Labour induction with Gestational Hypertension: A great obstetric challenge

Khaskheli, Meharunnissa; Baloch, Saira; Sheeba, Aneela; Baloch, Sarmad; Khan, Fahad

doi:10.12669/pjms.331.10386

Cited by 5 publications

(5 citation statements)

References 18 publications

(12 reference statements)

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“…In the study by Khaskelil et al majority (51.4%) of preeclamptic women were admitted at 35-38 weeks of gestation which is consistent with the present study [6] .…”

Section: Booked/unbookedsupporting

confidence: 92%

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Role of Nonstress test in improving the perinatal outcome in pregnancies complicated by preeclampsia

Jamatia¹,

Malhotra²,

Nanda³

et al. 2019

Int. J. Clin. Obstet. Gynaecol.

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Introduction: Antepartum fetal surveillance is the assessment of fetal well being in utero before the onset of labour. It helps in early detection of fetuses at risk, so that timely management can prevent further deterioration, thereby reducing perinatal morbidity / mortality. Around 10-30% of the mothers seen in antenatal period can be classified as high risk but they account for 70-80% of perinatal mortality / morbidity. Aim And Objectives: The role of NST in management of pregnancies complicated by preeclampsia and comparison of maternal and perinatal outcome in patients of preeclampsia undergoing NST and without NST. Material and Methods: Present study was carried out in 100 patients of preeclampsia with singleton pregnancy, cephalic presentation of more than 32 weeks period of gestation. Group I (cases) -100 patients of preeclampsia in whom NST was done. Group II (controls)retrospective analysis of medical records of 100 patients of preeclampsia in the past 1 year where NST was not done. Results: The mean age of women in group I was 24.63±3.63 years and 24.53±3.74 in group II. 4. Maximum number of women i.e. 59% in group I and 55% in group II were primi para (p >0.05). Majority of women were admitted at 37-38 weeks period of gestation i.e. 40% in group I and 38% in group II (p >0.05). Out of 100 women in group I who were subjected to nonstress tests, a total of 68(68%) women were found to have reactive NST while 32(32%) women had non-reactive NST. Thirty two non-reactive NST cases were further subjected to BPS out of which 26(81.25%) were normal and 6(18.75%) were associated with abnormal BPP. Twenty six patients who had normal BPP, were followed up with weekly BPP. Out of 68 NST reactive cases, fourty six (67.64%) women delivered vaginally and 22(32.35%) underwent cesarean section and in non-reactive 32 cases, nine (28.12%) women delivered vaginally and 23(71.87%) women underwent cesarean section which is statistically significant (p<0.05). Sixty (88.23%) newborns in reactive NST group had normal birth weight and 19(59.37%) newborns in non-reactive NST group had normal birth weight which is statistically significant (p<0.05). Apgar score >7/10 at 1 & 5 minutes was found in 64(94.11%) newborns in reactive NST group and 22(73.33%) newborns in nonreactive NST group which is statistically significant (p<0.05). Nine (13.23%) newborns were admitted in reactive NST group and 17(56.66%) in non-reactive NST group. Conclusion:The major goal of antepartum fetal surveillance is an appropriate & timely identification of fetuses at risk of morbidity and mortality & thus unnecessary delay in interventions can be avoided and hence a better perinatal outcome could be achieved. An equally important goal is to avoid unnecessary intervention in an uncompromised fetus.

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“…In the study by Khaskelil et al majority (51.4%) of preeclamptic women were admitted at 35-38 weeks of gestation which is consistent with the present study [6] .…”

Section: Booked/unbookedsupporting

confidence: 92%

“…In the study by Khaskheli et al it was observed that that 20% of preeclamptic women had undergone induction out of which 64.49% women had normal vaginal delivery and 28.3%women had LSCS. Failed induction occurred in 30.76% women [6] .…”

Section: Mode Of Deliverymentioning

confidence: 98%

Role of Nonstress test in improving the perinatal outcome in pregnancies complicated by preeclampsia

Jamatia¹,

Malhotra²,

Nanda³

et al. 2019

Int. J. Clin. Obstet. Gynaecol.

