JOURNAL ARTICLE
MULTICENTER STUDY
RANDOMIZED CONTROLLED TRIAL

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

P Tajik, K van der Tuuk, C M Koopmans, H Groen, M G van Pampus, P P van der Berg, J A van der Post, A J van Loon, C J M de Groot, A Kwee, A J M Huisjes, E van Beek, D N M Papatsonis, K W Bloemenkamp, G A van Unnik, M Porath, R J Rijnders, R H Stigter, K de Boer, H C Scheepers, A H Zwinderman, P M Bossuyt, B W Mol
BJOG: An International Journal of Obstetrics and Gynaecology 2012, 119 (9): 1123-30
22703475

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.

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