Pregnancy outcomes of expectant management of stable mild to moderate chronic hypertension as compared with planned delivery

• Published in: International journal of gynecology and obstetrics 2014-10, Vol.127 (1), p.15-20
• Main Authors: Hamed, Hossam O, Alsheeha, Muneera A, Abu-Elhasan, Ahmad M, Abd Elmoniem, Alaa E, Kamal, Manal M
• Format: Article
• Language: English
• Subjects: Adult; Chronic hypertension; Delivery, Obstetric; Expectant management; Female; Humans; Hypertension, Pregnancy-Induced; Obstetrics and Gynecology; Planned delivery; Pregnancy; Pregnancy Outcome; Pregnancy outcomes; Watchful Waiting; Young Adult
• ISSN: 0020-7292; 1879-3479
• DOI: 10.1016/j.ijgo.2014.04.010

Abstract Objective To compare outcomes between elective delivery at 37 weeks of pregnancy and expectant management among pregnant women with mild to moderate chronic hypertension. Methods In a two-center study, 76 women with mild to moderate chronic hypertension were randomly allocated to planned delivery at 37 completed weeks (group A) or expectant management for spontaneous onset of labor or reaching 41 weeks (group B) between April 2012 and October 2013. Differences were compared by t test, χ2 test, or Fisher exact test. Odds ratios (ORs) with 95% confidence interval (CIs) were determined. Results There were no differences in superimposed pre-eclampsia (SPE), severe hypertension, preterm delivery, placental abruption, oligohydramnios, intrauterine growth restriction, or perinatal mortality between the groups. Group B had higher gestational age at delivery ( P = 0.001) and birth weight ( P = 0.01), but lower cesarean (OR 3.4; 95% CI, 1.2–10.3; P = 0.03) and neonatal care unit admission (OR 5.4; 95% CI, 1.4–21.0; P = 0.01) rates. More women with SPE were diagnosed before than after 37 weeks in group B ( P = 0.01). Overall, patients who developed SPE had more adverse pregnancy outcomes than those who did not. Conclusion Mild to moderate chronic hypertension could be managed expectantly up to 41 weeks if SPE did not develop.