Bhageerathy, P S (2013) Induction of labour versus conservative management for mild gestational hypertension at term. Masters thesis, Christian Medical College, Vellore.
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Abstract
INTRODUCTION: Hypertensive disorders of pregnancy remain a leading cause of maternal and perinatal morbidity and mortality. Most of the time, it is a pregnancy specific disorder characterised by hypertension with or without proteinuria, sometimes progressing to multi- organ dysfunction with varying clinical features.The incidence of hypertensive disorders at term is high, though the incidence of maternal morbidity is low at this gestational age. But the incidence of maternal morbidity is higher remote from term, though the incidence of hypertensive disorders is low at this gestational age. AIMS AND OBJECTIVES: 1. To study whether induction of labour in women with singleton pregnancy complicated by gestational hypertension at 37 weeks reduces maternal morbidity and mortality when compared to conservative management. 2. To study whether this intervention increases instrumental delivery and caesarean section rates. 3. To study whether induction of labour in women with singleton pregnancy complicated by gestational hypertension at 37 weeks reduces neonatal morbidity and mortality when compared to conservative management. 4. To study whether induction of labour reduces the expenditure when compared to conservative management as the costs for foetal surveillance and increased number of antenatal visits can be avoided. METHODS: Eligible patients presenting to the Obstetric outpatient department of Christian Medical College, Vellore between 37 and 40 weeks from September 2011 to October 2012 with gestational hypertension (systolic blood pressure of 140 to 159 mm of Hg and diastolic blood pressure of 90 to 100 mm Hg) are randomised in 1:1 ratio to either induction of labour or conservative management after taking consent. Patients in the conservative management arm are monitored biweekly for any maternal or fetal compromise till 39 weeks and 5 days when they are induced. Women in the induction group were induced within 12 hours of randomisation. Details of delivery, any maternal or neonatal complications were recorded and analysed using Chi Square test for categorical variables and Student’s t test for comparison of continuous variables. A p value of less than 0.05 denoted statistical significance. RESULTS: 1. Though a higher rate of progression to severe hypertension and preeclampsia in the conservative group was noticed, this was not statistically significant. 2. There was no statistically significant difference in the incidence of complications like eclampsia, postpartum haemorrhage,thrombosis,HELLP syndrome,pulmonary oedema,renal failure, abruptionplacenta or maternal mortality . 3. There was no statistically significant difference in caesarean section rates between the 2 groups. 4. There was no statistically significant difference in neonatal morbidity and mortality. 5. A slight increase in the median total cost was found in the conservative management group. CONCLUSIONS: 1. The results of the study showed that induction of labour in women with singleton pregnancy complicated by gestational hypertension at term reduces maternal morbidity when compared to conservative management, though not statistically significant. There was no maternal mortality in either group. 2. There was no statistically significant difference in the instrumental delivery or caesarean section rates between the 2 groups. Induction of labour was not found to increase the caesarean section rate contrary to the popular belief. 3. There was no statistically significant difference in the neonatal morbidity and mortality between the 2 groups. 4. Induction of labour reduced the expenditure when compared to conservative management as the costs for foetal surveillance and increased number of antenatal visits can be avoided. A slight increase by about 600 rupees in the median total cost was found in the conservative management group when compared to the induction group, but this was not statistically significant.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Induction of labour, conservative management, mild gestational hypertension. |
| Subjects: | MEDICAL > Obstetrics and Gynaecology |
| Depositing User: | Subramani R |
| Date Deposited: | 18 Jun 2020 14:07 |
| Last Modified: | 18 Jun 2020 14:07 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/12501 |
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