Deliver Low Risk Patients at 39 Weeks to Prevent Hypertensive Complications?
BACKGROUND AND PURPOSE:
Moussa et al. (Journal of Maternal-Fetal & Neonatal Medicine, 2017) examined the proportion of adverse pregnancy outcomes in deliveries prior to or at ≥39 weeks in uncomplicated singleton nulliparous women (low-risk) versus women with history of preeclampsia in a prior gestation (high-risk)
A secondary analysis from the multicenter trials of low dose aspirin for preeclampsia prevention in 3021 low and 600 high-risk pregnancies
Outcomes were proportions of adverse pregnancy outcomes including:
Hypertensive disorders in pregnancy
Small for gestational age (SGA)
Respiratory distress syndrome
Outcomes were divided into <39 weeks and ≥39 weeks gestational age at delivery
In the low risk group:
12% had hypertensive disorders (58% occurring at ≥39 weeks)
9% neonatal intensive care unit admission (44% occurring at ≥39 weeks)
5.9% SGA (60% occurring at ≥39 weeks)
3.5% respiratory distress syndrome (33% occurring at ≥39 weeks)
0.4% placental abruption (31% occurring at ≥39 weeks)
In the high risk group:
33% had hypertensive disorders (35.5% occurring at ≥39 weeks)
15.5% neonatal intensive care unit admission (16% occurring at ≥39 weeks)
9.2% SGA (24% occurring at ≥39 weeks)
5% respiratory distress syndrome (3% occurring at ≥39 weeks)
2% placental abruption (8.3% occurring at ≥39 weeks)
In the low risk group, the majority of hypertensive disorders occur ≥39 weeks
In contrast, the majority of the high risk group developed hypertensive disorders <39 weeks
The authors suggest that to prevent adverse events related to hypertensive disorders, a policy of delivery / induction of low risk women at 39 weeks may be well advised
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