The impact of the HYPITAT I trial on obstetric management and outcomes for gestational hypertension and preeclampsia
After introductions were made, Dr. de Sonnaville described the HYPITAT 1 trial, highlighting the results showing the beneficial effects of induction of labor in pregnancies complicated by hypertensive disorders in term pregnancies. The recommendation of inducing patients with hypertensive disorders of pregnancy at term has been adopted by national guidelines.
The study involved adult patients, singleton pregnancies in the cephalic presentation, at 36-41 weeks gestation. They had two cohorts – 1. Pregnancies complicated by hypertensive disorders – gestational hypertension or Preeclampsia and 2. Pregnancies not complicated by hypertensive disorders. The outcomes were onset of labor, maternal complications and neonatal complications. They compared the proportions of the period before the trial (2000-2005) to the period after the trial (2008-2014). They performed a subgroup analysis, compared the HYPITAT recruiting hospitals to the non-recruiting hospitals for the patients with hypertensive disorders.
The most important results from study: In term pregnancies complicated by hypertension after the HYPITAT 1 trial a significant increased induction of labor rate and improved maternal outcomes (decreased eclampsia, HELLP syndrome and abruption) and reduction in perinatal death.
In their subgroup analysis they noted that the results were more significant in the recruiting hospitals compared to non-recruiting hospitals. 30% of the population were from recruiting, and 70% from non-recruiting. The large number of non-recruiting hospitals was due to fact that they were already inducing more women and the belief that they should induce HTN disorders.The reduction in appearance of HTN complications – eclampsia and HELLP was stronger in recruiting vs non-recruiting hospitals due to lower initial rates of IOL in the recruiting hospitals.
What did you notice after trial. In the period after the H1 trial, they noticed comparable rates of IOL and comparable rates of complications. The effect of intervention was stronger in the recruiting hospitals.
The adverse outcomes reviewed: the increase in induction of labor showed an increased rate of emergency cesarean delivery and increased appearance of postpartum. These trends were noted in the hypertension group and reference group. These were more pronounced in the reference group.
The primary impact of the study – This is a Quality improvement study, revealing the impact of the HYPITAT 1 trial.