A pregnant woman at 30 weeks with severe pre-eclampsia is started on antenatal corticosteroids and a decision is made for expectant management. The HYPITAT trial evaluated this exact dilemma. Which of its key findings directly guides the gestational age threshold for delivery in pre-eclampsia?
- A Induction at 34 weeks reduces adverse maternal outcomes without increasing neonatal morbidity
- B Expectant management beyond 34 weeks is always superior regardless of severity
- C Induction at 37 weeks in mild hypertensive disease reduces adverse outcomes compared to expectant management beyond 37 weeks ✓
- D Caesarean section is preferable to induction in all hypertensive disorders at any gestational age
Correct answer: C. Induction at 37 weeks in mild hypertensive disease reduces adverse outcomes compared to expectant management beyond 37 weeks
Explanation
The HYPITAT trial (Netherlands, 2009) studied women with mild hypertensive disorders at 36–41 weeks and found that induction of labour at 37 weeks significantly reduced adverse maternal outcomes (mainly progression to severe hypertension) compared to expectant management, without increasing caesarean rates or worsening neonatal outcomes. This established 37 weeks as the threshold for induction in mild pre-eclampsia. HYPITAT-II addressed 34–37 weeks and found expectant management had lower maternal morbidity, informing the nuanced gestational-age-specific guidance.
Reference: Williams Obstetrics, 26th ed.
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Written and medically reviewed by the StethoPrep medical team.