Pregnancy Hypertension 11 (2018) 12–17

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Pregnancy Hypertension
journal homepage: www.elsevier.com/locate/preghy

Indications for delivery in pre-eclampsia T

a,⁎ c b c c c a,b
N. Varnier , M.A. Brown , M. Reynolds , F. Pettit , G. Davis , G. Mangos , A. Henry
a
Department of Women’s and Children’s Health, St George Hospital, Kogarah, NSW, Australia
b
School of Women’s and Children’s Health, UNSW Medicine, Sydney, Australia
c
Department of Renal Medicine, St George Hospital, Kogarah, NSW, Australia

A B S T R A C T

Objective: Examine the frequency with which the most accepted indicators for delivery in pre-eclampsia are used
in a population with predominantly late-onset (birth > 32 weeks) pre-eclampsia (PE).
Methods: Retrospective cohort study using the St George Public Hospital (SGH) Hypertension in Pregnancy
database. Demographic, pregnancy, and outcome details were extracted and verified by comparison with data
collection sheets.
Results: From 2001 to 2013, 908 women (970 babies) with PE were included, of which a subgroup of 303
women (33%) had clearly delineated delivery triggers available. This subgroup of women had similar demo-
graphic and outcome characteristics to the total PE population.
In this group, the most common maternal trigger for delivery apart from gestational age 37+ weeks was
difficult to control/severe hypertension (114 cases, 38%) and the most common fetal trigger intrauterine growth
restriction (IUGR: 14 cases, 4%). 78 (35%) of term women had no specific delivery trigger other than gestation.
A primary maternal trigger and/or associated complication was slightly more common in those delivering <
37 weeks vs 37+ weeks (52 vs 38%, p = .03), while a fetal or combined maternal/fetal complication was over
four times more common in preterm women (25 vs 6%, p < .001).
Conclusion: In our population of predominantly late-onset PE, maternal triggers for delivery (predominantly
severe hypertension) far outweigh fetal triggers (predominantly IUGR). Fetal and mixed indicators for delivery
were relatively more common in women delivering preterm, possibly reflecting the severity of placental dys-
function in this subgroup.

1. Background indicators for delivery in hypertensive pregnancies [5,6]. As noted in

Management of the hypertensive expectant mother has evolved with
concurrent understanding of the pathophysiology of disease and out-
comes. Hypertensive disorders complicate 6–8% of all pregnancies,
with 3–4% complicated specifically by pre-eclampsia [1,2]. Although
there are multiple temporizing management strategies for pre-
eclampsia and gestational hypertensive disorders, definitive manage-
ment is delivery of the placenta (and therefore of the fetus) [3]. Fol-
lowing delivery, most symptoms of pre-eclampsia resolve within days to
weeks, and blood pressure has been shown to return to normal gen-
erally within a maximum of three months. However, as preterm or early
term delivery increases risk of morbidity for mother and baby [4],
difficulties arise in deciding what particular set of circumstances should
lead to delivery rather than expectant management of hypertensive
disorders of pregnancy.
Progression of pre-eclampsia, failure to control maternal blood
pressure, or failure of fetal growth are common recommended
the SOMANZ and ISSHP guidelines [6,7], triggers for delivery in the
case of pre-eclampsia include gestational age 37 weeks or more
(reaching “term”), deteriorating maternal condition (manifest as any of
uncontrollable blood pressure, severe persistent maternal symptoms
despite blood pressure control, or laboratory evidence of deteriorating
maternal end-organ function) and deteriorating fetal condition. Mul-
tiple triggers may be present.
Whilst some studies cite ‘severe disease’ as an indication for delivery
[6,8] we are not aware of studies describing the relative frequency with
which each specific delivery trigger (or combination of triggers) occurs.
Additionally, many studies focus on severe early-onset pre-eclampsia
where delivery occurs prior to 34 weeks due to the high rate of maternal
and fetal complications in early-onset cases [6,9,10]. However, the
predominant burden of hypertensive disorders of pregnancy still occurs
in the far more numerous late onset cases. A recent meta-analysis
suggested that the early-onset preeclampsia rate was 0.38 per 100 de-
liveries compared to 2.72 per 100 deliveries for late-onset preeclampsia

