Mild Gestational Hypertension Research Articles

Urinary protein and coagulation-fibrinolysis indicators in preeclampsia: Expression and significance.

This study investigates the expression and significance of urinary protein and coagulation-fibrinolysis indicators in preeclampsia, categorized into mild preeclampsia (109 cases) and severe preeclampsia (97 cases) based on disease severity. Additionally, 110 patients with gestational hypertension (gestational hypertension group) were included for comparative analysis. General information, laboratory indicators, urinary protein, and coagulation-fibrinolysis indicator levels were collected for each group. Significant differences were observed in blood pressure among groups (P<.05), while uric acid, serum creatinine, aspartate transaminase, alanine transaminase, and triglycerides showed no significant differences (P>.05). Total cholesterol, triglycerides, and low-density Lipoprotein levels in severe preeclampsia were higher than those in mild preeclampsia and gestational hypertension groups, whereas high-density lipoprotein, albumin, and platelet levels were lower in severe preeclampsia. No significant differences were observed in prothrombin time or D-dimer levels among groups (P>.05). Urinary protein, urinary protein quantification, activated partial thromboplastin time, thrombin time, and fibrinogen were identified as influencing factors for adverse maternal and infant outcomes in severe preeclampsia patients. The study concludes that urinary protein and coagulation-fibrinolysis indicators are elevated in preeclampsia, particularly in severe preeclampsia cases, suggesting their potential use as diagnostic influencing factors for severe preeclampsia.

Association of the Severity of Hypertensive Disorders in Pregnancy with Birthweight, Childhood Obesity, and Blood Pressure at Age 7.

We aimed to examine the effects of various severities of hypertensive disorders in pregnancy on birthweight, blood pressure (BP), and body mass index in offspring at age 7. In the China Labor and Delivery Survey and the United States Collaborative Perinatal Project (CPP), the relationship of the severity of hypertensive disorders and nutritional and cardiovascular outcomes in offspring was assessed using a multivariable logistic and general linear regression model. In both datasets, those with gestational hypertension were more likely to deliver large for gestational age (LGA) and macrosomia (adjusted odds ratios (aOR) ranged from 1.29 to 1.91), as well as low birth weight (LBW) neonates (aOR ranged from 1.23 to 3.56), compared with normotensive mothers. In the CPP, when gestational hypertension was further stratified into mild and severe, only those with mild gestational hypertension (the mild group) were more likely to deliver macrosomia and LGA (aOR ranged from 1.25 to 1.32). Others (severe gestational hypertension and preeclampsia/eclampsia) were closely related to LBW and small for gestational age (aOR ranged from 1.27 to 2.77). Moreover, children of mothers in the mild group tended to be overweight/obese and had elevated diastolic BP. We concluded that the severity of hypertensive disorders had different effects on birthweight, childhood overweight, and BP.

Study of coagulation profile and platelet count in pregnancy induced hypertension, preeclamptic and eclamptic patients

Introduction: Hypertensive disorders in pregnancy is one of the major causes of maternal & perinatal morbidity and mortality. Pregnancy induced hypertention (PIH) is defined as hypertension that develops as the direct result of the gravid state. Profound changes in coagulation and fibrinolytic system occur during normal pregnancy causing hypercoagulable state. Preeclampsia and eclampsia is a highly thrombotic and pro-coagulant state with platelet activation and thrombin and fibrin formation. Methodology: A prospective study carried out in department of pathology B. J. medical college during March 2021 to August 2021. Coagulation profile (PT, aPTT, and D-dimer) and platelet count was done in cases and values were correlated with the severity of PIH. Results: Total of 100 cases were included in the study. 26 were mild gestational hypertension, 13 cases were severe gestational hypertension, 36 cases were mild pre-eclampsia and 14 cases were in severe pre-eclampsia group and 11 patients in eclampsia group. Prolonged PT, aPTT, D-Dimer and thrombocytopenia was seen in 9 cases, 29 cases, 32 cases and 17 cases respectively. In our study we observed increased aPTT, D-dimer and thrombocytopenia in severe pre-eclampsia and eclampsia patients. Conclusion: Estimation of the coagulation parameters and platelet count play an important role in the evaluation of risk factors, early detection, and effective antenatal services. Which can help to reduce the maternal and fetal morbidity and mortality associated with pregnancy induced hypertension.

