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Pregnancy Hypertension 11 (2018) 12–17

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Pregnancy Hypertension
journal homepage: www.elsevier.com/locate/preghy

Indications for delivery in pre-eclampsia T
a,⁎ c b c c c a,b
N. Varnier , M.A. Brown , M. Reynolds , F. Pettit , G. Davis , G. Mangos , A. Henry
a
Department of Women’s and Children’s Health, St George Hospital, Kogarah, NSW, Australia
b
School of Women’s and Children’s Health, UNSW Medicine, Sydney, Australia
c
Department of Renal Medicine, St George Hospital, Kogarah, NSW, Australia

A B S T R A C T

Objective: Examine the frequency with which the most accepted indicators for delivery in pre-eclampsia are used
in a population with predominantly late-onset (birth > 32 weeks) pre-eclampsia (PE).
Methods: Retrospective cohort study using the St George Public Hospital (SGH) Hypertension in Pregnancy
database. Demographic, pregnancy, and outcome details were extracted and verified by comparison with data
collection sheets.
Results: From 2001 to 2013, 908 women (970 babies) with PE were included, of which a subgroup of 303
women (33%) had clearly delineated delivery triggers available. This subgroup of women had similar demo-
graphic and outcome characteristics to the total PE population.
In this group, the most common maternal trigger for delivery apart from gestational age 37+ weeks was
difficult to control/severe hypertension (114 cases, 38%) and the most common fetal trigger intrauterine growth
restriction (IUGR: 14 cases, 4%). 78 (35%) of term women had no specific delivery trigger other than gestation.
A primary maternal trigger and/or associated complication was slightly more common in those delivering <
37 weeks vs 37+ weeks (52 vs 38%, p = .03), while a fetal or combined maternal/fetal complication was over
four times more common in preterm women (25 vs 6%, p < .001).
Conclusion: In our population of predominantly late-onset PE, maternal triggers for delivery (predominantly
severe hypertension) far outweigh fetal triggers (predominantly IUGR). Fetal and mixed indicators for delivery
were relatively more common in women delivering preterm, possibly reflecting the severity of placental dys-
function in this subgroup.

1. Background indicators for delivery in hypertensive pregnancies [5,6]. As noted in
the SOMANZ and ISSHP guidelines [6,7], triggers for delivery in the
Management of the hypertensive expectant mother has evolved with case of pre-eclampsia include gestational age 37 weeks or more
concurrent understanding of the pathophysiology of disease and out- (reaching “term”), deteriorating maternal condition (manifest as any of
comes. Hypertensive disorders complicate 6–8% of all pregnancies, uncontrollable blood pressure, severe persistent maternal symptoms
with 3–4% complicated specifically by pre-eclampsia [1,2]. Although despite blood pressure control, or laboratory evidence of deteriorating
there are multiple temporizing management strategies for pre- maternal end-organ function) and deteriorating fetal condition. Mul-
eclampsia and gestational hypertensive disorders, definitive manage- tiple triggers may be present.
ment is delivery of the placenta (and therefore of the fetus) [3]. Fol- Whilst some studies cite ‘severe disease’ as an indication for delivery
lowing delivery, most symptoms of pre-eclampsia resolve within days to [6,8] we are not aware of studies describing the relative frequency with
weeks, and blood pressure has been shown to return to normal gen- which each specific delivery trigger (or combination of triggers) occurs.
erally within a maximum of three months. However, as preterm or early Additionally, many studies focus on severe early-onset pre-eclampsia
term delivery increases risk of morbidity for mother and baby [4], where delivery occurs prior to 34 weeks due to the high rate of maternal
difficulties arise in deciding what particular set of circumstances should and fetal complications in early-onset cases [6,9,10]. However, the
lead to delivery rather than expectant management of hypertensive predominant burden of hypertensive disorders of pregnancy still occurs
disorders of pregnancy. in the far more numerous late onset cases. A recent meta-analysis
Progression of pre-eclampsia, failure to control maternal blood suggested that the early-onset preeclampsia rate was 0.38 per 100 de-
pressure, or failure of fetal growth are common recommended liveries compared to 2.72 per 100 deliveries for late-onset preeclampsia


Corresponding author.
