Babies born between weeks 39 and 40 of pregnancy have the most positive outcomes, according to the American College of Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine, but it’s often necessary to induce labor earlier when the health of the mother or baby are threatened. Two such threats are late-term gestational hypertension and preeclampsia; traditionally, labor has been induced between 34 and 37 weeks to avert any complications from these conditions that could arise during a longer pregnancy. New research says diligent monitoring rather than early delivery may be the healthiest approach.
The findings of research done in the Netherlands were presented on February 6, 2014, to the members of the Society for Maternal-Fetal Medicine during their annual meeting, which was held in New Orleans, Louisiana. Kim Broekhuijsen, MD, presented the evidence on monitoring versus early delivery; she is a medical researcher at the University of Groningen (Netherlands) Medical Center’s Obstetrics and Gynecology Department.
Broekhuijsen and her research team evaluated the outcomes for 700 mothers and their babies born in 51 Dutch hospitals. All the mothers had gestational hypertension or preeclampsia. Some were monitored to prolong pregnancy but others were induced for preterm delivery.
The medical outcomes of each case, for mother and child, were analyzed. The number of children in each group who suffered neonatal respiratory distress syndrome (RDS) was counted. Adverse outcomes for the mothers included one or more of:
- HELLP syndrome
- Maternal death
- Placental abruption
- Pulmonary edema
HELLP syndrome is a variation of preeclampsia that occurs most often in the later stages of pregnancy. It is thought to be fatal about 25% of the time. It’s name means:
- H — hemolysis because it destroys red blood cells
- EL — elevated liver enzymes
- LP — low platelet count
The Dutch research group found that the rate of maternal complications was about the same in the group being monitored and the group undergoing induced labor:
- 3.1% in the monitored group
- 1.1% in the induced group
However, the rate of babies born with RDS was notably higher in the induced group than in the monitored group:
- 1.7% in the monitored group
- 5.7% in the induced group
A baby’s respiratory system doesn’t become fully developed until the last weeks of pregnancy. The risk of breathing difficulties is a major reason for delaying every birth until as close to full term as possible.
The Dutch study indicates there is a small risk of maternal complications when a woman is monitored instead of induced when hypertension and preeclampsia are diagnosed. The baby, however, may benefit significantly when pregnancy is monitored and delivery delayed. Broekhuijsen recommends induced early birth only when waiting may result in even more severe medical complications.
Source: “Expectant monitoring rather than immediate delivery recommended for women with hypertension or preeclampsia.” ScienceDaily. ScienceDaily, LLC. Feb 3, 2014. Web. Feb 15, 2014.