⁎
Corresponding author.
E-mail address: n.varnier@yahoo.com (N. Varnier).

https://doi.org/10.1016/j.preghy.2017.11.004
Received 17 January 2017; Received in revised form 3 September 2017; Accepted 20 November 2017
Available online 08 December 2017
2210-7789/ © 2017 International Society for the Study of Hypertension in Pregnancy. Published by Elsevier B.V. All rights reserved.
N. Varnier et al.
[11]. Similar findings were noted in the SCOPE study which found an
early onset PE rate (i.e. < 34-weeks’ gestation) of 0.5% [12].
We therefore examined the frequency with which the most com-
monly recognised triggers for delivery are considered responsible in the
setting of pre-eclampsia ≥32 weeks’ gestation (gestation limited by
study hospital special care nursery capacity). We also aimed to examine
the associations of demographic, pregnancy and outcome factors, in-
cluding time from presentation to delivery, with each delivery indica-
tion, in order to potentially guide future patient counselling and man-
agement.
2. Methods
We conducted a retrospective cohort study at St George Hospital, a
metropolitan Sydney teaching hospital with approximately
2700 births/annum. The primary data source accessed was the
Hypertension in Pregnancy (HIP) database, used since 1987 to docu-
ment the management of any hypertensive pregnancy at the hospital.
The data is collected in a standardised data collection sheet by mid-
wifery staff at the time of confinement and subsequently transposed
into an electronic database. The study was limited to a 12-year period
from which the most comprehensive data was available (January 1,
2002 to December 31, 2013) for St George Public Hospital patients.
The definition of hypertension in pregnancy has been the subject of
recent review [13]. For the purposes of this study, the parameters
outlined by the SOMANZ/ISSHP guidelines [14] which guide treatment
protocols at the study hospital, were used. Thus, patients with hy-
pertension in pregnancy were those with a systolic blood pressure
≥140 mmHg or diastolic ≥90 mmHg. A sustained finding of hy-
pertension in pregnancy was routinely treated with oral anti-
hypertensive agents as per local protocol. Severe hypertension in this
Unit at the time of the study was defined as a systolic blood pressure
≥170 mmHg or diastolic blood pressure ≥110 mmHg (treated urgently
with standard release nifedipine). This unit maintained a consistent
treatment policy throughout the data collection period and continues to
maintain the same treatment policy. ‘Tight’ control is favoured [15],
aiming for blood pressure readings below systolic blood pressure
≥140 mmHg or diastolic ≥90 mmHg. Patients are routinely com-
menced on oxprenolol 40 mg three times per day (TDS); methyldopa at
a starting dose of 250 mg TDS if beta-blockers are contraindicated.
These medications are titrated to maximum recommended doses
through close assessment in a day stay unit and admission if required.
Additional agents are added as required. The use of more than two
agents and sustained suboptimal control of blood pressure constitutes
‘difficult to control BP’.
Pre-eclampsia (PE) was diagnosed as hypertension at > 20 weeks’
gestation with evidence of effect on one or more other body systems
[16,17] including cardiovascular, renal, hepatic/coagulation systems,
neurological symptoms and the fetus and placenta. The HIP database
also records whether PE is de novo or superimposed on essential hy-
pertension.
The primary inclusion criterion was final diagnosis of de novo or
superimposed PE. Only pregnancies delivered at gestation greater than
32 completed weeks were eligible as delivery prior to this gestation is
not undertaken at the study hospital, and triggers for delivery may have
differed at the hospital to which the mother had been transferred.
Primary data sought were the recorded trigger or triggers for delivery as