E-mail address: n.varnier@yahoo.com (N. Varnier).

https://doi.org/10.1016/j.preghy.2017.11.004
Received 17 January 2017; Received in revised form 3 September 2017; Accepted 20 November 2017
Available online 08 December 2017
2210-7789/ © 2017 International Society for the Study of Hypertension in Pregnancy. Published by Elsevier B.V. All rights reserved.

6 weeks. 908 also records whether PE is de novo or superimposed on essential hy. Thus. gestational age at from which the most comprehensive data was available (January 1. We therefore examined the frequency with which the most com- Maternal Fetal monly recognised triggers for delivery are considered responsible in the setting of pre-eclampsia ≥32 weeks’ gestation (gestation limited by Gestational age > 37/40 Placental abruption study hospital special care nursery capacity). pre-existing The data is collected in a standardised data collection sheet by mid. hepatic/coagulation systems. Varnier et al. Data analysis protocols at the study hospital. n = 287 de novo PE. were used. more likely to have a twin delivery was present (e. and women < 32 weeks’ gestation transferred out. about delivery triggers.5% [12]. aiming for blood pressure readings below systolic blood pressure 2. Additional agents are added as required. To ensure accurate information 2002 to December 31. the parameters outlined by the SOMANZ/ISSHP guidelines [14] which guide treatment 2.05. 32 completed weeks were eligible as delivery prior to this gestation is demographic data and outcomes were similar between our background not undertaken at the study hospital. gestation at first presentation into an electronic database. Student’s t-test and ANOVA were used as appropriate to compare Unit at the time of the study was defined as a systolic blood pressure continuous variables.3 ± 2. history. propriate to test for significant differences between categorical vari- hypertensive agents as per local protocol. For the term group. pregnancies and 17 twins.1. mean gestation suggested by SOMANZ [6] and shown in Table 1. Patients are routinely com- menced on oxprenolol 40 mg three times per day (TDS). Only pregnancies delivered at gestation greater than graphic and pregnancy data is shown in Table 2. ‘Tight’ control is favoured [15]. the subgroup with trigger data is representative of our total PE popu- Primary data sought were the recorded trigger or triggers for delivery as lation. < 34-weeks’ gestation) of 0.17] including cardiovascular. those delivering at the [16. The HIP database triggers). Methods with abnormal LFTs Pulmonary oedema We conducted a retrospective cohort study at St George Hospital. After exclusion of women gestation with evidence of effect on one or more other body systems with gestational or essential hypertension only. recent review [13]. South Eastern Sydney Local Health District Human Research and Ethics These medications are titrated to maximum recommended doses Committee (HREC 13/152. suggesting differed at the hospital to which the mother had been transferred. 2013) for St George Public Hospital patients. pregnancy and outcome factors. another obstetric indicator for delivering preterm were significantly older. mode of birth. All tests were two-tailed. pregnancy history (singleton or wifery staff at the time of confinement and subsequently transposed multiple pregnancy. with each delivery indica. obstetric ment the management of any hypertensive pregnancy at the hospital. The primary data source accessed was the complications with underlying maternal and pregnancy characteristics. in these cases. renal disease. For the purposes of this study. and triggers for delivery may have PE population and the study (delivery trigger) population. renal.9 weeks (74% GA 37+ weeks at delivery). Similar findings were noted in the SCOPE study which found an Table 1 early onset PE rate (i. As shown in Table 2. Deterioration renal function Persistent neurological symptoms Persistent epigastric pain. significant differences between term and preterm groups regarding Note was also made where PE was diagnosed but was not the primary preeclampsia type (de novo vs superimposed).1 years. a metropolitan Sydney teaching hospital with approximately 2700 births/annum. LNR/13/POWH/384). ≥140 mmHg or diastolic ≥90 mmHg. Of these.e. Pregnancy Hypertension 11 (2018) 12–17 [11]. branes) with subsequent intrapartum or postpartum diagnosis of pre. delivery. The use of more than two 3. We also aimed to examine Uncontrollable blood pressure Severe growth restriction the associations of demographic. 