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Am J Perinatol 2023; 40(03): 235-242
DOI: 10.1055/a-1889-6292
SMFM Fellowship Series Article

Stage 1 Hypertension in Nulliparous Pregnant Patients and Risk of Unplanned Cesarean Delivery

Anna Natenzon
1   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, St. Francis Hospital, Trinity Health of New England, Hartford, Connecticut
,
Caitlin W. Parrott
2   Department of Obstetrics and Gynecology, Albany Medical Center, Albany, New York
,
Nihita Manem
3   Albany Medical College, Albany Medical Center, Albany, New York
,
Craig M. Zelig
4   Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Albany Medical Center, Albany, New York
› Author Affiliations Funding None.
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Abstract

Objective The aim of the study is to determine whether stage 1 hypertension is a risk factor for cesarean at ≥390/7 weeks.

Study Design This is a retrospective cohort study of nulliparas delivering at ≥390/7weeks. Exposure was defined as stage 1 hypertension and compared with normotension. The primary outcome was unplanned cesarean. Statistical analysis was performed using SPSS 27.

Results Two hundred and fifty patients had stage 1 hypertension and 250 had normotension. Thirty-eight percent of the patients with stage 1 hypertension required cesarean as did 22% of controls (risk ratio [RR]=1.55, 95% confidence interval [CI]: 1.23–1.96, p <0.001). This remained significant after controlling for confounders in a logistic regression (odds ratio [OR]=1.61, 95% confidence interval [CI]: 1.02–2.55, p <0.040). Upon secondary analysis, these results were statistically significant for gestational age ≥395/7 weeks (adjusted odds ratio [AOR]=1.89, 95% CI: 1.05–3.39, p=0.033) but not from 390/7 to 394/7weeks (AOR=0.68, 95% CI: 0.31–1.50, p=0.34).

Conclusion In nulliparas, stage 1 hypertension is an independent risk factor for unplanned cesarean.

Key Points

  • Stage 1 hypertension correlates with more cesareans.

  • Unplanned cesarean for nonreassuring fetal status correlates with impaired placental function.

  • Stages 1 and 2 hypertension carry similar risks.

Keywords

cesarean delivery - hypertension - placental insufficiency

Condensation

Stage-1 hypertension, as newly defined in 2017 by the American Heart Association, is associated with an increased rate of unplanned cesarean delivery in term singleton pregnancies.


Note

This study was presented as a poster at the 41st Annual Pregnancy Meeting, Society for Maternal Fetal Medicine, Virtual, January 25–30, 2021.




Publication History

Received: 16 February 2022

Accepted: 18 June 2022

Accepted Manuscript online:
01 July 2022

Article published online:
08 September 2022

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