Intensification of fetal and maternal surveillance in pregnant women with hypertensive disorders

Objective: To examine the need to intensify fetal and maternal surveillance in pregnant women with mild pregnancy hypertension. Methods: The multi-center cohort study in 2413 healthy nulliparae analyzed differences in hypertension-related adverse events (small-for-gestational age, perinatal mortality, eclampsia, abruptio placentae and HELLP syndrome) according to maximum diastolic blood pressure and proteinuria. Results: Compared to the reference group (diastolic blood pressure 70-85 mmHg) (n = 1882) the relative risks of adverse fetal and maternal outcome in 34 proteinuric hypertensive women were 8.9 (95% CI 3.3-24.1) and 41.5 (95% CI 9.7-178.4), respectively. In 203 non-proteinuric women with a maximum diastolic blood pressure of greater than or equal to 95 mmHg only the relative risk of adverse maternal outcome was increased (11.6, 95% CI 3.1-42.8), but it was not increased in 230 non-proteinuric women with a maximum diastolic of 90 mmHg. Conclusions: Intensified surveillance in women with mild pregnancy hypertension is not indicated and should be reserved for groups with increased fetal and maternal risk. (C) 1998 International Federation of Gynecology and Obstetrics.