Home Medicine Chronic hypertension in pregnancy: synthesis of influential guidelines
Article
Licensed
Unlicensed Requires Authentication

Chronic hypertension in pregnancy: synthesis of influential guidelines

  • Ioannis Tsakiridis ORCID logo , Sonia Giouleka , Alexandra Arvanitaki ORCID logo , Apostolos Mamopoulos , George Giannakoulas , Georgios Papazisis , Apostolos Athanasiadis and Themistoklis Dagklis ORCID logo EMAIL logo
Published/Copyright: April 20, 2021
Journal of Perinatal Medicine
From the journal Journal of Perinatal Medicine Volume 49 Issue 7

Abstract

Chronic hypertension in pregnancy accounts for a substantial proportion of maternal morbidity and mortality and is associated with adverse perinatal outcomes, most of which can be mitigated by appropriate surveillance and management protocols. The aim of this study was to review and compare recommendations of published guidelines on this condition. Thus, a descriptive review of influential guidelines from the National Institute for Health and Care Excellence, the Society of Obstetric Medicine of Australia and New Zealand, the International Society of Hypertension, the International Society for the Study of Hypertension in Pregnancy, the European Society of Cardiology, the International Federation of Gynecology and Obstetrics, the Society of Obstetricians and Gynaecologists of Canada and the American College of Obstetricians and Gynecologists on chronic hypertension in pregnancy was conducted. All guidelines agree on the definition and medical management, the need for more frequent antenatal care and fetal surveillance and the re-evaluation at 6–8 weeks postpartum. There is also a consensus that the administration of low-dose aspirin is required to prevent preeclampsia, although the optimal dosage remains controversial. No universal agreement has been spotted regarding optimal treatment blood pressure (BP) targets, need for treating mild-to-moderate hypertension and postnatal BP measurements. Additionally, while the necessity of antenatal corticosteroids and magnesium sulfate for preterm delivery is universally recommended, the appropriate timing of delivery is not clearly outlined. Hence, there is a need to adopt consistent practice protocols to optimally manage these pregnancies; i.e. timely detect and treat any potential complications and subsequently reduce the associated morbidity and mortality.

Keywords: antihypertensive; arterial hypertension; chronic hypertension; comparison; definition; guidelines; investigation; management; pre-existing hypertension; pregnancy
Corresponding author: Themistoklis Dagklis, MD, PhD, Assistant Professor in Obstetrics and Gynecology, Third Department of Obstetrics and Gynaecology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece, Phone and Fax: +30 2310 992150, E-mail:
Ioannis Tsakiridis and Sonia Giouleka share first authorship.

  1. Research funding: Alexandra Arvanitaki is the recipient of the International Training and Research Fellowship EMAH Stiftung Karla Voellm, Krefeld, Germany.

  2. Author contributions: Themistoklis Dagklis developed the original idea for the study and participated in the revision. Ioannis Tsakiridis designed and drafted the manuscript, implemented the project and submitted the article. Sonia Giouleka drafted and coordinated the manuscript. Alexandra Arvanitaki revised the manuscript for intellectual content. Apostolos Mamopoulos cooperated in the analysis and the revision. George Giannakoulas supervised the manuscript development. Georgios Papazisis participated in manuscript editing. Apostolos Athanasiadis coordinated and revised the manuscript. All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: Not applicable.

  5. Ethical approval: Not applicable.

References

1. Bateman, BT, Bansil, P, Hernandez-Diaz, S, Mhyre, JM, Callaghan, WM, Kuklina, EV. Prevalence, trends, and outcomes of chronic hypertension: a nationwide sample of delivery admissions. Am J Obstet Gynecol 2012;206:134 e1–8. https://doi.org/10.1016/j.ajog.2011.10.878.Search in Google Scholar

2. Roberts, CL, Algert, CS, Morris, JM, Ford, JB, Henderson-Smart, DJ. Hypertensive disorders in pregnancy: a population-based study. Med J Aust 2005;182:332–5. https://doi.org/10.5694/j.1326-5377.2005.tb06730.x.Search in Google Scholar