A retrospective study of coagulation parametres in patients of pregnancy induced hypertension

Introduction: Human pregnancy also known as gestation, is the time between fertilization of ovum to delivery of a baby. It is approcximately a process of 9 months during which new baby develops inside a womb. Physiologically, pregnancy is a hypercoagulative state. Hypercoagulable state in pregnancy is a naturally occuring preventive response to prevent excess loss of blood during delivery. It is essential to know the range of variations of the coagulation factors during normal pregnancy, if any specific component has to be incriminated as a causative agent for the vascular disorder. Preeclampsia is a serious and life threatening complication in pregnant women. It is a pregnancy specific disorder which rates among one of the major causes of maternal and foetal morbidity and mortality. Aims and Objectives: To evaluate severity of eclampsia by estimating coagulation profile tests in pregnancy induced hypertensive patients. To compare these biochemical parameters between the test group and control group. To correlate the outcome of pregnancy with these biochemical parameters. Materials and Methods: This retrospective study includes 120 females of uncomplicated pregnancy of age group 16-35 years as a control group and 120 females of same age group with pregnancy with hypertension (PIH) attending obstetric outdoor patient department (OPD) of the institute in the year of 2015. Blood samples are withdrawn from all participants for biochemical markers of coagulation study that includes total platelet count (PC), prothrombin time (PT) and activated partial thromboplastin time (APTT). Results: Among total 120 PIH participants, 44 (36.67%) cases were having mild gestational hypertension, 11 (9.17%) cases were having severe gestational hypertension, 34 (28.33%) cases were having mild preeclampsia and 31 (25.83%) cases were having severe preeclampsia. The mean value of PT and APTT is found to be high in PIH cases as compared to control group participants. Conclusion: Parameters

Evaluating the maternal and perinatal sequelae of severe gestational hypertension

Hypertensive disorders of pregnancy are widespread and have long-standing implications for women's health. Historically, the management of "severe gestational hypertension," or the presence of severely elevated blood pressures without any other signs or symptoms of end-organ damage meeting the criteria for preeclampsia, has been unclear. The new American College of Obstetricians and Gynecologists guidelines based on expert opinion recommend that severe gestational hypertension be treated similarly to preeclampsia with severe features, but data regarding outcomes for women with this diagnosis have been limited. This study aimed to compare the maternal and perinatal sequelae of severe gestational hypertension with that of other types of hypertensive disorders of pregnancy. This is a retrospective cohort study of women with hypertensive disease of pregnancy who delivered at a single tertiary care center between February and December 2018. Women with chronic hypertension; hemolysis, elevated liver enzymes, and low platelet count syndrome; preexisting kidney, liver, rheumatologic, or hematologic disorders; or multifetal pregnancies were excluded. Women were categorized as having severe gestational hypertension if they had a sustained systolic blood pressure of >160 mm Hg or a diastolic blood pressure of >110 mm Hg without other criteria for preeclampsia. The primary comparison was between women with severe gestational hypertension and women with preeclampsia without severe features. Secondary comparisons included women with severe gestational hypertension vs women with other types of hypertensive disease of pregnancy. The primary outcome for this analysis was small-for-gestational-age birth. We also evaluated other maternal and neonatal morbidities including but not limited to pulmonary embolism, stroke, eclampsia, blood transfusion, mechanical ventilation, intensive care unit admission, death, 5-minute Apgar score of ≤4, umbilical cord pH, neonatal intensive care unit admission of >2 days, respiratory distress syndrome, and neonatal death. Bivariate analyses using chi-square tests and logistic regressions adjusting for race, ethnicity, age, body mass index, parity, and insurance status were performed to compare frequencies of outcomes for each type of hypertensive disease of pregnancy with those of severe gestational hypertension. Of 2076 women eligible for inclusion, 12.2% (n=254) had severe gestational hypertension and 379 (18.2%) had preeclampsia without severe features. Although there was no difference in the odds of small-for-gestational-age birth between women with severe gestational hypertension and women with preeclampsia without severe features(14.7% vs 9.8%; adjusted odds ratio, 0.72; 95% confidence interval, 0.44-1.21), the latter were significantly less likely to receive a prescription for antihypertensive medication at discharge (OR 0.11, 95% CI 0.06-0.22) or to be readmitted postpartum (OR 0.14, 95% CI 0.04-0.50). There was no difference in the primary outcome, that is, rate of small-for-gestational-age birth, between women with severe gestational hypertension and women with preeclampsia without severe features. However, women with severe gestational hypertension had greater odds of other maternal and neonatal morbidities than women with preeclampsia without severe features or mild gestational hypertension. These findings support recent recommendations regarding the management of women with severe gestational hypertension.