17 superimposed PE) The primary inclusion criterion was final diagnosis of de novo or had delivery trigger data and 604 outcome data only. the following data was also analysed: maternal age and parity. Chi-square test or Fisher exact tests were used as ap- pertension in pregnancy was routinely treated with oral anti. gestational diabetes).7 ± 6. pre-existing diabetes. any 37. Deteriorating liver function agement. Version 22. private hospital (with no access to records for verification of delivery neurological symptoms and the fetus and placenta. maintain the same treatment policy. presentation to delivery interval. (GA) at time of diagnosis 36. in- Deteriorating platelet count Non-reassuring fetal cluding time from presentation to delivery. and at delivery where GA of 37+ weeks was in itself sufficient to trigger delivery. Baseline demo- superimposed PE. complication was difficult to control/severe hypertension (114 cases. Ethics approval ≥140 mmHg or diastolic ≥90 mmHg. and more likely to be multiparous (Table 2). Intravascular haemolysis status tion. and for singleton vs twin pregnancy. cholestasis or premature rupture of mem. Severe hypertension in this ables.0). methyldopa at The study was approved as low/negligible risk research by the a starting dose of 250 mg TDS if beta-blockers are contraindicated. women had a final diagnosis of PE. with statistical sig- ≥170 mmHg or diastolic blood pressure ≥110 mmHg (treated urgently nificance defined as a probability value of < . 3557 deliveries of pregnancies affected by hypertension were re- Pre-eclampsia (PE) was diagnosed as hypertension at > 20 weeks’ corded in the database for the study period. pregnancy. A sustained finding of hy. Subgroup analysis was with standard release nifedipine). The most common maternal trigger for delivery or associated term eclampsia. The study was limited to a 12-year period of hypertension. patients with hy- pertension in pregnancy were those with a systolic blood pressure Data were analysed using SPSS (IBM SPSS Statistics for Windows.N. Average maternal age was 30. Results agents and sustained suboptimal control of blood pressure constitutes ‘difficult to control BP’. SOMANZ triggers for delivery (7). Hypertension in Pregnancy (HIP) database.2. 304 (287 singleton pertension. There were no additional maternal or fetal complications from Table 1 were recorded.g. in order to potentially guide future patient counselling and man. medical history including chronic hypertension. however women with PE indicator for delivery. used since 1987 to docu. birth weight. through close assessment in a day stay unit and admission if required. nausea or vomiting 2. To examine the association of preterm delivery triggers and term 38%) and the most common fetal trigger was intrauterine growth 13 . This unit maintained a consistent performed for women who were term (37 or more completed weeks at treatment policy throughout the data collection period and continues to time of delivery) vs preterm. original HIP data from January 2010 to The definition of hypertension in pregnancy has been the subject of December 2013 was cross-checked against patient medical records.7 ± 1.

4. A primary maternal trigger/associated complication was one-third had no associated concerning maternal or fetal features and slightly more common in those delivering < 37 weeks vs 37+ weeks were delivered on the basis of term gestation alone.1 . years 30.3 ± 2.6 ± 1. 321 study population (n = 225) (n = 79) preterm delivery babies) babies) N (%) N (%) N (%) N (%) Parity . maternal and fetal indications for delivery (25% vs 6%). Severe hypertension was also the most common associated women (11%) only developed pre-eclampsia intrapartum or post. and the women had no specific complication other than their PE diagnosis and most common fetal indicator was suspected intrauterine growth re- were thus delivered on the basis of their gestation alone.07 ± 0.05 ± 0.1. patients with maternal triggers than term patients (Table 3). reflect a higher clinical threshold for proceeding with preterm delivery ferences in delivery triggers/associated complications between women and therefore.1 . Pregnancy Hypertension 11 (2018) 12–17 Table 2 Demographic and pregnancy characteristics.6 . having their first and subsequent deliveries. Bold values designate statistically significant values. Conversely.3 35. consistent with our group’s previous research was 3. of which 11/19 (58%) were emergent/ may reflect differing preeclampsia phenotypes.7 ± 1.052 166 (74) 47 (60) .001 GA at delivery (weeks) 37. 25% in preterm group).7 ± 6. it may Regarding demographic subgroups. 