Who's at risk?: Prediction in term pregnancies complicated by hypertensive disorders.

Abstract

This thesis is divided into two parts. Part 1 describes a number of studies on the prediction of specific outcomes in women with hypertensive disorders at term. It elaborates on the HYPITAT trail, which concluded that induction of labour is the management of choice in these women. In four manuscripts we evaluated whether progression to severe disease, postpartum haemorrhage, adverse neonatal outcome and caesarean section (CS) risk could be predicted from clinical characteristics. This to analyse weather induction of labour is also the best treatment in an individual patient. Future research will have to show whether these models can serve to guide clinical management. In part 2 we evaluated the influence of cervix favourability and blood pressure patterns as well as the impact of the HYPITAT trial in clinical practice. First we showed that the benefits of induction of labour can be found in women with an unfavourable cervix. Second, the development of severe hypertension is accelerated exponentially over time and is a risk factor for CS. Third we found an increased number of labour inductions, resulting in better maternal outcome. In conclusion, the work in this thesis indicates that prediction models can be relevant in obstetric care. Quantification of risks of various outcomes may help clinical management. Further research needs to be done to evaluate these prediction models and develop optimal management of an individual woman with GH or mild PE at term