Clinical Utility of Weekly Laboratory Testing in the Outpatient Management of Preeclampsia and Gestational Hypertension.

Objective To investigate the utility of obtaining weekly laboratory testing in patients managed as an outpatient for gestational hypertension and preeclampsia without severe features. Study Design A multisite retrospective cohort study was performed evaluating preterm women diagnosed with gestational hypertension/preeclampsia managed in an outpatient setting between gestational ages of 23 0/7 and 36 6/7 . Patients were divided into two groups: weekly laboratory evaluation (laboratories group) and a no laboratories group. The primary study outcome was composite maternal morbidity including more than one of the following: development of severe features, HELLP syndrome, eclampsia, placental abruption, maternal intensive care unit admission, or maternal death. Results A total of 204 patients were included in this study, laboratories group ( n = 120) and no laboratories group ( n = 84). The laboratories group was older (28.8 vs. 26.6 years, p = 0.02), had a higher rate of chronic hypertension (44 [36.7%] vs. 17 [20.2%], p = 0.01), and more often experienced the primary composite outcome (53 [44.2%] vs. 24 [28.5%], p = 0.02). No patients in our cohort were delivered for abnormal laboratory values. Conclusion This study found that weekly laboratory testing may have minimal clinical utility in the outpatient management protocol in monitoring patients with mild gestational hypertension or preeclampsia. Delivery was guided by other clinical factors.

Medical and surgical complications in pregnancy and obstetric labour complications in the Japan Environment and Children’s Study (JECS) cohort: a birth cohort study

This study aimed to describe the distribution of pregnancies with medical and obstetric complications based on the Japan Environment and Children’s Study (JECS). We evaluated the distribution of the history of obstetric/gynaecological diseases, the history of obstetric labour complications, pregnancy with medical and surgical complications, and obstetric labour complications in participants in the JECS. Of 100,818 pregnant women with medical record entries after delivery, 15,305 (15.2%) had medical and surgical complications in pregnancy and 46,756 (46.4%) experienced obstetric labour complications. The proportion of pregnancies with heart disease, kidney disease and hepatitis was 0.3%, 0.3% and 0.1%, respectively. Gestational diabetes was diagnosed in 2715 (2.7%) women. The proportion of women with mild and severe gestational hypertension was 2.3% and 1%, respectively. The JECS is the largest birth cohort in Japan. These data will provide useful, basic information for perinatal care in Japan. IMPACT STATEMENT What is already known on this subject? Epidemiological studies have suggested that pre-existing diseases and complications of pregnancy, such as heart disease in pregnancy, gestational hypertension and gestational diabetes, may have implications for pregnancy outcomes, as well as for children’s health and development. What the results of this study add? We evaluated the distribution of the history of obstetric/gynaecological diseases, the history of obstetric labour complications, medical and surgical complications in pregnancy, and obstetric labour complications using data from the Japan Environment and Children’s Study (JECS). What the implications are of these findings for clinical practice and/or further research? The JECS is the largest birth cohort in Japan. Our data will provide useful, basic information for perinatal care in Japan.

Fetal growth patterns in pregnancy-associated hypertensive disorders: NICHD Fetal Growth Studies

