562 Delivery outcomes in women with hypertensive disorders of pregnancy: comparing induction versus immediate cesarean delivery

Abstract

To compare delivery outcome and associated maternal and neonatal complications in women with hypertensive disorders of pregnancy (HDP) who undergo induction of labor (IOL) versus immediate primary cesarean delivery (CD). This is a retrospective cohort study of nulliparous women with a singleton pregnancy at term delivering at NYU Langone Health and NYU Langone Hospital Brooklyn in 2018 with a diagnosis of HDP. Women who presented in labor (modified Bishop score >5) were excluded. Delivery outcomes and indication for CD were tabulated for the IOL group. A composite of maternal and fetal/neonatal complications occurring after the decision on delivery mode were compared between women who underwent IOL (defined as cervical ripening and/or oxytocin) versus immediate CD after diagnosis. Outcomes were analyzed using Chi-squared and Fischer’s exact test, with p<0.05 considered significant. 261 women met criteria for inclusion, including 241 (93.1%) who underwent IOL of labor and 18 (7.0%) with CD without labor. There was no difference between groups in severity of HDP diagnosis (p=0.66). Of those that underwent IOL, 140 (58.1%) had a vaginal delivery (VD). The most common indication for CD was labor arrest (67.9%), followed by fetal intolerance of labor (20.5%). Worsening HDP accounted for 3.6% of indications for CD. There was no difference between IOL and CD groups in rates of composite maternal complications (34.0% versus 33.3%, p=0.95, Table 1). There was no difference in fetal/neonatal composite complications between IOL and CD groups (21.2% versus 5.6%, p=0.11, Table 1). In nulliparous women with HDP at term, IOL is not associated with additional maternal or fetal/neonatal complications compared to immediate CD and is associated with a high rate of VD success. Understanding how the decision for IOL or CD influence maternal and neonatal complications in the setting of HDP will inform patient and provider counseling. Further studies should investigate how the rate of successful VD with IOL influences the risk/benefit balance for this decision.