group. 4,8 Similarly progression to preeclampsia and eclampsia was more in conservative management group as compared to induction group which was also seen in study conducted by Pallipuram et al 4 The present study found increased incidence of PPH in the conservative group in comparison to the induction group which was similar to the study conducted by Pallipuram et al 4 and The HYPITAT trial. 8 They found no incidence of abruption in either group, whereas in the present study Group B had slightly increased incidence of abruption cases compared to Group A (3.33% vs. 1%) although the differences were not significant statistically.…”

Section: Discussionsupporting

confidence: 88%

“…In the present study, when the baseline characteristics were compared it was seen that the mean age and parity were similar in both Group A and Group B which was similar to the study conducted by Pallipuram et al and Khaskheli MN et al, and also HYPITAT trial. 4,7,8 In the present study gestational hypertension was seen more in unbooked cases (68.33% in group A and 70% in group B). Bangal VB et al, also found that 80% of the patients were unbooked.…”

Section: Discussionsupporting

confidence: 49%

“…The risk caused by gestational hypertension to the fetus includes severe growth retardation, hypoxemia, acidosis, premature birth and death. 4 The management of severe gestational hypertension and preeclampsia at term is clear and the only definitive treatment is delivery. 5 But the management of mild gestational hypertension at term is not clear.…”

Section: Introductionmentioning

confidence: 99%

“…6 Those who advise delivery at 37-38 weeks of gestation refer to maternal risks of expectant management whereas those who recommend expectant management cite the increased rates of caesarean delivery from induction, particularly in those with unfavorable cervix, as well as the increased rates of neonatal morbidities in infants born at 37+0 to 38+6 weeks of gestation. 4 With the lack of good clinical evidence on the subject and resulting practice variation, additional data comparing immediate delivery and expectant monitoring in patients with hypertensive diseases are needed.…”

Section: Introductionmentioning

confidence: 99%

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A comparative study of maternal and fetal outcomes following induction of labour versus expectant management in mild gestational hypertension at term

Alam

Choubey

2019

Int J Reprod Contracept Obstet Gynecol

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Background: To compare the maternal and neonatal outcomes between planned induction of labour and expectant management in women with mild gestational hypertension at term.Methods: A prospective hospital based observational study. The 120 pregnant women with mild gestational hypertension were randomized in a 1:1 ratio either to receive immediate induction of labour (group A comprising 60 women) or expectant management (group B comprising 60 women). Primary outcomes were incidence of any maternal mortality, renal failure, pulmonary oedema, need for ICU care or post-partum eclampsia and also composite maternal morbidity like severe gestational hypertension, pre-eclampsia, eclampsia, abruption and PPH. Secondary outcomes were mode of delivery, need for antihypertensives and MgSO4.Results: Though there were no maternal death or renal or pulmonary complications in any group, progression to severe hypertension was more in group B (expectant management) compared to group A (immediate induction) (18.33% vs. 3.33%). Increased incidence of pre-eclampsia and eclampsia were noted in group B (15% and 3%) as compared to group A (0%). Incidence of Abruption and PPH was less in group A 1.67% and 5% compared to group B 3.33% and 10 % respectively. Spontaneous vaginal delivery rate was low and caesarean section rates were high in group A (61.67% and 31.67%) compared to group B (68.33% and 25% respectively). Need for antihypertensive and MgSO4 were less in group A (3.33% each) compared to group B (18.33% and 16.66% respectively).Conclusions: Requirement of antihypertensive, progression to severe hypertension, pre-eclampsia, eclampsia, use of MgSO4, incidence of abruption, PPH were less in group A compared to group B. However, induction at completion of 37 weeks may be associated with increased incidence of operative deliveries.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 49%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

A comparative study of maternal and fetal outcomes following induction of labour versus expectant management in mild gestational hypertension at term

Alam

Choubey

2019

Int J Reprod Contracept Obstet Gynecol

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Immediate versus delayed induction of labour in hypertensive disorders of pregnancy: a systematic review and meta-analysis

