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Journal Summary: Immediate delivery vs expectant monitoring for hypertensive disorders at 34-37 wk (HYPITAT II): RCT

Routine immediate delivery for women with non-severe hypertensive disorders at 34-37 weeks significantly increases the risk of neonatal respiratory distress syndrome. Expectant management is recommended until 37 weeks or until clinical deterioration occurs.

Broekhuijsen K, van Baaren GJ, van Pampus MG, HYPITAT-II study group.  Immediate delivery versus expectant monitoring for hypertensive disorders of pregnancy between 34 and 37 weeks of gestation (HYPITAT-II): an open-label, randomised controlled trial. Lancet 2015; 385: 2492-501

Summary

The optimal management of women with non-severe hypertension at 34-37 weeks is uncertain, weighing competing risks of clinical deterioration with expectant management versus neonatal morbidity with immediate delivery.

This RCT included 703 women with non-severe hypertension between 34 and 37 weeks who were randomized to either immediate delivery within 24 hours or expectant monitoring with the aim of continuing gestation to 37 weeks.

The primary outcome was a composite of adverse maternal outcome (thromboembolic disease, pulmonary oedema, eclampsia, HELLP syndrome, placental abruption or maternal death) and neonatal respiratory distress syndrome.

No maternal or perinatal deaths occurred. The risk of composite adverse maternal outcome did not differ significantly between the groups, but the risk of respiratory distress syndrome was significantly higher in the immediate delivery group (RR 3.3, p=0.005).

Clinical implications

For women with non-severe hypertension at 34 to 37 weeks, expectant management reduces neonatal morbidity without significantly increasing adverse maternal outcome compared with immediate delivery.

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