suggested by SOMANZ [6] and shown in Table 1. For the term group,
where GA of 37+ weeks was in itself sufficient to trigger delivery, any
additional maternal or fetal complications from Table 1 were recorded.
Note was also made where PE was diagnosed but was not the primary
indicator for delivery; in these cases, another obstetric indicator for
delivery was present (e.g. cholestasis or premature rupture of mem-
branes) with subsequent intrapartum or postpartum diagnosis of pre-
eclampsia.
To examine the association of preterm delivery triggers and term
13
Pregnancy Hypertension 11 (2018) 12–17
Table 1
SOMANZ triggers for delivery (7).
Maternal Fetal
Gestational age > 37/40 Placental abruption
Uncontrollable blood pressure Severe growth
restriction
Deteriorating platelet count Non-reassuring fetal
Intravascular haemolysis status
Deteriorating liver function
Deterioration renal function
Persistent neurological symptoms
Persistent epigastric pain, nausea or vomiting
with abnormal LFTs
Pulmonary oedema
complications with underlying maternal and pregnancy characteristics,
the following data was also analysed: maternal age and parity; obstetric
history, medical history including chronic hypertension, pre-existing
renal disease, pre-existing diabetes; pregnancy history (singleton or
multiple pregnancy, gestational diabetes); gestation at first presentation
of hypertension; presentation to delivery interval; gestational age at
delivery, birth weight, mode of birth. To ensure accurate information
about delivery triggers, original HIP data from January 2010 to
December 2013 was cross-checked against patient medical records.
2.1. Data analysis
Data were analysed using SPSS (IBM SPSS Statistics for Windows,
Version 22.0). Chi-square test or Fisher exact tests were used as ap-
propriate to test for significant differences between categorical vari-
ables. Student’s t-test and ANOVA were used as appropriate to compare
continuous variables. All tests were two-tailed, with statistical sig-
nificance defined as a probability value of < .05. Subgroup analysis was
performed for women who were term (37 or more completed weeks at
time of delivery) vs preterm, and for singleton vs twin pregnancy.
2.2. Ethics approval
The study was approved as low/negligible risk research by the
South Eastern Sydney Local Health District Human Research and Ethics
Committee (HREC 13/152, LNR/13/POWH/384).
3. Results
3557 deliveries of pregnancies affected by hypertension were re-
corded in the database for the study period. After exclusion of women
with gestational or essential hypertension only, those delivering at the
private hospital (with no access to records for verification of delivery
triggers), and women < 32 weeks’ gestation transferred out, 908
women had a final diagnosis of PE. Of these, 304 (287 singleton
pregnancies and 17 twins; n = 287 de novo PE, 17 superimposed PE)
had delivery trigger data and 604 outcome data only. Baseline demo-
graphic and pregnancy data is shown in Table 2. As shown in Table 2,
demographic data and outcomes were similar between our background
PE population and the study (delivery trigger) population, suggesting
the subgroup with trigger data is representative of our total PE popu-
lation. Average maternal age was 30.7 ± 6.1 years, mean gestation
(GA) at time of diagnosis 36.3 ± 2.6 weeks, and at delivery
37.7 ± 1.9 weeks (74% GA 37+ weeks at delivery). There were no
significant differences between term and preterm groups regarding
preeclampsia type (de novo vs superimposed), however women with PE
delivering preterm were significantly older, more likely to have a twin
pregnancy, and more likely to be multiparous (Table 2).
The most common maternal trigger for delivery or associated term
complication was difficult to control/severe hypertension (114 cases,
38%) and the most common fetal trigger was intrauterine growth
N. Varnier et al. Pregnancy Hypertension 11 (2018) 12–17