Fetal growth patterns in pregnancy-associated hypertensive disorders is poorly understood because prospective longitudinal data are lacking. The objective of the study was to compare longitudinal fetal growth trajectories between normotensive women and those with pregnancy-associated hypertensive disorders. This is a study based on data from a prospective longitudinal cohort study of fetal growth performed at 12 US sites (2009-2013). Project gestational age was confirmed by ultrasound between 8 weeks 0 days and 13 weels 6 days, and up to 6 ultrasounds were performed across gestation. Hypertensive disorders were diagnosed based on 2002 American College of Obstetricians and Gynecologists guidelines and grouped hierarchically as severe preeclampsia (including eclampsia or HELLP [hemolysis, elevated liver enzymes, and low platelet count] syndrome), mild preeclampsia, severe gestational hypertension, mild gestational hypertension, or unspecified hypertension. Women without any hypertensive disorder constituted the normotensive group. Growth curves for estimated fetal weight and individual biometric parameters including biparietal diameter, head circumference, abdominal circumference, and femur and humerus length were calculated for each group using linear mixed models with cubic splines. Global and weekly pairwise comparisons were performed between women with a hypertensive disorder compared with normotensive women to analyze differences while adjusting for confounding variables. Delivery gestational age and birthweights were compared among groups. Of 2462 women analyzed, 2296 (93.3%) were normotensive, 63 (2.6%) had mild gestational hypertension, 54 (2.2%) mild preeclampsia, 32 (1.3%) severe preeclampsia, and 17 (0.7%) unspecified hypertension. Compared with normotensive women, those with severe preeclampsia had estimated fetal weights that were reduced between 22 and 38 weeks (all weekly pairwise values of P < .008). Women with severe preeclampsia compared with those without hypertension also had significantly smaller fetal abdominal circumference between 23-31 and 33-37 weeks' gestation (weekly pairwise values of P < .04). Scattered weekly growth differences were noted on other biometric parameters between these 2 groups. The consistent differences in estimated fetal weight and abdominal circumference were not observed between women with other hypertensive disorders and those who were normotensive. Women with severe preeclampsia delivered significantly earlier (mean gestational age 35.9 ± 3.2 weeks) than the other groups (global P < .0001). Birthweights in the severe preeclampsia group were also significantly lower (mean -949.5 g [95% confidence interval, -1117.7 to -781.2 g]; P < .0001) than in the normotensive group. Among women with pregnancy-associated hypertensive disorders, only those destined to develop severe preeclampsia demonstrated a significant and consistent difference in fetal growth (ie, smaller estimated fetal weight and abdominal circumference) when compared with normotensive women.

Expectant Management vs. Induction of Labor in Women With Severe Proteinuria in Preeclampsia [20K

INTRODUCTION: A 2013 report from the American College of Obstetricians and Gynecologists (the College) task force removed greater than 5g proteinuria in a 24-hour urine collection from the severe symptoms list for preeclampsia. We sought to determine the perinatal outcomes following implementation of this guideline. METHODS: A decision analytic model was created using TreeAge software. Our study compared induction of labor (IOL) at 34 weeks gestation with expectant management from 34-37 weeks gestation. For each week of expectant management, we calculated the rate of spontaneous delivery and risk of developing severe symptoms. Utilities were included with a discounted life expectancy rate of 3% to produce quality adjusted life years (QALYs). Our theoretical population included 100,000 pregnant women with mild gestational hypertension, greater than 5 g protein in a 24-hour urine collection and no other severe symptoms. We analyzed both neonatal and maternal outcomes. RESULTS: Expectant management based on the new guidelines resulted in 23,068 cases of progression to or complications of severe disease, 3 additional maternal deaths, and 10 more stillbirths. Conversely, IOL at 34 weeks resulted in 440 more neonatal deaths and 355 more cases of cerebral palsy. CONCLUSION: Our model and analysis support the updated College guideline for expectant management of women with mild hypertension, greater than 5 g proteinuria and no other severe symptoms. Although expectant management leads to higher rates of maternal death, stillbirths, and adverse maternal events, the significant rates of cerebral palsy and neonatal death in preterm delivery at 34 weeks support expectant management over IOL at 34 weeks.

Analysis of influence of anesthetic effect, maternal and infant outcomes and safety of subarachnoid block using sulfentanyl combined with ropivacaine for patients with gestational hypertension in the cesarean section

