Please use this identifier to cite or link to this item: http://hdl.handle.net/2440/86971
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Type: Journal article
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
Author: Tajik, P.
van der Tuuk, K.
Koopmans, C.
Groen, H.
van Pampus, M.
van der Berg, P.
van der Post, J.
van Loon, A.
de Groot, C.
Kwee, A.
Huisjes, A.
van Beek, E.
Papatsonis, D.
Bloemenkamp, K.
van Unnik, G.
Porath, M.
Rijnders, R.
Stigter, R.
de Boer, K.
Scheepers, L.
et al.
Citation: BJOG: an International Journal of Obstetrics and Gynaecology, 2012; 119(9):1123-1130
Publisher: Wiley
Issue Date: 2012
ISSN: 1470-0328
1471-0528
Statement of
Responsibility: 
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
RMID: 0020136928
DOI: 10.1111/j.1471-0528.2012.03405.x
Appears in Collections:Obstetrics and Gynaecology publications

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