ResearchObstetricsElective delivery at 340/7 to 366/7 weeks' gestation and its impact on neonatal outcomes in women with stable mild gestational hypertension
Section snippets
Materials and Methods
The study population was identified retrospectively from a large national database containing clinical data collected prospectively from high-risk pregnant women receiving outpatient perinatal nursing services from Alere (Atlanta, GA; formerly Matria Healthcare).5 These services provide comprehensive outpatient services for conditions that place a pregnancy at risk for adverse outcomes. The population consisted of both commercially insured and Medicaid patients receiving care from obstetricians
Results
During the study period, there were 1858 patients with mild gestational hypertension delivering ≥340/7 weeks: 607 (33%) had maternal and/or fetal reasons for delivery whereas 1251 (67%) women had elective delivery. These later patients are the subject of this study. Of those 1251 women with elective delivery, 319 (25.5%) were delivered at 340/7–366/7 weeks, 305 (24.4%) at 370/7–376/7 weeks, and 627 (50.1%) were delivered at ≥380/7 weeks' gestation. Maternal characteristics are presented in
Comment
In the population studied, we found that 25.5% of patients with stable mild gestational hypertension without proteinuria had elective delivery late preterm. To our knowledge, this is the first study to provide data on this subject from community practices from across the United States. We also found elective delivery in women with stable mild gestational hypertension was also associated with increased rates of cesarean section as well as neonatal complications and neonatal length of hospital
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Cited by (29)
Hypertensive Disorders of Pregnancy
2019, Emergency Medicine Clinics of North AmericaCitation Excerpt :For women beyond 37 weeks of gestation, delivery rather than continued observation is suggested. One retrospective study of women diagnosed with mild gestational hypertension who underwent elective delivery found that waiting until the gestational age was greater than 38 weeks was associated with lower rates of low birth weight, small-for-gestational age delivery, neonatal intensive care unit admission, and respiratory distress syndrome.66 Blood pressures are typically monitored for at least 72 hours postpartum and again 7 to 10 days after delivery, with continued assessment for symptoms of end-organ dysfunction.
Indicated preterm birth in a type 3 maternity ward: Evaluation of practices
2016, Journal de Gynecologie Obstetrique et Biologie de la ReproductionTiming of induction of labor
2015, Seminars in PerinatologyImmediate delivery versus expectant monitoring for hypertensive disorders of pregnancy between 34 and 37 weeks of gestation (HYPITAT-II): An open-label, randomised controlled trial
2015, The LancetCitation Excerpt :Therefore, interpretation of these results should take into account local options for monitoring and emergency intervention. The proportions of neonates of different gestational ages with respiratory distress syndrome accorded with previous studies.19,22,23 Although median time from randomisation to delivery differed between the two groups by only 5 days, this resulted in a significant difference in respiratory distress syndrome and a few secondary neonatal outcomes.
Obstetric decision-making and the late and moderately preterm infant
2012, Seminars in Fetal and Neonatal Medicine
Reprints not available from the authors.
B.M.S. is a consultant for Alere; J.R.B. is a speaker.
Cite this article as: Barton JR, Barton LA, Istwan NB, et al. Elective delivery at 340/7 to 366/7 weeks' gestation and its impact on neonatal outcomes in women with stable mild gestational hypertension. Am J Obstet Gynecol 2011;204:44.e1-5.