Expectant monitoring had better outcomes than immediate delivery for women with high BP

Women with gestational hypertension or preeclampsia should have expectant monitoring instead of immediate delivery between 34 and 37 weeks of pregnancy, according to findings presented at The Pregnancy Meeting.

“Delivery, with the risk of breathing difficulties or other problems due to premature birth, should ideally only be chosen if it prevents worse complications,” researcher Kim Broekhuijsen, MD, of the University of Groningen, the Netherlands, said in a press release. She presented the findings of the HYPITAT-II study at The Pregnancy Meeting, the annual meeting of the Society for Maternal-Fetal Medicine.

Broekhuijsen and colleagues investigated whether delivery at 34 to 37 weeks would reduce adverse maternal outcomes in women with gestational hypertension or preeclampsia without compromising neonatal outcomes.

From June 2009 to March 2013, the researchers randomly assigned 754 women between 34 and 37 weeks gestation with gestational hypertension, preeclampsia or deteriorating chronic hypertension at 51 hospitals in the Netherlands to planned delivery (n=353) or expectant monitoring (n=351).

The primary maternal outcome was a composite of eclampsia, HELLP syndrome, pulmonary edema, thromboembolic disease, placental abruption and maternal death. The primary neonatal outcome was neonatal respiratory distress syndrome.

There was no significant difference in the primary maternal outcome between the groups (delivery group, 1.1%; monitoring group, 3.1%; RR=0.3; 95% CI, 0.08-1.08), the researchers found. However, those who had immediate delivery were more likely to have babies with neonatal respiratory distress syndrome (delivery group, 5.7%; monitoring group, 1.7%; RR=3.01; 95% CI, 1.3-6.99).

“We now have evidence suggesting that delivery of all women with these disorders does not prevent enough complications to justify the problems it causes in newborns,” Broekhuijsen stated in the release. “But if we could predict which women will develop these types of complications, we could choose delivery for them, while safely allowing pregnancy to continue (ie, expectant monitoring) in the large majority of women. This would prevent complications due to hypertensive disorders, without causing unnecessary premature births.”

For more information:

Broekhuijsen K. Oral Plenary Session I: Abstract 2. Presented at: The Pregnancy Meeting; Feb. 3-8, 2014; New Orleans.

Disclosure: Broekhuijsen reports no relevant financial disclosures.