Objective To study the influence of anesthetic effect, maternal and infant outcomes and safety of subarachnoid block used sulfentanyl combined with ropivacaine for patients with gestational hypertension in the cesarean section. Methods 180 cases of gestational hypertension ready to cesarean section were selected as study subjects, and they were randomly divided into A group, B group and C group by digital table method, 60 cases in each group.A group used 10mg ropivacaine, B group used 13mg ropivacaine, C group used 5μg sulfentanyl combined with 10mg ropivacaine.The anesthetic effect, circulation function, duration of pain, operation time, neonatal Apgar score at 1 and 5 min after birth, neonatal weight, motor block evaluation after operation, adverse reaction and complication were compared in three groups. Results The anesthetic effect between B group and C group had no statistical difference(χ2=1.233, 1.465, all P>0.05). The anesthetic effect of B group and C group was better than that of A group(F=5.633, 7.299, all P 0.05). Compared with T0, the HR and MAP of B group at T1, T2, T3, T4 had statistical differences compared with A group and C group(F=5.633, 7.299, all P 0.05). The duration of pain between B group and C group had no statistical difference(t=0.822, P>0.05). The duration of pain of A group was longer than that of B group and C group(F=8.316, P 0.05). The improved Bromage score between A group and C group had no statistical difference(t=2.627, 1.991, all P>0.05). The improved Bromage score between B group and A, C group had statistical differences(F=6.371, 5.693, all P<0.05). The complete recovery time of motor nerve of B group was much longer than that of A group and C group(F=8.924, P<0.05). The incidence rates of vomit and nausea of A group and B group were much higher than that of C group(F=3.561, 12.581, all P<0.05). The incidence rate of bradycardia and hypotension of B group was much higher than that of A group and C group(F=8.273, 10.833, all P<0.05). Conclusion During subarachnoid block anaethesia using 5μg sulfentanyl combined with 10mg ropivacaine can be applied to mild and moderate gestational hypertension, it has advantages such as less adverse reaction, good analgesic effect, less hemodynamic effect, and it is worthy of clinical promotion. Key words: Hypertension, Pregnancy-Induced; Sulfentanyl; Ropivavaine; Subarachnoid Space; Nerve Block

Lipids in Hypertensive Disorders of Pregnancy and Birth Weight

Hypertensive Disorders of Pregnancy affect growth of fetus, birth weight too. However all babies are not small. This might have something to do with lipids. Objective: Present study was to study serum lipid levels in normal pregnant, women with HDsP, specially lipid abnormalities in HDsP and birth weight of baby. Materials and methods: Prospective study was carried out with singleton pregnancy, gestational age more than 20 weeks with HDsP. Normotensive pregnant women, matched for age, (+2) parity (+1), gestational age (+2 weeks) were controls. Fasting serum lipids, cholesterol, triglycerides, high density lipoproteins (HDL), low density lipoproteins (LDL), very low density lipoproteins (VLDL) were estimated at entry, repeated 7 days. Criterion for small for gestation weight was less than 2500 gms birth weight of >37 weeks babies. Preterm were excluded for analysis. Results: During study there were 7233 births, 964 had HDsP (13.32%), 635 (66%) term (>37 weeks) pregnancy. Of 451 women with mild gestational hypertension (GH), 425 had abnormal lipids, 117 (27.52%) of them, of 26 with normal lipids, 23.07% had SGA babies, more babies SGA with higher LDL, VLDL, Tri glycerides, lower HDL. Among 58 term cases with severe GH, 50 had abnormal lipid levels, 8 (16%) and of 8 with normal lipids, one (12.5%) had SGA baby, more babies SGA with abnormal lipids. Among 65 of term gestation with mild PE, 48 had abnormal lipids, 17 (35.41%) and of 17 with normal lipids 4 (23.52%) had SGA babies with abnormal lipids, more SGA babies with abnormal lipids. With severe PE, all 44 had some lipid abnormality, 59% had SGA babies. All 17 with eclampsia at term had abnormal lipids, 16 (94.11%) had SGA babies. However in all categories difference was statistically insignificant. Conclusion: Lipid abnormalities were present in quite a few cases of HDsP and when present affected baby weight. A lot of more research is needed.

Comparison of Hemodynamic Response and Vasopressor Requirement Following Spinal Anaesthesia, between Normotensive and Mild Gestational Hypertension Patients Undergoing Caesarean Section: A Prospective Study

Comparison of Hemodynamic Response and Vasopressor Requirement Following Spinal Anaesthesia, between Normotensive and Mild Gestational Hypertension Patients Undergoing Caesarean Section: A Prospective Study

Immediate Delivery Versus Expectant Monitoring for Hypertensive Disorders of Pregnancy Between 34 and 37 Weeks of Gestation (HYPITAT-II): An Open-label, Randomized-Controlled Trial

(Lancet. 2015;385(9986):2492–2501) Hypertensive disorders of pregnancy occur in approximately 10% of all pregnancies. Although the first Hypertension and Preeclampsia Intervention Trial At Term (HYPITAT) study demonstrated that immediate delivery reduces the risk of adverse maternal outcomes for women with mild gestational hypertension or preeclampsia past 37 weeks of gestation, little is known about the risks and benefits of immediate delivery versus continuing the pregnancy for women at 34 to 37 weeks of gestation who have hypertensive disorders. This open-label, randomized-controlled trial investigated the effect of immediate delivery versus expectant management on maternal and neonatal outcomes for women with hypertensive disorders at 34 to 37 weeks’ gestation.

