OBJECTIVE: To determine the optimal timing of delivery in pregnancies with pre-existing (chronic) hypertension by quantifying the gestational age-specific risks of stillbirth associated with ongoing pregnancy and the gestational age-specific risks of neonatal mortality or serious neonatal morbidity following the induction of labour. DESIGN: Population-based cohort study. SETTING: USA. POPULATION: A total of 171 669 singleton births to women with pre-existing hypertension between 1995 and 2005. Pregnancies additionally complicated by diabetes mellitus, cardiac, pulmonary or renal disease were excluded. METHODS: The week-specific risks of stillbirth between 36 and 41 completed weeks of gestation were contrasted with the week-specific risks of neonatal mortality or serious neonatal morbidity among births following induction of labour in women with pre-existing hypertension. MAIN OUTCOME MEASURES: Stillbirth, neonatal mortality or serious neonatal morbidity (defined as a composite outcome which included any of the following: neonatal seizures, severe respiratory morbidity or 5-minute Apgar score ≤3). RESULTS: The risk of stillbirth in women with pre-existing hypertension remained stable at 1.0-1.1 per 1000 ongoing pregnancies until 38 weeks, before rising steadily to 3.5 per 1000 [95% confidence interval (CI): 2.4, 5.0] at 41 weeks. The risk of serious neonatal morbidity/neonatal mortality decreased sharply between 36 and 38 weeks from 137 [95% CI: 127, 146] to 26 [95% CI: 24, 29] per 1000 induced births, before stabilising beyond 39 weeks. CONCLUSIONS: Among women with otherwise uncomplicated pre-existing hypertension, delivery at 38 or 39 weeks appears to provide the optimal trade-off between the risk of adverse fetal and adverse neonatal outcomes.
OBJECTIVE: To determine the optimal timing of delivery in pregnancies with pre-existing (chronic) hypertension by quantifying the gestational age-specific risks of stillbirth associated with ongoing pregnancy and the gestational age-specific risks of neonatal mortality or serious neonatal morbidity following the induction of labour. DESIGN: Population-based cohort study. SETTING: USA. POPULATION: A total of 171 669 singleton births to women with pre-existing hypertension between 1995 and 2005. Pregnancies additionally complicated by diabetes mellitus, cardiac, pulmonary or renal disease were excluded. METHODS: The week-specific risks of stillbirth between 36 and 41 completed weeks of gestation were contrasted with the week-specific risks of neonatal mortality or serious neonatal morbidity among births following induction of labour in women with pre-existing hypertension. MAIN OUTCOME MEASURES: Stillbirth, neonatal mortality or serious neonatal morbidity (defined as a composite outcome which included any of the following: neonatal seizures, severe respiratory morbidity or 5-minute Apgar score ≤3). RESULTS: The risk of stillbirth in women with pre-existing hypertension remained stable at 1.0-1.1 per 1000 ongoing pregnancies until 38 weeks, before rising steadily to 3.5 per 1000 [95% confidence interval (CI): 2.4, 5.0] at 41 weeks. The risk of serious neonatal morbidity/neonatal mortality decreased sharply between 36 and 38 weeks from 137 [95% CI: 127, 146] to 26 [95% CI: 24, 29] per 1000 induced births, before stabilising beyond 39 weeks. CONCLUSIONS: Among women with otherwise uncomplicated pre-existing hypertension, delivery at 38 or 39 weeks appears to provide the optimal trade-off between the risk of adverse fetal and adverse neonatal outcomes.
Authors: Melissa G Rosenstein; Yvonne W Cheng; Jonathan M Snowden; James M Nicholson; Aaron B Caughey Journal: Obstet Gynecol Date: 2012-07 Impact factor: 7.661
Authors: Liona C Poon; Laura A Magee; Stefan Verlohren; Andrew Shennan; Peter von Dadelszen; Eyal Sheiner; Eran Hadar; Gerard Visser; Fabricio Da Silva Costa; Anil Kapur; Fionnuala McAuliffe; Amala Nazareth; Muna Tahlak; Anne B Kihara; Hema Divakar; H David McIntyre; Vincenzo Berghella; Huixia Yang; Roberto Romero; Kypros H Nicolaides; Nir Melamed; Moshe Hod Journal: Int J Gynaecol Obstet Date: 2021-07 Impact factor: 4.447
Authors: Grażyna Bączek; Ewa Rzońca; Patryk Rzońca; Sylwia Rychlewicz; Margareta Budner; Agnieszka Bień Journal: Int J Environ Res Public Health Date: 2022-08-03 Impact factor: 4.614