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Antepartum testing in the hypertensive patient: when to begin
R A Pircon1, D C Lagrew, C V Towers
1Department of Obstetrics and Gynecology, St. Joseph's Medical Center, Milwaukee, WI 53210.
American Journal of Obstetrics and Gynecology
|June 1, 1991
Summary
For pregnancies with hypertension, antepartum testing timing is crucial. Patients with specific conditions may need early testing, while others can safely delay until 33 weeks.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
Background:
- Antepartum testing is recommended for pregnancies complicated by hypertension.
- Clinical guidance on the optimal timing for initiating antepartum testing is limited.
Purpose of the Study:
- To determine the appropriate timing for initiating antepartum surveillance in patients with chronic hypertension and nonproteinuric pregnancy-induced hypertension.
- To analyze the relationship between abnormal test results and gestational age at delivery.
Main Methods:
- Retrospective review of antepartum testing results from 1976 to 1987.
- Focus on contraction stress tests (CSTs) as the primary surveillance method.
- Analysis of 917 patients with chronic hypertension or nonproteinuric pregnancy-induced hypertension.
Main Results:
- 5.8% of patients (53/917) had at least one positive CST.
- 22 patients delivered before 35 weeks' gestation due to abnormal test results.
- Early intervention (<35 weeks) was not predictable by maternal age or blood pressure; often associated with comorbidities like SLE, IUGR, diabetes, or superimposed preeclampsia.
Conclusions:
- Patients with comorbidities may require antepartum testing to commence as early as fetal viability.
- For patients without these specific comorbidities, testing can be initiated at 33 weeks' gestation without significant risk.
- This study provides evidence-based recommendations for optimizing antepartum surveillance timing in hypertensive pregnancies.