Abstract
BackgroundMothers 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.MethodsWe 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).ResultsFourteen 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.ConclusionDelayed 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.
Highlights
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
Search results In total, 994 citations were identified, of which 409were retrieved from Medline, 312 from Scopus, 209 from Embase, 55 from Cochrane Controlled Register of Trials (CENTRAL), 6 from ClinicalTrials.gov and 3 from WHO International Clinical Trials Registry Platform (ICTRP)
Our analysis demonstrated that delayed induction significantly reduces the risk of neonatal respiratory distress syndrome among late onset mild preeclampsia patients
Summary
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. Expectant management consists of frequent monitoring of blood pressure, maternal symptoms (like headache, abdominal pain, blurring of vision, decrease in foetal movements, vaginal bleeding), liver & renal function test and complete blood count depending on the severity of the disease. Indications for delivery of these women include poor blood pressure control despite treatment, developing eclamptic maternal symptoms like headache, visual disturbances, epigastric pain, nausea and vomiting, unfavourable blood tests result and decrease in foetal movements. This line of management is associated with increased maternal morbidity and mortality wherein the disease may progress to preeclampsia or eclampsia, HELLP syndrome or abruptio placenta [15, 16]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
