Monitored outpatient management of mild gestational hypertension remote from term

Abstract

OBJECTIVE: Our purpose was to test the hypothesis that monitored outpatient management of mild gestational hypertension remote from term reduces maternal hospitalization without adversely affecting maternal and perinatal outcome. STUDY DESIGN: Five hundred ninety-two patients at 24 to 36 weeks' gestation with mild gestational hypertension were monitored on an outpatient basis with four times daily automated blood pressure measurement and daily assessment of weight, proteinuria, and fetal movement. Maternal and perinatal outcomes were compared with previously published results from inpatient management of mild gestational hypertension. RESULTS: The mean gestational age at enrollment was 32.5 ± 3.2 weeks with a mean gestational age at delivery of 36.7 ± 3.6 weeks. The mean pregnancy prolongation was 27.4 ± 3.3 days, which is similar to previously reported inpatient studies. The mean antepartum hospitalization for all patients during management was only 1.7 days. Three pregnancies were complicated by abruptio placentae, six by the syndrome of hemolysis, elevated liver enzymes, and low platelet count, and none by eclampsia. The mean birth weight was 2757 ± 555 gm, with a birth weight of ≥2000 gm achieved in 84% of managed patients. Eighty-seven percent of infants required a newborn hospitalization of ≤7 days. Fifty-four percent of patients with significant proteinuria at enrollment were delivered at <37.0 weeks' gestation, whereas only 29% of patients without proteinuria were delivered prematurely. The corrected perinatal mortality rate was 3.4 in 1000 total births. CONCLUSION: Properly monitored outpatient management of mild gestational hypertension remote from term reduces the number of days of maternal hospitalization with similar maternal and perinatal outcome compared with previously published results from inpatient management. (AM J OBSTET GYNECOL 1994;170:765-9.)