Table 2
Demographic and pregnancy characteristics.

Excluded PE population Study population P values no trigger vs Term delivery Preterm delivery P values term vs
(n = 604 women, 649 (n = 304 women, 321 study population (n = 225) (n = 79) preterm delivery
babies) babies)
N (%) N (%) N (%) N (%)

Parity
- Primiparous 384 (64) 213 (70) .052 166 (74) 47 (60) .02
- Multiparous 220 (36) 91 (30) 59 (26) 32 (41)

Plurality
- Singleton 559 (93) 287 (94) .30 222 (99) 65 (82) .001
- Twin 45 (7) 17 (6) 3 (1) 14 (18)

PE subtype
- De-novo 564 (93) 287 (94) .55 214 (95) 73 (92) .46
- Superimposed 40 (7) 17 (6) 11 (5) 6 (8)

Mean ± SD Mean ± SD Mean ± SD Mean ± SD

Maternal age, years 30.3 ± 5.6 30.7 ± 6.1 .39 30.2 ± 6.0 32.0 ± 6.1 .02
Birthweight, singletons (kg) 3.05 ± 0.74 3.07 ± 0.66 .79 3.26 ± 0.55 2.50 ± 0.54 < .001
GA at diagnosis (weeks) 36.2 ± 2.7 36.3 ± 2.6 .65 37.7 ± 1.9 34.1 ± 1.8 < .001
GA at delivery (weeks) 37.5 ± 2.1 37.7 ± 1.9 .32 38.6 ± 1.3 35.1 ± 1.0 < .001
GA 37 + weeks at delivery, 427 (71) 225 (74) .29 – – –
n (%)

PE = preeclampsia; SD = standard deviation; GA = gestational age.

Bold values designate statistically significant values.

restriction (IUGR: 14 cases, 4%) (Table 3). Seventy-eight (35%) term
women had no specific complication other than their PE diagnosis and
were thus delivered on the basis of their gestation alone, while 27
women (11%) only developed pre-eclampsia intrapartum or post-
partum. A primary maternal trigger/associated complication was
slightly more common in those delivering < 37 weeks vs 37+ weeks
(52 vs 38%, p = .02), while a fetal or combined maternal/fetal com-
plication was over four times more common in preterm women (25 vs
6%, p < .001). Overall, maternal and fetal indications for delivery
were more common in women delivered pre-term (Table 3).
Pregnancy outcomes are shown in Table 4. Over half of pregnancies
were induced (n = 172; 57%); 23% of women laboured spontaneously
and 20% (n = 70) had an elective caesarean section (‘elective cae-
sarean’: constitutes a pre-labour caesarean section, planned at a time
acceptable to both the woman and the team) [18,19]. There was a
significantly greater proportion of elective Caesarean and fewer at-
tempted inductions of labour in the preterm group. Mean birth weight
was 3.07 ± 0.66 kg. As expected, birthweight was significantly lower
in the preterm group, although the proportion of singleton babies of
birthweight < 10th centile for gestation [20] did not differ significantly
(18% in term group, 25% in preterm group). In the preterm group when
the delivery trigger was either fetal or mixed fetal/maternal, 19/20
women (95%) had a Caesarean, of which 11/19 (58%) were emergent/
urgent.
Regarding demographic subgroups, there were no significant dif-
ferences in delivery triggers/associated complications between women
having their first and subsequent deliveries, (Table 5) however parous
women were more likely to deliver preterm. Women with twin preg-
nancies were, unsurprisingly, more likely to deliver preterm (82% vs
23%). They were also more likely than singleton pregnancies to have a
mixed maternal/fetal indication for delivery (24% vs 4%, p = .006) and
less likely to have no specified trigger or a non-PE diagnosis as the
indication for delivery (p < .001).
4. Discussion
4.1. Main findings
In this cohort of preeclamptic women ≥32 weeks’ gestation man-
aged at a single unit with consistent diagnosis and management pro-
tocols, the most common maternal indicator for delivery in the preterm
population was severe or difficult to control blood pressure, and the
most common fetal indicator was suspected intrauterine growth re-
striction. Severe hypertension was also the most common associated
feature of term PE, occurring in approximately one-third of cases, while
one-third had no associated concerning maternal or fetal features and
were delivered on the basis of term gestation alone. On comparison of
the term and preterm PE populations, the presence of both a maternal
and fetal indication for delivery was much more common in preterm PE
(25% vs 6%).
4.1.1. Preterm vs term women
Although there were a significantly higher proportion of preterm
patients with maternal triggers than term patients (Table 3), maternal
complications (predominantly severe hypertension) were still present in
over one-third of term women. Additionally, rates of serious compli-
cations such as liver/haematological dysfunction and eclampsia did not
differ between groups, consistent with our group’s previous research
showing adverse maternal outcomes across the gestational age spec-
trum [4]. Conversely, presence of a primary fetal indication for delivery
(predominantly IUGR or suspected fetal distress from ultrasound/car-
diotocograph findings), or mixed maternal/fetal final indication for
delivery, was over four times more common in the preterm group. This
may reflect differing preeclampsia phenotypes, with a greater degree of
overt placental pathology in the preterm group [21]. Moreover, it may
reflect a higher clinical threshold for proceeding with preterm delivery
and therefore, more advanced disease by the time delivery is triggered.
Clinically, this was reflected in a very high rate of caesarean section
(half of which were emergency cases after an attempt at induction) in
the 20 preterm women who had both a maternal and fetal indication for
delivery. Although the numbers in this subgroup are small, it does
suggest that these patients should not be quoted (normal pregnancy)
population statistics regarding Caesarean rates/induction outcomes,
and that after discussion elective Caesarean is reasonable to offer if that
is the maternal preference.
Also noted in the preterm delivery group was that a higher pro-
portion were parous rather than nulliparous. This may be a chance
statistical finding due to multiple comparisons. It may also represent
close surveillance of a known higher-risk group in our cohort, and
prompt diagnosis and management of late preterm preeclampsia when
it arose, as over half the parous women in this study had a prior history
of a hypertensive disorder of pregnancy.

