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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
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-ecla...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Blackwell Publishing Ltd
2012
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3440582/ https://www.ncbi.nlm.nih.gov/pubmed/22703475 http://dx.doi.org/10.1111/j.1471-0528.2012.03405.x |
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author | Tajik, P van der Tuuk, K Koopmans, CM Groen, H van Pampus, MG van der Berg, PP van der Post, JA van Loon, AJ de Groot, CJM Kwee, A Huisjes, AJM van Beek, E Papatsonis, DNM Bloemenkamp, KW van Unnik, GA Porath, M Rijnders, RJ Stigter, RH de Boer, K Scheepers, HC Zwinderman, AH Bossuyt, PM Mol, BW |
author_facet | Tajik, P van der Tuuk, K Koopmans, CM Groen, H van Pampus, MG van der Berg, PP van der Post, JA van Loon, AJ de Groot, CJM Kwee, A Huisjes, AJM van Beek, E Papatsonis, DNM Bloemenkamp, KW van Unnik, GA Porath, M Rijnders, RJ Stigter, RH de Boer, K Scheepers, HC Zwinderman, AH Bossuyt, PM Mol, BW |
author_sort | Tajik, P |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-3440582 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2012 |
publisher | Blackwell Publishing Ltd |
record_format | MEDLINE/PubMed |
spelling | pubmed-34405822012-09-13 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 Tajik, P van der Tuuk, K Koopmans, CM Groen, H van Pampus, MG van der Berg, PP van der Post, JA van Loon, AJ de Groot, CJM Kwee, A Huisjes, AJM van Beek, E Papatsonis, DNM Bloemenkamp, KW van Unnik, GA Porath, M Rijnders, RJ Stigter, RH de Boer, K Scheepers, HC Zwinderman, AH Bossuyt, PM Mol, BW BJOG Maternal Medicine 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. Blackwell Publishing Ltd 2012-08 2012-06-18 /pmc/articles/PMC3440582/ /pubmed/22703475 http://dx.doi.org/10.1111/j.1471-0528.2012.03405.x Text en © 2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2012 RCOG http://creativecommons.org/licenses/by/2.5/ Re-use of this article is permitted in accordance with the Creative Commons Deed, Attribution 2.5, which does not permit commercial exploitation. |
spellingShingle | Maternal Medicine Tajik, P van der Tuuk, K Koopmans, CM Groen, H van Pampus, MG van der Berg, PP van der Post, JA van Loon, AJ de Groot, CJM Kwee, A Huisjes, AJM van Beek, E Papatsonis, DNM Bloemenkamp, KW van Unnik, GA Porath, M Rijnders, RJ Stigter, RH de Boer, K Scheepers, HC Zwinderman, AH Bossuyt, PM Mol, BW 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 |
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 |
title_full | 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 |
title_fullStr | 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 |
title_full_unstemmed | 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 |
title_short | 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 |
title_sort | 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 |
topic | Maternal Medicine |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3440582/ https://www.ncbi.nlm.nih.gov/pubmed/22703475 http://dx.doi.org/10.1111/j.1471-0528.2012.03405.x |
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