The study of the correlation of pregnancy-induced hypertension in the case of indexing syndrome and pregnancy outcome

Objective To study the correlation of pregnancy-induced hypertension in the case of indexing syndrome and pregnancy outcome, and to explore their clinical applicability. Methods 30 cases of birth mothers with pregnancy-induced hypertension were selected.According to the severity of hypertension, the patients were divided into the severe pregnancy-induced hypertension group, the moderate pregnancy-induced hypertension and the mild gestational hypertension group.The different levels of pregnancy-induced hypertension maternal outcome indicators, and different maternal outcomes in the two groups were analyzed and compared. Results Preterm birth (58.3%), cesarean section (66.7%), gestational age (33.6±2.8)weeks, baby weight (2 330.3±652.3)g of pregnancy-induced hypertension group were significantly higher than moderate pregnancy-induced hypertension group[18.2%, 18.2%, (36.6±3.7)weeks and (2 892.6±761.4)g], the differences were statistically significant (χ2=3.884 5, χ2=5.490 0, t=2.204 8, t=1.907 1, all P<0.05). The eclampsia (41.7%), postpartum hemorrhage (58.36%), acute renal failure (41.7%) of pregnancy-induced hypertension group were significantly less than the moderate (9.1%, 18.2%, 9.1%), mild maternal gestational hypertension group (0.0%, 14.3%, 0.0%), the differences were statistically significant(χ2=3.158 6, χ2=3.884 5, χ2=3.158 6, all P<0.05). Those of moderate maternal gestational hypertension group were significantly higher than the mild gestational hypertension group, the differences were statistically significant (P<0.05). Conclusion Pregnancy-induced hypertension syndrome has significant effect on pregnancy outcomes, the severity degree of pregnancy-induced hypertension is positively correlated with pregnancy outcomes, so early prevention of pregnancy-induced hypertension can increase overall maternal prognosis. Key words: Pregnancy induced hypertension; Pregnancy outcomes; Relevance

Immediate Delivery Versus Expectant Monitoring for Hypertensive Disorders of Pregnancy Between 34 and 37 Weeks of Gestation (HYPITAT-II)

Patients with hypertensive disorders of pregnancy usually have the 2 treatment options, either immediate delivery or continuing the pregnancy. Although immediately delivery of the placenta is seen as the more definitive of the 2 treatments, it does carry the potentially higher risks of an earlier birth (preterm if <37 weeks’ gestation), neonatal complications, and need for cesarean delivery. In particular, little is known of immediate delivery’s effect on maternal and neonatal outcomes in women between 34 and 37 weeks’ gestation. Therefore, this study, HYPITAT II, examines a cohort of pregnant women with mild hypertensive disorders at 34 to 37 weeks’ gestation, in order to evaluate the outcomes related to immediate delivery versus expectant monitoring (continuing pregnancy). This was an open-label, randomized controlled trial, in which 703 women with mild gestational hypertension, preeclampsia, deteriorating preexisting hypertension, and/or superimposed preeclampsia were examined at 34 to 36 weeks’ gestation. Patients with severe disease were excluded. Within 24 hours of randomization, patients in the immediate delivery group (n = 353) who had a Bishop score of 6 or greater underwent labor induced by amniotomy with oxytocin augmentation, had a score of less than 6, cervical priming prior to induction of labor, or, if they had a contraindication as determined by the attending obstetrician, cesarean delivery. Expectant monitoring (n = 351) was conducted per standard local protocols. Both maternal and neonatal outcomes were observed until discharge, and then patients were followed up at 6 weeks after birth. Primary maternal outcome was a composite of adverse maternal outcomes (thromboembolic complications, pulmonary edema, HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome, eclampsia, placental abruption, death), whereas secondary maternal outcomes were mode of delivery and cesarean delivery. Primary neonatal outcome was respiratory distress syndrome, whereas secondary outcomes covered a wide range of neonatal complications. The primary neonatal outcome, or respiratory distress syndrome, occurred more frequently in the immediate delivery group than in the expectant monitoring group (5.7% vs 1.7%; relative risk, 3.30; absolute risk, 4.0%; P = 0.005), and in a post hoc analysis, overall risk of neonatal morbidity was higher in the immediate delivery group than in the expectant monitoring group. However, neonates in the expectant monitoring group were at significantly increased risk of admission to the neonatal intensive care unit, infection or sepsis, or transient tachypnea. Although less, the risk of adverse primary maternal outcomes, as a composite, was not statistically significantly different between the 2 groups (1.1% immediate vs 3.1% expectant monitoring; relative risk, 0.36; absolute risk, 2.0; P = 0.067). HELLP syndrome was observed as the most common adverse outcome in both groups. Risk of cesarean delivery between groups also did not differ significantly. None of the adverse maternal outcomes led to neonatal complications. Immediate delivery carries significantly increased risk of adverse neonatal outcomes, such as respiratory distress syndrome. Although women with mild hypertensive disorders at 34 to 37 weeks’ gestation may benefit slightly from immediate delivery, until further studies are conducted to clarify the uncertainty, the authors recommend expectant monitoring as the primary route of treatment for this population and that immediate delivery take place only when needed.

