Induction of labour versus conservative management for mild gestational hypertension at term
Keywords:Induction of labour, Mild gestational hypertension, Expectant management, Term
Background: Hypertensive disorders of pregnancy remain a leading cause of maternal and perinatal morbidity and mortality. The aim of this study was to find out whether immediate induction of labour in women with singleton pregnancy complicated by mild gestational hypertension at term reduced maternal and neonatal morbidity, mortality and expenditure when compared to conservative management without increasing instrumental delivery and caesarean section rates.
Methods: This was a randomized controlled trial to compare immediate induction of labour to conservative management for mild gestational hypertension in women between 18-35 years of age with singleton pregnancy with mild gestational hypertension at 37-39.5 weeks without any other complications. Eligible patients presenting to the obstetric outpatient department or labour room of Christian Medical College, Vellore with gestational hypertension were randomized (49 patients in the induction arm and 51 patients in the conservative arm) and followed up. The maternal and neonatal outcomes in both groups were compared.
Results: There was no maternal mortality in both the groups. There was increased incidence of composite maternal morbidity (pre-eclampsia, eclampsia, HELLP syndrome, pulmonary oedema, renal failure, thromboembolic disease, abruption, need for ICU care and major postpartum haemorrhage) in the conservative arm when compared to induction arm (14 versus 8), though not statistically significant (p 0.23).There was no significant difference in the caesarean section rates between the two groups (p 0.313 and 0.306 respectively) despite the much favorable Bishop score in the conservative group (p 0.054). There was no significant difference in neonatal morbidity and mortality. A slight increase by about 600 rupees in the median total cost was found with conservative management when compared to induction group.Conclusions: The study did not show a statistically significant difference in maternal mortality, composite maternal morbidity, neonatal mortality and morbidity as well as treatment cost between immediate induction of labour and conservative management for mild gestational hypertension at term.
Ganzvoort W, Sibai BM. Temporising versus interventionist management (preterm and at term). Best Pract Res Clin Obstet Gynaecol. 2011;25(4):463-76.
Koopmans CM, Bijlenga D, Aarnoudse JG, van Beek E, Bekedam DJ, van den Berg PP et al. Induction of labour versus expectant monitoring in women with pregnancy induced hypertension or mild preclampsia at term: the HYPITAT trial. BMC Pregnancy Childbirth. 2007;7:14.
Duley L. The global impact of pre-eclampsia and eclampsia. Semin Perinatol. 2009;33:130-37.
Khan KS, Wojdyla D, Say L. WHO analysis of causes of maternal death: a systematic review. Lancet. 2006;365:1006-74.
Saudan P. Does gestational hypertension become pre-eclampsia? Br J Obstet Gynaecol. 1998;105:1177-84.
Lau TK, Pang MW, Sahota DS, Leung TN. Impact of hypertensive disorders of pregnancy at term on infant birth weight. Acta Obstet Gynecol Scand. 2005;84:875-7.
Koopmans CM, Bijlenga D, Groen H, Vijgen SM, Aarnoudse JG, Bekedam DJ et al. Induction of labour versus expectant monitoring for gestational hypertension or mild pre-eclampsia after 36 weeks’ gestation (HYPITAT): a multicenter, open-label randomized controlled trial. Lancet. 2009;374:979-88.
Tajik P, van der Tuuk K, Koopmans CM, Groen H, van Pampus MG, van der Berg PP et al. Should cervical favorability play a role in the decision for labour induction in gestational hypertension or mild preeclampsia at term? An exploratory analysis of the HYPITAT trial. Br J Obstet Gynaecol. 2012;119:1123-30.
Johnson DD. Induced labour for preeclampsia and gestational hypertension. Lancet. 2009;374:951-2.
Mortiary T. An economic analysis of induction of labour and expectant monitoring in women with gestational hypertension or preeclampsia at term (HYPITAT trial). Br J Obstet Gynaecol. 2011;118:763.
vaan der Tuuk K, Koopmans CM, Groen H, Mol BW, van Pampus MG, HYPITAT study group. Impact of HYPITAT trial on doctors’ behavior and prevalence of eclampsia in the Netherlands. Br J Obstet Gynaecol. 2011;118:1658-60.