Publication:

Induction of labour versus conservative management for mild gestational hypertension at term

Background Hypertensive disorders of pregnancy remain a leading cause of maternal and perinatal morbidity and mortality. The aim of this study was to find out whether immediate induction of labour in women with singleton pregnancy complicated by mild gestational hypertension at term reduced maternal and neonatal morbidity, mortality and expenditure when compared to conservative management without increasing instrumental delivery and caesarean section rates.

Methods This was a randomized controlled trial to compare immediate induction of labour to conservative management for mild gestational hypertension in women between 18-35 years of age with singleton pregnancy with mild gestational hypertension at 37-39.5 weeks without any other complications. Eligible patients presenting to the obstetric outpatient department or labour room of Christian Medical College, Vellore with gestational hypertension were randomized (49 patients in the induction arm and 51 patients in the conservative arm) and followed up. The maternal and neonatal outcomes in both groups were compared.

Results There was no maternal mortality in both the groups. There was increased incidence of composite maternal morbidity (pre-eclampsia, eclampsia, HELLP syndrome, pulmonary oedema, renal failure, thromboembolic disease, abruption, need for ICU care and major postpartum haemorrhage) in the conservative arm when compared to induction arm (14 versus 8), though not statistically significant (p 0.23).There was no significant difference in the caesarean section rates between the two groups (p 0.313 and 0.306 respectively) despite the much favorable Bishop score in the conservative group (p 0.054). There was no significant difference in neonatal morbidity and mortality. A slight increase by about 600 rupees in the median total cost was found with conservative management when compared to induction group.

Conclusions The study did not show a statistically significant difference in maternal mortality, composite maternal morbidity, neonatal mortality and morbidity as well as treatment cost between immediate induction of labour and conservative management for mild gestational hypertension at term.