73-OR

Objectives To study adverse outcomes associated with definitions of preeclampsia and compare them to patients not meeting diagnostic criteria for preeclampsia. Methods A multicenter, prospective, observational study was conducted on women with suspected preeclampsia (PE). Patients were managed by local protocol, and final diagnoses were adjudicated by independent panel. Subjects were classified as Traditional PE (TrPE) with both hypertension and proteinuria, or eclampsia or HELLP syndrome (ACOG 2012); Nonproteinuric PE (NpPE) with severe gestational hypertension (BP >160/110) or mild hypertension plus ⩾1 severe feature (ACOG, 2013); or No diagnosis (NoD). Adverse outcomes included preterm birth (PTB), SGA, IUFD, neonatal demise (NND), and severe maternal adverse outcomes (MAO - abruption, renal failure, pulmonary edema, fatty liver, TTP, DIC, stroke, and retinal detachment). Comparisons tested with Chi square, α = 0.05. Results A total of 757 subjects with signs or symptoms of PE were enrolled Table 1 ). 96 had chronic hypertension or mild gestational hypertension. As compared to TrPE, women with NpPE experienced similar rates of all adverse outcomes. Subjects with NoD also had similar rates of IUFD, NND, and MAO. However, women with NoD experienced lower rates of PTB p Conclusions Among patients with suspected preeclampsia before 35 weeks, the risks of severe adverse outcomes are elevated, even for those who fall outside current clinical diagnostic categories. Patients without a diagnosis, however have fewer preterm deliveries and SGA babies. Diagnostic criteria for preeclampsia poorly predict severe adverse outcomes, and may contribute to preterm delivery. Disclosures D. Woelkers: None. J. Barton: None. P. von Dadelszen: None. B. Sibai: None.

Does Induction of Labor Increase the Risk for Cesarean Section?