Shao

Song

et al. 2020

BMC Pregnancy Childbirth

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Background Mothers with hypertensive disorder of pregnancy can be managed with either immediate or delayed induction of labour with expectant monitoring of both mother and baby. There are risks and benefits associated with both the type of interventions. Hence, this review was conducted to compare outcomes of immediate and delayed induction of labour among women with hypertensive disorder of pregnancy based on disease severity and gestational age. Methods We conducted systematic searches in various databases including Medline, Cochrane Controlled Register of Trials (CENTRAL), Scopus, and Embase from inception until October 2019.Cochrane risk of bias tool was used to assess the quality of published trials. A meta-analysis was performed with random-effects model and reported pooled Risk ratios (RR) with 95% confidence intervals (CIs). Results Fourteen randomized controlled trials with 4244 participants were included. Majority of the studies had low or unclear bias risks. Amongst late onset mild pre-eclampsia patients, the risk of renal failure was significantly lower with immediate induction of labour (pooled RR: 0.36; 95%CI: 0.14 to 0.92). In severe pre-eclampsia patients, immediate induction of labour significantly reduced the risk of having small-for-gestational age babies compared to delayed induction of labour (pooled RR: 0.49; 95%CI: 0.29–0.84).Delayed induction was found to significantly reduce the risk of neonatal respiratory distress syndrome risk among late onset mild pre-eclampsia patients (pooled RR: 2.15; 95%CI: 1.14 to 4.06) None of the other outcomes demonstrated statistically significant difference between the two interventions. Conclusion Delayed induction of labour with expectant monitoring may not be inferior to immediate induction of labour in terms of neonatal and maternal outcomes. Expectant approach of management for late onset mild pre-eclampsia patients may be associated with decreased risk of neonatal respiratory distress syndrome, while immediate induction of labour among severe pre-eclampsia patients is associated with reduced risk of small-for-gestational age babies and among mild pre-eclampsia patients, it is associated with reduced risk of severe renal impairment.

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Determining optimal timing of birth for women with chronic or gestational hypertension at term: The WILL (When to Induce Labour to Limit risk in pregnancy hypertension) randomised trial

Magee,

Kirkham,

Tohill

et al. 2024

PLoS Med

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Background Chronic or gestational hypertension complicates approximately 7% of pregnancies, half of which reach 37 weeks’ gestation. Early term birth (at 37 to 38 weeks) may reduce maternal complications, cesareans, stillbirths, and costs but may increase neonatal morbidity. In the WILL Trial (When to Induce Labour to Limit risk in pregnancy hypertension), we aimed to establish optimal timing of birth for women with chronic or gestational hypertension who reach term and remain well. Methods and findings This 50-centre, open-label, randomised trial in the United Kingdom included an economic analysis. WILL randomised women with chronic or gestational hypertension at 36 to 37 weeks and a singleton fetus, and who provided documented informed consent to “Planned early term birth at 38+0–3 weeks” (intervention) or “usual care at term” (control). The coprimary outcomes were “poor maternal outcome” (composite of severe hypertension, maternal death, or maternal morbidity; superiority hypothesis) and “neonatal care unit admission for ≥4 hours” (noninferiority hypothesis). The key secondary was cesarean. Follow-up was to 6 weeks postpartum. The planned sample size was 540/group. Analysis was by intention-to-treat. A total of 403 participants (37.3% of target) were randomised to the intervention (n = 201) or control group (n = 202), from 3 June 2019 to 19 December 2022, when the funder stopped the trial for delayed recruitment. In the intervention (versus control) group, losses to follow-up were 18/201 (9%) versus 15/202 (7%). In each group, maternal age was about 30 years, about one-fifth of women were from ethnic minorities, over half had obesity, approximately half had chronic hypertension, and most were on antihypertensives with normal blood pressure. In the intervention (versus control) group, birth was a median of 0.9 weeks earlier (38.4 [38.3 to 38.6] versus 39.3 [38.7 to 39.9] weeks). There was no evidence of a difference in “poor maternal outcome” (27/201 [13%] versus 24/202 [12%], respectively; adjusted risk ratio [aRR] 1.16, 95% confidence interval [CI] 0.72 to 1.87). For “neonatal care unit admission for ≥4 hours,” the intervention was considered noninferior to the control as the adjusted risk difference (aRD) 95% CI upper bound did not cross the 8% prespecified noninferiority margin (14/201 [7%] versus 14/202 [7%], respectively; aRD 0.003, 95% CI −0.05 to +0.06), although event rates were lower-than-estimated. The intervention (versus control) was associated with no difference in cesarean (58/201 [29%] versus 72/202 [36%], respectively; aRR 0.81, 95% CI 0.61 to 1.08. There were no serious adverse events. Limitations include our smaller-than-planned sample size, and lower-than-anticipated event rates, so the findings may not be generalisable to where hypertension is not treated with antihypertensive therapy. Conclusions In this study, we observed that most women with chronic or gestational hypertension required labour induction, and planned birth at 38+0–3 weeks (versus usual care) resulted in birth an average of 6 days earlier, and no differences in poor maternal outcome or neonatal morbidity. Our findings provide reassurance about planned birth at 38+0–3 weeks as a clinical option for these women. Trial registration isrctn.com ISRCTN77258279.

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Induction of labour versus conservative management for mild gestational hypertension at term

Cited by 3 publications

References 9 publications

A comparative study of maternal and fetal outcomes following induction of labour versus expectant management in mild gestational hypertension at term

A comparative study of maternal and fetal outcomes following induction of labour versus expectant management in mild gestational hypertension at term

Immediate versus delayed induction of labour in hypertensive disorders of pregnancy: a systematic review and meta-analysis

Determining optimal timing of birth for women with chronic or gestational hypertension at term: The WILL (When to Induce Labour to Limit risk in pregnancy hypertension) randomised trial

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