4%) (Table 3).74 3. It may also represent close surveillance of a known higher-risk group in our cohort. Discussion Also noted in the preterm delivery group was that a higher pro- portion were parous rather than nulliparous. In the preterm group when diotocograph findings). 23% of women laboured spontaneously Although there were a significantly higher proportion of preterm and 20% (n = 70) had an elective caesarean section (‘elective cae.001). it arose.0 ± 6. 427 (71) 225 (74) .3 ± 5. 649 (n = 304 women. the presence of both a maternal plication was over four times more common in preterm women (25 vs and fetal indication for delivery was much more common in preterm PE 6%.19]. maternal sarean’: constitutes a pre-labour caesarean section.66 kg. and In this cohort of preeclamptic women ≥32 weeks’ gestation man. more likely to deliver preterm (82% vs the 20 preterm women who had both a maternal and fetal indication for 23%).001 GA 37 + weeks at delivery.79 3. the term and preterm PE populations.02 . while partum. Excluded PE population Study population P values no trigger vs Term delivery Preterm delivery P values term vs (n = 604 women.0 < . (half of which were emergency cases after an attempt at induction) in nancies were. (Table 5) however parous Clinically. indication for delivery (p < . GA = gestational age. They were also more likely than singleton pregnancies to have a delivery. prompt diagnosis and management of late preterm preeclampsia when aged at a single unit with consistent diagnosis and management pro.1 ± 1.7 ± 1.7 36. while a fetal or combined maternal/fetal com. or mixed maternal/fetal final indication for the delivery trigger was either fetal or mixed fetal/maternal. restriction (IUGR: 14 cases.46 . this was reflected in a very high rate of caesarean section women were more likely to deliver preterm. although the proportion of singleton babies of trum [4]. Mean birth weight differ between groups.2 ± 6. SD = standard deviation. while 27 striction.Primiparous 384 (64) 213 (70) .65 37. p = . singletons (kg) 3. was over four times more common in the preterm group. Main findings statistical finding due to multiple comparisons. with a greater degree of urgent. presence of a primary fetal indication for delivery birthweight < 10th centile for gestation [20] did not differ significantly (predominantly IUGR or suspected fetal distress from ultrasound/car- (18% in term group.26 ± 0.N. Additionally.Singleton 559 (93) 287 (94) .1.001 GA at diagnosis (weeks) 36.66 .5 ± 2.29 – – – n (%) PE = preeclampsia. Women with twin preg. unsurprisingly.0 32.30 222 (99) 65 (82) . there were no significant dif. Overall. occurring in approximately one-third of cases.55 214 (95) 73 (92) .001). Varnier et al. Pregnancy outcomes are shown in Table 4. more advanced disease by the time delivery is triggered. Over half of pregnancies 4. were more common in women delivered pre-term (Table 3).001 . as over half the parous women in this study had a prior history tocols. it does mixed maternal/fetal indication for delivery (24% vs 4%. This women (95%) had a Caesarean.1. 19/20 delivery. There was a over one-third of term women. feature of term PE. Moreover.Twin 45 (7) 17 (6) 3 (1) 14 (18) PE subtype .Superimposed 40 (7) 17 (6) 11 (5) 6 (8) Mean ± SD Mean ± SD Mean ± SD Mean ± SD Maternal age. overt placental pathology in the preterm group [21]. Seventy-eight (35%) term population was severe or difficult to control blood pressure. 57%). birthweight was significantly lower showing adverse maternal outcomes across the gestational age spec- in the preterm group. planned at a time complications (predominantly severe hypertension) were still present in acceptable to both the woman and the team) [18.54 < . On comparison of (52 vs 38%.Multiparous 220 (36) 91 (30) 59 (26) 32 (41) Plurality .02).55 2.6 30. cations such as liver/haematological dysfunction and eclampsia did not tempted inductions of labour in the preterm group. 14 . Although the numbers in this subgroup are small.006) and suggest that these patients should not be quoted (normal pregnancy) less likely to have no specified trigger or a non-PE diagnosis as the population statistics regarding Caesarean rates/induction outcomes.2 ± 2. rates of serious compli- significantly greater proportion of elective Caesarean and fewer at.1 ± 1.9 34.8 < . As expected.39 30.32 38. Preterm vs term women were induced (n = 172.De-novo 564 (93) 287 (94) .02 Birthweight.07 ± 0. p < . and that after discussion elective Caesarean is reasonable to offer if that is the maternal preference. p = .9 .50 ± 0. the most common maternal indicator for delivery in the preterm of a hypertensive disorder of pregnancy. This may be a chance 4.1 37.