14
N. Varnier et al. Pregnancy Hypertension 11 (2018) 12–17

Table 3 previously reported (6–10%) [21,22]. This could be related to the

Maternal and fetal indicators for delivery. length of pregnancy in a higher risk population who are not routinely
induced at 37 weeks unless PE has been diagnosed. It may also reflect in
Term Preterm P value
delivery, n delivery, n part increased local ascertainment of intrapartum and early postpartum
(%) (%) cases (vs antenatal diagnosis), as timing of diagnosis can be differ-
Total Total entiated both through the HIP database and our centre’s obstetric da-
n = 225 n = 79 tabase.
Any Maternal 84 (37.3) 41 (51.9) .02
Trigger/ 4.2. Comparative literature
association×
Maternal triggers Difficult to control/ 78 (34.7) 36 (45.6) .06 Whilst a number of guidelines are available regarding the general
Severe Hypertension*
indicators for delivery in pre-eclampsia, a review of available literature
Liver or haematological 5 (2.2) 5 (6.3) .13
dysfunction failed to yield any comparative studies reviewing the actual frequency
Eclampsia 1 (0.4) 0 (0) 1.0 of each indicator for delivery (search carried out using OVID MedLine
Gestational Diabetes 14 (6.2) 2 (2.5) .21 and PubMed, included search terms: “pre-eclampsia”, “delivery”, “in-
Other† 11 (4.9) 10 (12.7) .02
dication”, “trigger”, “induction”).
No specific trigger (PE 59 (26.2) 15 (19) .20
but spontaneous Although ‘severe disease’ is often cited as a key indicator for de-
labour) livery in pre-eclampsia this is not always defined in a standard manner,
GH/EH†† 9 (4) 0 (0) .12 though the ISSHP has sought to address this recently [1,6,23]. More-
Preeclampsia alone††† 43 (19.1) 11 (13.9) .30 over, the literature is commonly focused on the early-onset population
Postdates 5 (2.2) N/A
[9] and fails to consider the clinical reality of a late-onset pre-
Any Fetal Trigger 20 (8.9) 22 (27.8) < .001
Fetal triggers Intrauterine 6 (2.7) 8 (10.1) .01 eclampsia, mostly occurring above 34-weeks’ gestation. This study as-
GrowthRestriction sesses the frequency of each indicator as delineated in the local SO-
(IUGR) MANZ guidelines, which are similar to the recent ISSHP guidelines
Abnormal CTG/Fetal 6 (2.7) 7 (8.9) .05
[13].
distress (incl. abnormal
doppler)
PROM/PPROM 2 (0.9) 1 (1.3) 1.0 4.3. Strengths and limitations
Other*** 6 (2.7) 6 (7.6) .09
Final Indication for Delivery The main strengths of this study are a) As far as we are aware, ex-
Primary maternal indication 85 (37.8) 41 (51.9) .03
amination of the relative frequency of triggers for delivery across a late
Primary fetal indication 10 (4.4) 7 (8.9) .14
Mixed maternal/fetal indication 3 (1.3) 13 (16.5) < .001 preterm/term preeclamptic population has not been performed, and b)
Non-PE primary indication 24 (10.7) 7 (8.9) 0.65 the study was carried out in a single centre whose management pro-
Spontaneous pre-term delivery – 9 (11.4) tocols are consistent, managed by one team and a single agreed man-
No specified delivery trigger 78 (34.7) –
agement protocol, thus minimising the effect of individual preferences
Intra- or post-partum diagnosis, IOL for non- 25 (11.1) 2 (2.5) .02
BP reason
or bias upon timing of delivery. The major limitations of the study are
its retrospective nature and its modest sample size, with indications for
GH: gestational hypertension; EH: essential hypertension; PROM: premature rupture of delivery data limited to the proportion of cases with original datasheets
membranes; PPROM: preterm, premature rupture of membranes, IOL: induction of la- available (as indications for delivery have only been added to our
bour, CTG: cardiotocograph. electronic database more recently). However, analysis has been carried
Bold values designate statistically significant values.
×
out on the data available and comparison with the subgroup of verified
For term group, preeclampsia alone sufficient to trigger delivery: Table 3 shows
whether additional maternal or fetal indicators were also present.
data has confirmed accuracy of recording.
* Blood pressure requiring treatment with two or more agents. Retrospective studies carry their own inherent limitations, including
†
Other primary maternal indication for delivery than preeclampsia (e.g. cholestasis) – lack of data fields that may be relevant to interpretation of outcome,
with subsequent intrapartum or postpartum development of preeclampsia. such as BMI which was not until recently included in this study hos-
††
Delivered for GH/EH but then developed preeclampsia intrapartum or postpartum. pital’s databases. Despite cross-checking for triggers data against both
†††
Preeclampsia is the only indicator for delivery (e.g. routine delivery at 37 weeks or
our datasheets and patient files/electronic records, there remains scope
following diagnosis beyond term).
*** Includes: Small for gestational age, Malposition, Oligohydramnios, Antepartum
for error in interpretation of clinician decision-making which could
Haemorrhage, Decreased fetal movement. only be overcome with a prospective study design.

