Hi Henci,

Do you know if there is evidence to support routine induction in PIH/gestational hypertension at 39 weeks due to the placenta aging faster in hypertensive women? Blood pressure is controlled with medication, labs, BPPs, and NSTs all normal.

Thanks! By: RNChrista

I'm sorry, but this isn't something that falls within my sphere of expertise. I'll see if there is someone else at Lamaze International who can answer your question.

-- Henci By: Henci Goer

Hi Christa.
I'm not sure if this can be applied to gestational hypertension, but the following is a quote from the ACOG Practice Bulletin on "Chronic Hypertension in Pregnancy" (July 2001)

"Pregnant women with uncomplicated chronic hypertension of a mild degree generally can be delivered vaginally at term (25); most have good maternal and neonatal outcomes (3). Cesarean delivery should be reserved for other obstetric indications. Women with mild hypertension during pregnancy and a prior adverse pregnancy outcome (eg, stillbirth) may be candidates for earlier delivery after documentation of fetal lung maturity (as long as fetal status is reassuring). Women with severe chronic hypertension during pregnancy most often either deliver prematurely or have to be delivered prematurely for fetal or maternal indications (10)."

High blood pressure that presents in pregnancy may be a marker of preeclampsia, however, and the only definitive treatment in this case is delivery. The concern is not just for placental insufficiency but also for maternal complications such as seizure and stroke. Balancing timing of birth with continued risk to mother and baby seems reasonable. In my practice, we begin sweeping membranes and recommending other relatively gentle means of inducing labor (intercourse, castor oil) when women's blood pressure begins to creep up near term. We combine this with relaxation techniques and increased rest and fluid and protein intake for the mother. None of these are necessarily evidence-based, however!

I hope this helps.
Amy Romano, MSN, CNM
Editor, Lamaze Institute for Normal Birth By: Amy Romano

Thanks for your response Amy. As it turned out, my blood pressure became uncontrolled by medication and I started getting some pretty bad pitting edema. Castor oil failed so I ended up with a AROM induction. It turned out to be a wonderful birth, esp by hospital standards.

Thanks for the info! By: RNChrista

I'm glad to hear everything went so well for you. Congratulations!

-- Henci By: Henci Goer