No specific trigger (PE 59 (26.1) 11 (13.9) 1 (1.4) 7 (8. managed by one team and a single agreed man- No specified delivery trigger 78 (34. “trigger”. with only 19% having no other concurrent abnormality.6) . routine delivery at 37 weeks or our datasheets and patient files/electronic records. “delivery”.22]. PE alone at 37+ weeks is sufficient trigger for delivery. n delivery.2) 15 (19) .6) . However. with only a small minority of remain small.3) 1.4) 0 (0) 1.4.05 [13].14 Mixed maternal/fetal indication 3 (1.001 Fetal triggers Intrauterine 6 (2. cholestasis) – lack of data fields that may be relevant to interpretation of outcome.21 and PubMed. 25 (11.3) 41 (51.1) . “in- Other† 11 (4.7) 8 (10. preeclampsia alone sufficient to trigger delivery: Table 3 shows whether additional maternal or fetal indicators were also present.20 but spontaneous Although ‘severe disease’ is often cited as a key indicator for de- labour) livery in pre-eclampsia this is not always defined in a standard manner.9) 0. ex- Primary maternal indication 85 (37. More- Preeclampsia alone††† 43 (19. with indications for GH: gestational hypertension.7) 7 (8. distress (incl.02 Trigger/ 4. supports an increased partum or postpartum PE in this group was noted to be higher than placental severity of pre-term disease with consequent increased po- tential for intervention or poor fetal outcome. there remains scope following diagnosis beyond term). “induction”). analysis has been carried Bold values designate statistically significant values.2) 5 (6. available (as indications for delivery have only been added to our bour.4) tocols are consistent. and b) Non-PE primary indication 24 (10.8) < .7) 7 (8.9) . This study as- GrowthRestriction sesses the frequency of each indicator as delineated in the local SO- (IUGR) MANZ guidelines.9) 10 (12.13 dysfunction failed to yield any comparative studies reviewing the actual frequency Eclampsia 1 (0.2) 2 (2.1) 2 (2. abnormal doppler) PROM/PPROM 2 (0. Pregnancy Hypertension 11 (2018) 12–17 Table 3 previously reported (6–10%) [21.7) 6 (7. Future research ciated abnormality/complication of their pre-eclampsia. premature rupture of membranes. It confirms that severe/ In this group. length of pregnancy in a higher risk population who are not routinely induced at 37 weeks unless PE has been diagnosed. × out on the data available and comparison with the subgroup of verified For term group. n part increased local ascertainment of intrapartum and early postpartum (%) (%) cases (vs antenatal diagnosis). Varnier et al. the majority of patients had at least one asso.6. PROM: premature rupture of delivery data limited to the proportion of cases with original datasheets membranes. and further studies from other Units are needed to see term cases having a diagnosed fetal complication or major maternal whether these data are applicable nationally or internationally. IOL: induction of la. It may also reflect in Term Preterm P value delivery.or post-partum diagnosis. * Blood pressure requiring treatment with two or more agents. with subsequent intrapartum or postpartum development of preeclampsia.7) 36 (45. mostly occurring above 34-weeks’ gestation. Conclusion term leads to higher likelihood of severe hypertension. CTG: cardiotocograph.g. pital’s databases.0 4.0 of each indicator for delivery (search carried out using OVID MedLine Gestational Diabetes 14 (6. Malposition.06 Whilst a number of guidelines are available regarding the general