Duration of labor induction in nulliparous women with hypertensive disorders of pregnancy and maternal and neonatal outcomes

Colvin, Zachary; Feng, Mingen; Pan, Amy; Palatnik, Anna

doi:10.1080/14767058.2020.1844658

Cited by 4 publications

(2 citation statements)

References 22 publications

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“…Most studies mentioned above showed that adverse maternal or neonatal events are not more common if a vaginal delivery is attempted, which is in line with our findings. Only one study of Colvin and colleagues was found, which stated that a duration of labour over 24 h was associated with an increased risk for maternal and neonatal morbidity [ 32 ]. Thus, we suggest discussing induction of labour generously in women with preeclampsia if delivery is indicated, even when blood pressure levels are high and/or gestational age is young, providing there is no obstetrical contraindication for vaginal delivery.…”

Section: Discussionmentioning

confidence: 99%

Perinatal Outcome and Its Association with Blood Pressure Levels in Women with Preeclampsia

Willy

Schmitz

Klockenbusch

et al. 2022

JCM

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Background: Timing and mode of delivery in women with preeclampsia remains challenging, often balancing the risk of severe maternal complications and preterm delivery with its risks for the newborn. It is known that women with very high blood pressure levels in pregnancy have more unfavourable outcomes, but there is little data on neonatal outcome in these cases and the effect of the delivery mode. Methods: We included 158 preeclamptic women in our single-centre retrospective cohort study. Patients were divided into three subgroups depending on blood pressure levels, and delivery mode as well as neonatal outcomes were analysed. Furthermore, the effect of gestational age at delivery was assessed. Results: Maternal blood pressure levels correlated negatively with gestational age at delivery (p = 0.007) and positively with delivery via caesarean section (p = 0.003). Induction of labour was more frequent in women with lower blood pressure levels (p = 0.008) and higher gestational age (p < 0.001). If labour was induced, vaginal delivery was achieved equally often in all gestational ages. Neonatal outcome appears to be more favourable after vaginal delivery compared to planned caesarean section (p < 0.001). Conclusions: Induction of labour should be discussed generously in preeclamptic women, even if blood pressure levels are high and/or gestational age is young, as success rates seem to be adequate and neonatal outcome is more favourable after vaginal delivery. Large prospective trials are needed to better evaluate success rates, risks and complications of induced labour and the effects of delivery mode on neonatal outcome in preeclampsia.

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Section: Discussionmentioning

confidence: 99%

Perinatal Outcome and Its Association with Blood Pressure Levels in Women with Preeclampsia

Willy

Schmitz

Klockenbusch

et al. 2022

JCM

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“…1,2 In addition to mortality risk, the maternal complications of HDP include pulmonary edema, myocardial infarction, stroke, coagulopathy, and renal failure. 3 There is evidence [4][5][6][7][8] and biological plausibility (i.e., imbalance of angiogenic factors and coagulopathy, [9][10][11] prolonged induction of labor due to preterm pregnancies, and use of magnesium sulfate [MgSO 4 ]-a medication associated with smooth muscle relaxation and potentially uterine atony 12,13 ) suggesting that individuals with HDP are more likely to have postpartum hemorrhage (PPH), defined as blood loss of 1,000 mL or more within 24 hours of delivery. 14 However, the current American College of Obstetricians and Gynecologists (ACOG) practice bulletin on gestational hypertension (gHTN) and preeclampsia does not acknowledge this assoication.…”

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confidence: 99%

Risk of Postpartum Hemorrhage in Hypertensive Disorders of Pregnancy: Stratified by Severity

Cagino,

Wiley,

Ghose

et al. 2024

Am J Perinatol

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We aimed to determine the composite maternal hemorrhagic outcome (CMHO) among individuals with and without HDP, stratified by disease severity. Additionally, we investigated the composite neonatal adverse outcome (CNAO) among individuals with HDP who had versus did not have PPH. Our retrospective cohort study included all singletons who delivered at a Level IV center over two consecutive years. The primary outcome was the rate of CMHO, defined as blood loss ≥ 1000 mL, use of uterotonics, mechanical tamponade, surgical techniques for atony, transfusion, venous thromboembolism, ICU admission, hysterectomy, or maternal death. A subgroup analysis was performed to investigate the primary outcome stratified by 1) cHTN, 2) gHTN and preeclampsia without severe features, and 3) preeclampsia with severe features. A multivariable regression analysis was performed to investigate the association of HDP with and without PPH on a CNAO which included APGAR <7 at 5min, bronchopulmonary dysplasia, intraventricular hemorrhage, necrotizing enterocolitis, seizures, neonatal sepsis, meconium aspiration syndrome, ventilation > 6 hours, hypoxic-ischemic encephalopathy or neonatal death. Of 8,357 singletons, 2,827 (34%) had HDP. Preterm delivery <37 weeks, induction of labor, prolonged oxytocin use, and MgSO4 usage were more common in those with versus without HDP (p<0.001). CMHO was higher among individuals with HDP than those without HDP (26% vs.19%; aRR 1.11, 95% CI 1.01-1.22). In the subgroup analysis, only individuals with preeclampsia with severe features were associated with higher CMHO (n=802; aRR 1.52, 95% CI 1.32-1.75). There was a higher likelihood of CNAO in individuals with both HDP and PPH compared to those with HDP without PPH (aRR 1.49, 95% CI 1.06-2.09). CMHO was higher among those with HDP. After stratification, only those with preeclampsia with severe features had an increased risk of CMHO. Among individuals with HDP, those who also had a PPH had worse neonatal outcomes than those without hemorr

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Induction of Labor

Adhikari

2023

Queenan's Management of High‐Risk Pregnancy

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Duration of labor induction in nulliparous women with hypertensive disorders of pregnancy and maternal and neonatal outcomes

Cited by 4 publications

References 22 publications

Perinatal Outcome and Its Association with Blood Pressure Levels in Women with Preeclampsia

Perinatal Outcome and Its Association with Blood Pressure Levels in Women with Preeclampsia

Risk of Postpartum Hemorrhage in Hypertensive Disorders of Pregnancy: Stratified by Severity

Induction of Labor

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