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|Title:||Should cervical favourability play a role in the decision for labour induction in gestational hypertension or mild pre-eclampsia at term? An exploratory analysis of the HYPITAT trial|
van der Tuuk, K.
van Pampus, M.
van der Berg, P.
van der Post, J.
van Loon, A.
de Groot, C.
van Beek, E.
van Unnik, G.
de Boer, K.
|Citation:||BJOG: an International Journal of Obstetrics and Gynaecology, 2012; 119(9):1123-1130|
|Tajik P ... Mol B ... et al.|
|Abstract:||Objective: To examine whether cervical favourability (measured by cervical length and the Bishop score) should inform obstetricians’ decision regarding labour induction for women with gestational hypertension or mild pre-eclampsia at term. Design: A post hoc analysis of the Hypertension and Pre-eclampsia Intervention Trial At Term (HYPITAT). Setting: Obstetric departments of six university and 32 teaching and district hospitals in the Netherlands. Population: A total of 756 women diagnosed with gestational hypertension or pre-eclampsia between 36 + 0 and 41 + 0 weeks of gestation randomly allocated to induction of labour or expectant management. Methods: Data were analysed using logistic regression modelling. Main outcome measures: The occurrence of a high-risk maternal situation defined as either maternal complications or progression to severe disease. Secondary outcomes were caesarean delivery and adverse neonatal outcomes. Results: The superiority of labour induction in preventing high-risk situations in women with gestational hypertension or mild pre-eclampsia at term varied significantly according to cervical favourability. In women who were managed expectantly, the longer the cervix the higher the risk of developing maternal high-risk situations, whereas in women in whom labour was induced, cervical length was not associated with a higher probability of maternal high-risk situations (test of interaction P = 0.03). Similarly, the beneficial effect of labour induction on reducing the caesarean section rate was stronger in women with an unfavourable cervix. Conclusion: Against widely held opinion, our exploratory analysis showed that women with gestational hypertension or mild pre-eclampsia at term who have an unfavourable cervix benefited more from labour induction than other women. Trial registration: The trial has been registered in the clinical trial register as ISRCTN08132825.|
|Keywords:||Bishop score; cervical length; expectant management; gestational hypertension; induction of labour; pre-eclampsia|
|Rights:||© 2012 The Authors. Re-use of this article is permitted in accordance with the Terms and Conditions set out at http://wileyonlinelibrary.com/onlineopen#OnlineOpen_Terms|
|Appears in Collections:||Obstetrics and Gynaecology publications|
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