Several studies have compared continued hospitalization and outpatient care. In a pilot study from Parkland Hospital, 72 nulliparas with new-onset hypertension from 27 to 37 weeks were assigned either to continued hospitalization or to outpatient care (Horsager, 1995). he only significant diference was that women in the home care group developed severe preeclampsia significantly more frequently than hospitalized women42 versus 25 percent. In another trial, ater hospital evaluation, 218 women with mild gestational nonprotein uric hypertension were similarly divided (Crowther, 1992). As shown in Table 40-7, the mean hospital duration was 22.2 days for women with inpatient management compared with only 6.5 days in the home care group. Preterm delivery before 34 and before 37 weeks' gestation was increased twofold in the outpatient group. However, maternal and newborn outcomes were otherwise similar.
Another approach, popular in Europe, is day care (Milne, 2009). In one study, 54 women with hypertension after 26 weeks' gestation were assigned to either day care or routine outpatient management (see Table 40-7) (Tufnell, 1992). Progression to overt preeclampsia and labor inductions were signiicantly greater in the routine outpatient management group. In another, 395 women participated in either day care or inpatient management (Turnbull, 2004). Almost 95 percent had mild-to-moderate hypertension. Of enrolled women, 288 lacked proteinuria, and 86 had � 1 + proteinuria. There were no perinatal deaths, and none of the women developed eclampsia or HELLP syndrome. Costs for either scheme were not signiicantly diferent, and general satisfaction favored day care.
In sum, either inpatient or close outpatient management is appropriate for a woman with mild de novo hypertension, including those with nonsevere preeclampsia. Most of these studies were carried out in academic centers with dedicated management teams. hat said, the key to success is close surveillance and a conscientious patient with good home support.
he use of antihypertensive drugs to prolong pregnancy or modiY perinatal outcomes in pregnancies complicated by various hypertensive disorders has been of considerable interest. Treatment for women with chronic hypertension complicating pregnancy is discussed in detail in Chapter 50 (p. 980).
Drug treatment for early mild preeclampsia has been disappointing (Table 40-8). Sibai and colleagues (1987a) reported that women given labetalol had significantly lower mean blood pressures. However, mean pregnancy prolongation, gestational age at delivery, and birthweight did not difer between groups. he cesarean delivery rate and the number of newborns admitted to special-care nurseries were also similar. The requency of growth-restricted neonates was doubled in women given labetalol-19 versus 9 percent. The three other studies listed in Table 40-8 compared labetalol or the calcium-channel blockers nifedipine and isradipine against placebo. Except for fewer episodes of severe hypertension, none of these studies showed any benefits from antihypertensive treatment (Magee, 2015). Similar conclusions were reached by Abalos and associates (2014), who reviewed 49 randomized trials of active antihypertensive therapy compared with either no treatment or placebo given to women with mild-to-moderate gestational hypertension.
Up through the early 1990s, the prevailing\practice was that women with severe preeclampsia were usually delivered without delay. However, another approach for women with preterm severe preeclampsia has also been advocated. This approach calls for "conservative" or "expectant" management with the aA11 women had preeclampsia.
blncludes postpartum hypertension.
cp < .05 when study drug compared with placebo.
HTN = hypertension; NS = not stated.