Timing of Delivery in Mild Gestational Hypertension: Expectant Management Versus Immediate Induction
Keywords:
Gestational hypertension, induction of labor, expectant management, preeclampsia prevention, timing of deliveryAbstract
Introduction: Mild gestational hypertension without severe features presents a management dilemma. Early delivery may prevent progression to preeclampsia, whereas expectant management may reduce neonatal complications from prematurity.
Methods: Literature search in CENTRAL and MEDLINE for randomized controlled trials comparing induction at 37 weeks versus expectant management until 38–39 weeks. Outcomes included maternal severe hypertension, cesarean delivery, and neonatal respiratory distress.
Results: Six trials (3,200 women) were included. Induction at 37 weeks reduced progression to severe hypertension (8% vs. 15%; risk ratio 0.55) but increased induction failure (18% vs. 4%). Neonatal outcomes were equivalent except for a modest reduction in jaundice in the expectant group. No difference in maternal mortality or eclampsia.
Discussion: Earlier induction reduces maternal hypertensive complications but increases interventions. The absence of significant neonatal harm supports shared decision-making. Studies excluded women with pre-existing hypertension or fetal growth restriction.
Conclusions: Induction at 37 weeks for mild gestational hypertension reduces severe hypertension without increasing major neonatal morbidity. Expectant management is reasonable for well-controlled cases.