In the term group, the majority of patients had at least one asso-
ciated abnormality/complication of their pre-eclampsia, with only 19%
having no other concurrent abnormality. The most common compli-
cation was severe hypertension (35%), with only a small minority of
term cases having a diagnosed fetal complication or major maternal
complication such as eclampsia. This is consistent with findings from
the HYPITAT study [1] wherein continued expectant management at
term leads to higher likelihood of severe hypertension, and that unless
new evidence arises to suggest risks of early term delivery in PE out-
weigh benefits, PE alone at 37+ weeks is sufficient trigger for delivery.
In this group, we also found a significant minority where PE was not
part of decision making regarding delivery: 11% of women laboured
spontaneously and were then noted to have PE either intra-partum or
postpartum, while 11% underwent induction for a non-PE reason and
were subsequently diagnosed with PE. The rate of diagnosis of intra-
partum or postpartum PE in this group was noted to be higher than
4.4. Future research
Subgroup numbers in the preterm (32–37 weeks) triggers group
remain small, and further studies from other Units are needed to see
whether these data are applicable nationally or internationally.
5. Conclusion
This study quantifies the frequency of triggers/indications for de-
livery in pre-eclampsia ≥32 weeks’ gestation. It confirms that severe/
difficult to control maternal blood pressure is the most common in-
dicator for delivery across gestations, with fetal triggers/complications
occurring in a minority of cases, although substantially higher in the
preterm group. A mixed maternal/fetal indication, which was sig-
nificantly more common in preterm gestation, supports an increased
placental severity of pre-term disease with consequent increased po-
tential for intervention or poor fetal outcome.

15
N. Varnier et al. Pregnancy Hypertension 11 (2018) 12–17

Table 4
Pregnancy outcome data.