Rising rates of cesarean delivery are a major concern for all medical professionals. Reducing the frequency of induction is often mentioned as a means to reverse this trend. Published studies and review articles have examined induction of labor (IOL) versus expectant management and the risk for cesarean delivery, with conflicting results. This systematic review and meta-analysis was performed to determine whether IOL compared with expectant management in women with intact membranes increased the rate of cesarean delivery. MEDLINE, EMBASE, and the Cochrane Database of Clinical Trials were searched. Studies were included if IOL, for indications other than premature rupture of membranes, was compared with expectant management and outcome data on route of delivery were provided. Quantitative analyses with fixed- and random-effects models were performed. Of 1368 unique citations, the review included 37 studies; 27 were induction trials of uncomplicated pregnancies at 37 to 42 weeks of gestation and 10 evaluated IOL versus expectant management in pregnancies with suspected macrosomia, gestational diabetes, oligohydramnios, twins, intrauterine growth restriction, and mild gestational hypertension as well as in women with a high risk score for cesarean delivery. The reported overall cesarean delivery rates varied from 1% to 47%. In almost all studies, IOL was necessary in many of the expectantly managed patients, with rates of 4% to 50%. Most trials reported that the time to delivery increased by approximately 1 week in the expectantly managed group versus the IOL group. Nineteen trials were evaluated to be of high quality; and 17, of low quality. A quantitative summary analysis combined results of 31 trials, with 6248 and 5917 women randomized to IOL and expectant management, respectively. Induction of labor was associated with a reduction in the risk for cesarean delivery compared with expectant management (odds ratio [OR], 0.83; 95% confidence interval [CI], 0.76–0.92). The reduced risk for cesarean delivery was seen in both subgroups of the trials, specifically those examining IOL in women with late-term and postterm gestations (OR, 0.85; 95% CI, 0.76–0.95), and in the trials of IOL for other indications (OR, 0.81; 95% CI, 0.69–0.95). Subgroup analysis of only the 19 high-quality trials revealed a similar result (OR, 0.82; 95% CI, 0.73–0.91). Meta-analysis of the risk for cesarean delivery for fetal distress or the outcomes of postpartum hemorrhage and operative vaginal delivery did not find an increase with IOL. In addition, no statistically significant differences were seen between IOL and expectant management for Apgar score of less than 7 at 5 minutes, admission to the neonatal intensive care unit, or perinatal death. Induction of labor is associated with a moderate but statistically significant reduction in the risk for cesarean delivery. Differences in other maternal and neonatal outcomes were not apparent. On the basis of these findings, it may be that women at high risk for cesarean delivery (older age or obese) could benefit from elective induction. This should be investigated in further clinical trials.

380: Optimal delivery timing for mild gestational hypertension: a decision analysis

380: Optimal delivery timing for mild gestational hypertension: a decision analysis

Etiology and Management of Postpartum Hypertension-Preeclampsia

Postpartum hypertension can be related to persistence of gestational hypertension, preeclampsia, or preexisting chronic hypertension, or it could develop de novo postpartum secondary to other causes. There are limited data describing the etiology, differential diagnosis, and management of postpartum hypertension-preeclampsia. The differential diagnosis is extensive, and varies from benign (mild gestational or essential hypertension) to life-threatening such as severe preeclampsia-eclampsia, pheochromocytoma, and cerebrovascular accidents. Therefore, medical providers caring for postpartum women should be educated about continued monitoring of signs and symptoms and prompt management of these women in a timely fashion. Evaluation and management should be performed in a stepwise fashion and may require a multidisciplinary approach that considers predelivery risk factors, time of onset, associated signs/symptoms, and results of selective laboratory and imaging findings. The objective of this review is to increase awareness and to provide a stepwise approach toward the diagnosis and management of women with persistent and/or new-onset hypertension-preeclampsia postpartum period.

Medical treatment of early‐onset mild gestational hypertension reduces total peripheral vascular resistance and influences maternal and fetal complications

Complications in early-onset mild gestational hypertension (GH) are better predicted by total peripheral vascular resistance (TPVR) > 1350 dyne than by blood pressure. We therefore aimed to assess the possible reduction of severe complications by lowering TPVR with nitric oxide (NO) donors, oral fluids and standard antihypertensive therapy in women with early-onset mild GH. A group of 400 patients with early-onset (20-27 weeks' gestation) mild GH (systolic and diastolic blood pressure < 170/110 mmHg) and TPVR > 1350 dyne were enrolled in a prospective non-randomized trial with sequential allocation: 100 patients were treated with nifedipine (Group A); 100 with nifedipine and NO donors (Group B); 100 with nifedipine and oral fluids (Group C); and 100 with nifedipine, NO donors and oral fluids (Group D). TPVR was checked 1 month after initiation of therapy, and the number of patients with severe maternal and fetal complications was recorded in each group. The relationship between reduction in TPVR and the frequency of severe complications was assessed. Severe complications developed in 51% of patients in Group A, 48% in Group B, 53% in Group C and 35% in Group D, the frequency in Group D being significantly lower than that in the other treatment groups (P < 0.05). A reduction in TPVR of < 15% predicted the occurrence of severe complications with sensitivity 95.2% and specificity 88.3%. In Group D a reduction in TPVR of ≥ 15% was more probable (odds ratio (OR) = 2.03; 95% CI, 1.15-3.60; P < 0.015) and severe complications were less probable (OR = 0.52; 95% CI, 0.29-0.91; P < 0.023). In women with early-onset mild GH, combined treatment with NO donors, oral fluids and nifedipine optimally reduces TPVR and seems to reduce maternal and fetal complications.