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“…In the present study, when the baseline characteristics were compared it was seen that the mean age and parity were similar in both Group A and Group B which was similar to the study conducted by Pallipuram et al and Khaskheli MN et al, and also HYPITAT trial. 4,7,8 In the present study gestational hypertension was seen more in unbooked cases (68.33% in group A and 70% in group B). Bangal VB et al, also found that 80% of the patients were unbooked.…”

Section: Discussionsupporting

confidence: 49%

A comparative study of maternal and fetal outcomes following induction of labour versus expectant management in mild gestational hypertension at term

Alam

Choubey

2019

Int J Reprod Contracept Obstet Gynecol

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Background: To compare the maternal and neonatal outcomes between planned induction of labour and expectant management in women with mild gestational hypertension at term.Methods: A prospective hospital based observational study. The 120 pregnant women with mild gestational hypertension were randomized in a 1:1 ratio either to receive immediate induction of labour (group A comprising 60 women) or expectant management (group B comprising 60 women). Primary outcomes were incidence of any maternal mortality, renal failure, pulmonary oedema, need for ICU care or post-partum eclampsia and also composite maternal morbidity like severe gestational hypertension, pre-eclampsia, eclampsia, abruption and PPH. Secondary outcomes were mode of delivery, need for antihypertensives and MgSO4.Results: Though there were no maternal death or renal or pulmonary complications in any group, progression to severe hypertension was more in group B (expectant management) compared to group A (immediate induction) (18.33% vs. 3.33%). Increased incidence of pre-eclampsia and eclampsia were noted in group B (15% and 3%) as compared to group A (0%). Incidence of Abruption and PPH was less in group A 1.67% and 5% compared to group B 3.33% and 10 % respectively. Spontaneous vaginal delivery rate was low and caesarean section rates were high in group A (61.67% and 31.67%) compared to group B (68.33% and 25% respectively). Need for antihypertensive and MgSO4 were less in group A (3.33% each) compared to group B (18.33% and 16.66% respectively).Conclusions: Requirement of antihypertensive, progression to severe hypertension, pre-eclampsia, eclampsia, use of MgSO4, incidence of abruption, PPH were less in group A compared to group B. However, induction at completion of 37 weeks may be associated with increased incidence of operative deliveries.

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“…Women with HDP have significantly higher probability of adverse maternal and fetal outcomes than normal pregnant women. 6 Stratified management of maternal risk factors can help to identify highrisk pregnant women in a timely manner and ease the socioeconomic burden on the patients and on the healthcare system. Currently, SMM is considered the most important indicator of maternal management quality.…”

Section: Discussionmentioning

confidence: 99%

Prediction model for severe maternal morbidity in pregnant women with hypertensive disorders of pregnancy

Bian,

Zheng,

Liu

et al. 2024

Pak J Med Sci

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Objectives: To investigate risk factors for severe maternal morbidity (SMM) in pregnant women with hypertensive disorders of pregnancy (HDP) and to develop a risk prediction model. Methods: A prospective observational cohort study was conducted among pregnant women who were hospitalized for hypertensive disorders of pregnancy (HDP) between January 2016 and December 2020 in Fujian College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Province, China (a training set), and a risk predictive model was constructed. Pregnant women with HDP who were hospitalized between January 2021 and December 2021 were selected as a validation set. Concordance index (C-index) and calibration curves were used to test predictive model discrimination and calibration. Results: We included 970 pregnant women (790 in the training set and 180 in the validation set). Least absolute shrinkage and selection operator regression was used to screen for nine related variables such as intra-uterine growth retardation (IUGR), diastolic blood pressure (DBP) and systolic blood pressure (SBP) at suspected diagnosis, total bilirubin, albumin (ALB), uric acid, total cholesterol, serum magnesium, and suspected gestational age. SBP at suspected diagnosis (OR =1.22, 95%CI:1.08–1.42) and total cholesterol (OR = 1.78, 95% CI:1.17–2.80) were independent risk factors of severe maternal morbidity in pregnant women with HDP. A nomogram was constructed, and internal validation of the nomogram model was done using the bootstrap self-sampling method. C-index in the training and the validation set was 0.798 and 0.909, respectively. Conclusion: Our prediction model can be used to determine gestational hypertension severity in pregnant women. Abbreviations:SMM: Severe maternal morbidity; HDP: Hypertensive disorders of pregnancy; LASSO: Least absolute shrinkage and selection operator; IUGR: intrauterine growth retardation; SBP: Systolic blood pressure; DBP: Diastolic blood pressure; ALB: Serum albumin concentration; URIC: Serum uric acid concentrations. doi: https://doi.org/10.12669/pjms.40.6.9095 How to cite this: Bian Y, Zheng S, Liu X, Jiang X. Prediction model for severe maternal morbidity in pregnant women with hypertensive disorders of pregnancy. Pak J Med Sci. 2024;40(6):1054-1062. doi: https://doi.org/10.12669/pjms.40.6.9095 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Labour induction with Gestational Hypertension: A great obstetric challenge

Cited by 5 publications

References 18 publications

Role of Nonstress test in improving the perinatal outcome in pregnancies complicated by preeclampsia

Role of Nonstress test in improving the perinatal outcome in pregnancies complicated by preeclampsia

A comparative study of maternal and fetal outcomes following induction of labour versus expectant management in mild gestational hypertension at term

Prediction model for severe maternal morbidity in pregnant women with hypertensive disorders of pregnancy

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