Severe Hypertension* indicators for delivery in pre-eclampsia. while 11% underwent induction for a non-PE reason and preterm group.02 BP reason or bias upon timing of delivery. Retrospective studies carry their own inherent limitations.9) .7) – agement protocol. a review of available literature Liver or haematological 5 (2. such as BMI which was not until recently included in this study hos- †† Delivered for GH/EH but then developed preeclampsia intrapartum or postpartum. as timing of diagnosis can be differ- Total Total entiated both through the HIP database and our centre’s obstetric da- n = 225 n = 79 tabase.03 amination of the relative frequency of triggers for delivery across a late Primary fetal indication 10 (4. electronic database more recently). we also found a significant minority where PE was not difficult to control maternal blood pressure is the most common in- part of decision making regarding delivery: 11% of women laboured dicator for delivery across gestations.N. including † Other primary maternal indication for delivery than preeclampsia (e. the literature is commonly focused on the early-onset population Postdates 5 (2. only be overcome with a prospective study design.8) 41 (51. data has confirmed accuracy of recording. Oligohydramnios. Decreased fetal movement.9) .9) .3) . Comparative literature association× Maternal triggers Difficult to control/ 78 (34. 15 . EH: essential hypertension. The major limitations of the study are its retrospective nature and its modest sample size. 4. In the term group.9) 22 (27. complication such as eclampsia. which are similar to the recent ISSHP guidelines Abnormal CTG/Fetal 6 (2.5) .9) .3) 13 (16. *** Includes: Small for gestational age.3. Despite cross-checking for triggers data against both ††† Preeclampsia is the only indicator for delivery (e. GH/EH†† 9 (4) 0 (0) .65 the study was carried out in a single centre whose management pro- Spontaneous pre-term delivery – 9 (11.01 eclampsia. Antepartum for error in interpretation of clinician decision-making which could Haemorrhage. included search terms: “pre-eclampsia”. This could be related to the Maternal and fetal indicators for delivery.09 Final Indication for Delivery The main strengths of this study are a) As far as we are aware. This study quantifies the frequency of triggers/indications for de- weigh benefits. and that unless new evidence arises to suggest risks of early term delivery in PE out.23].g.02 dication”.5) . although substantially higher in the postpartum. A mixed maternal/fetal indication.2) N/A [9] and fails to consider the clinical reality of a late-onset pre- Any Fetal Trigger 20 (8. Subgroup numbers in the preterm (32–37 weeks) triggers group cation was severe hypertension (35%). PPROM: preterm.30 over. The most common compli. The rate of diagnosis of intra. livery in pre-eclampsia ≥32 weeks’ gestation. with fetal triggers/complications spontaneously and were then noted to have PE either intra-partum or occurring in a minority of cases.5) < .7) . nificantly more common in preterm gestation. IOL for non.001 preterm/term preeclamptic population has not been performed. which was sig- were subsequently diagnosed with PE.2. Any Maternal 84 (37. This is consistent with findings from the HYPITAT study [1] wherein continued expectant management at 5. thus minimising the effect of individual preferences Intra. Strengths and limitations Other*** 6 (2.12 though the ISSHP has sought to address this recently [1.