Overall group, n (%) Term delivery, n (%) Preterm delivery, n (%) P-value (term vs preterm)
Total n = 304 women, 321 babies Total n = 225 women 228 Total n = 79 women 93 babies##
babies#
Mean ± SD Mean ± SD Mean ± SD

Birth weight (singletons only), kg 3.07 ± 0.66 3.26 ± 0.55 2.50 ± 0.54 < .001
Gestation at delivery, weeks 37.7 ± 1.9 38.6 ± 1.3 35.1 ± 1.0

N (%) N (%) N (%)

Birthweight < 10th centilea (singletons) 56 (19.5) 40 (18.0) 16 (24.6) .24
Spontaneous labour* 70 (23.0) 58 (25.8) 12 (15.2) .054
No established labour 62 (20.4) 31 (13.8) 31 (39.2) < .001
Induction 172 (56.6) 136 (60.4) 36 (45.6) .02
MOD: Vaginal delivery 115 (37.8) 89 (39.6) 26 (32.9) .30
Assisted vaginal delivery 72 (23.7) 59 (26.2) 13 (16.5) .08
Caesarean section** 117 (38.5) 77 (34.1) 40 (50.6) .01
- Emergency/urgent caesarean 82 (27.0) 56 (24.8) 26 (32.9) .17
- Elective caesarean 35 (11.5) 21 (9.3) 14 (17.7) .04

SD = standard deviation; MOD = Mode of delivery.

Bold values designate statistically significant values.
a
For gestational age as per Australian birthweight centiles (23).
* Australian averages: Spontaneous labour: 54.2%, No labour: 19.4%, Induction: 26.3%; NSW: 54.1, 18.6%, 27.3% (18).
** Australian average 32% (18).
#
222 singleton, 3 twin pregnancies.
##
65 singleton, 14 twin pregnancies.

Table 5
Maternal and fetal indicators for delivery by parity.

Nulliparous, n (%) Multiparous, n (%) P value

Total n = 213 Total n = 91

Any maternal trigger/association 87 (41) 38 (42) .88

Maternal triggers Difficult to control/Severe Hypertension* 78 (37) 36 (40) .63
Liver or haematological dysfunction 9 (4) 2 (2) .52
Eclampsia 1 (0.5) 0 (0) 1.0
Gestational diabetes 13 (6) 3 (3) .32
Other† 12 (6) 11 (12) .06
No specific trigger (PE but spontaneous labour) 56 (26) 18 (20) .68
GH/EH†† 7 (3) 2 (2) .73
Preeclampsia alone††† 35 (16) 19 (21) .35
Postdates 6 (3) 0 (0) .18
Any fetal trigger 29 (14) 13 (14) .88
Fetal triggers Intrauterine Growth Restriction (IUGR) 10 (5) 4 (4) .91
Abnormal CTG/Fetal distress (incl. abnormal Doppler) 9 (4) 5 (5) .63
PROM/PPROM 3 (1) 0 (0) 1.0
Other*** 8 (4) 4 (4) .76
Final Indication for Delivery
Primary maternal indication 85 (40) 40 (44) .55
Primary fetal indication 13 (6) 4 (4) .54
Mixed maternal/fetal indication 8 (4) 8 (9) .08
Non-PE primary indication 24 (11) 7 (8) .33
Spontaneous pre-term delivery 6 (3) 3 (3) 1.0
No specified delivery trigger 57 (27) 22 (24) .73
Intra- or post-partum diagnosis, IOL for non-BP reason 20 (9) 7 (8) .62

GH: gestational hypertension; EH: essential hypertension; PROM: premature rupture of membranes; PPROM: preterm, premature rupture of membranes, IOL: induction of labour, CTG:
cardiotocograph.
* Blood pressure requiring treatment with two or more agents.
†
Other primary maternal indication for delivery than preeclampsia (e.g. cholestasis) – with subsequent intrapartum or postpartum development of preeclampsia.
††
Delivered for GH/EH but then developed preeclampsia intrapartum or postpartum.
†††
Preeclampsia is the only indicator for delivery (e.g. routine delivery at 37 weeks or following diagnosis beyond term).
*** Includes: Small for gestational age, Malposition, Oligohydramnios, Antepartum Haemorrhage, Decreased fetal movement.

Acknowledgement online version, at http://dx.doi.org/10.1016/j.preghy.2017.11.004.

The authors would like to extend their thanks to Ms Jennifer Beddoe
who is responsible for maintenance of the database which is herein
referenced.
Appendix A. Supplementary data
Supplementary data associated with this article can be found, in the
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