Antepartum Haemorrhage. Pre-eclampsia: a lifelong disorder.6) 136 (60.g. No labour: 19. † Other primary maternal indication for delivery than preeclampsia (e. kg 3.63 Liver or haematological dysfunction 9 (4) 2 (2) . Bekedam. IOL for non-BP reason 20 (9) 7 (8) . [2] M. * Blood pressure requiring treatment with two or more agents.1016/j.7) .0) 56 (24.68 GH/EH†† 7 (3) 2 (2) . at http://dx.2017. Lancet 374 (9694) (2009) 979–988 PubMed PMID: 19656558.5) 21 (9. Bold values designate statistically significant values. Koopmans.26 ± 0.11.30 Assisted vaginal delivery 72 (23.N.1) 40 (50. D.9) . †† Delivered for GH/EH but then developed preeclampsia intrapartum or postpartum.06 No specific trigger (PE but spontaneous labour) 56 (26) 18 (20) .5) 40 (18. et al. Overall group.24 Spontaneous labour* 70 (23. routine delivery at 37 weeks or following diagnosis beyond term). EH: essential hypertension.org/10.0 N (%) N (%) N (%) Birthweight < 10th centilea (singletons) 56 (19.preghy.g. Bijlenga.76 Final Indication for Delivery Primary maternal indication 85 (40) 40 (44) .01 . Med. 18.5) 0 (0) 1.6) . NSW: 54. H. open- Appendix A. Table 5 Maternal and fetal indicators for delivery by parity.18 Any fetal trigger 29 (14) 13 (14) .001 Gestation at delivery. Malposition.004.6) 26 (32.55 2.54 Mixed maternal/fetal indication 8 (4) 8 (9) .1. abnormal Doppler) 9 (4) 5 (5) .3 35.9 38. 27. Acknowledgement online version.6) . 3 twin pregnancies.88 Maternal triggers Difficult to control/Severe Hypertension* 78 (37) 36 (40) . 321 babies Total n = 225 women 228 Total n = 79 women 93 babies## babies# Mean ± SD Mean ± SD Mean ± SD Birth weight (singletons only). 14 twin pregnancies.J. weeks 37.52 Eclampsia 1 (0.8) 12 (15. n (%) P-value (term vs preterm) Total n = 304 women.88 Fetal triggers Intrauterine Growth Restriction (IUGR) 10 (5) 4 (4) . cholestasis) – with subsequent intrapartum or postpartum development of preeclampsia. Oligohydramnios.04 SD = standard deviation. * Australian averages: Spontaneous labour: 54.0 No specified delivery trigger 57 (27) 22 (24) .0 Gestational diabetes 13 (6) 3 (3) . ## 65 singleton. ††† Preeclampsia is the only indicator for delivery (e.35 Postdates 6 (3) 0 (0) .33 Spontaneous pre-term delivery 6 (3) 3 (3) 1.M.5) 77 (34. MOD = Mode of delivery.66 3. ** Australian average 32% (18). Aust.91 Abnormal CTG/Fetal distress (incl.0) 16 (24. *** Includes: Small for gestational age. premature rupture of membranes.Emergency/urgent caesarean 82 (27. Pregnancy Hypertension 11 (2018) 12–17 Table 4 Pregnancy outcome data.6 ± 1.2%. in the 16 .54 < .32 Other† 12 (6) 11 (12) . PPROM: preterm.doi. Supplementary data label randomised controlled trial.3) 14 (17. n (%) Term delivery.2) 13 (16. a For gestational age as per Australian birthweight centiles (23).2) . S. Decreased fetal movement. J.0 Other*** 8 (4) 4 (4) .08 Caesarean section** 117 (38.M.62 GH: gestational hypertension.8) 31 (39.1 ± 1.02 MOD: Vaginal delivery 115 (37. The authors would like to extend their thanks to Ms Jennifer Beddoe References who is responsible for maintenance of the database which is herein referenced.8) 89 (39. [1] C.054 No established labour 62 (20.50 ± 0. n (%) Multiparous.A. IOL: induction of labour. Nulliparous.73 Preeclampsia alone††† 35 (16) 19 (21) .9) .8) 26 (32.6) . # 222 singleton.4) 36 (45. Induction of labour versus expectant monitoring for gestational hypertension or mild pre-eclampsia after 36 weeks' gestation (HYPITAT): a multicentre.2) < . n (%) P value Total n = 213 Total n = 91 Any maternal trigger/association 87 (41) 38 (42) .08 Non-PE primary indication 24 (11) 7 (8) .or post-partum diagnosis.5) .55 Primary fetal indication 13 (6) 4 (4) .G.6%.4) 31 (13. Vijgen.7 ± 1.17 . D.7) 59 (26. 179 (4) (2003) Supplementary data associated with this article can be found.001 Induction 172 (56.Elective caesarean 35 (11. n (%) Preterm delivery.4%. Varnier et al.3% (18). Brown.0) 58 (25.73 Intra.3%. J. Induction: 26.63 PROM/PPROM 3 (1) 0 (0) 1. Groen. PROM: premature rupture of membranes.07 ± 0.. CTG: cardiotocograph. Aarnoudse.

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