3. Ananth, CV, Duzyj, CM, Yadava, S, Schwebel, M, Tita, ATN, Joseph, KS. Changes in the prevalence of chronic hypertension in pregnancy, United States, 1970 to 2010. Hypertension 2019;74:1089–95. https://doi.org/10.1161/hypertensionaha.119.12968.Search in Google Scholar

4. Sibai, BM. Chronic hypertension in pregnancy. Obstet Gynecol 2002;100:369–77. https://doi.org/10.1016/s0029-7844(02)02128-2.Search in Google Scholar

5. Gilbert, WM, Young, AL, Danielsen, B. Pregnancy outcomes in women with chronic hypertension: a population-based study. J Reprod Med 2007;52:1046–51.Search in Google Scholar

6. Panaitescu, AM, Syngelaki, A, Prodan, N, Akolekar, R, Nicolaides, KH. Chronic hypertension and adverse pregnancy outcome: a cohort study. Ultrasound Obstet Gynecol 2017;50:228–35. https://doi.org/10.1002/uog.17493.Search in Google Scholar PubMed

7. Vanek, M, Sheiner, E, Levy, A, Mazor, M. Chronic hypertension and the risk for adverse pregnancy outcome after superimposed pre-eclampsia. Int J Gynaecol Obstet 2004;86:7–11. https://doi.org/10.1016/j.ijgo.2004.03.006.Search in Google Scholar PubMed

8. Bramham, K, Parnell, B, Nelson-Piercy, C, Seed, PT, Poston, L, Chappell, LC. Chronic hypertension and pregnancy outcomes: systematic review and meta-analysis. BMJ 2014;348:g2301. https://doi.org/10.1136/bmj.g2301.Search in Google Scholar PubMed PubMed Central

9. Ramakrishnan, A, Lee, LJ, Mitchell, LE, Agopian, AJ. Maternal hypertension during pregnancy and the risk of congenital heart defects in offspring: a systematic review and meta-analysis. Pediatr Cardiol 2015;36:1442–51. https://doi.org/10.1007/s00246-015-1182-9.Search in Google Scholar PubMed PubMed Central

10. Cirillo, PM, Cohn, BA. Pregnancy complications and cardiovascular disease death: 50-year follow-up of the Child Health and Development Studies pregnancy cohort. Circulation 2015;132:1234–42. https://doi.org/10.1161/circulationaha.113.003901.Search in Google Scholar

11. Tuovinen, S, Raikkonen, K, Pesonen, AK, Lahti, M, Heinonen, K, Wahlbeck, K, et al.. Hypertensive disorders in pregnancy and risk of severe mental disorders in the offspring in adulthood: the Helsinki Birth Cohort Study. J Psychiatr Res 2012;46:303–10. https://doi.org/10.1016/j.jpsychires.2011.11.015.Search in Google Scholar PubMed

12. Tuovinen, S, Raikkonen, K, Kajantie, E, Henriksson, M, Leskinen, JT, Pesonen, AK, et al.. Hypertensive disorders in pregnancy and cognitive decline in the offspring up to old age. Neurology 2012;79:1578–82. https://doi.org/10.1212/wnl.0b013e31826e2606.Search in Google Scholar

13. Taylor, RN, Roberts, JM, Gary Cunningham, F, Lindheimer, MD. Chesley’s hypertensive disorders in pregnancy, 4th ed. Elsevier Science; 2014:489 p. https://doi.org/10.1016/B978-0-12-407866-6.00022-5.Search in Google Scholar

14. National Institute for Health and Care Excellence (NICE). Hypertension in pregnancy: diagnosis and management. UK: NICE; 2019.Search in Google Scholar

15. Lowe, SA, Bowyer, L, Lust, K, McMahon, LP, Morton, MR, North, RA, et al.. The SOMANZ guidelines for the management of hypertensive disorders of pregnancy 2014. Aust N Z J Obstet Gynaecol 2015;55:11–6. https://doi.org/10.1111/ajo.12253.Search in Google Scholar

16. Unger, T, Borghi, C, Charchar, F, Khan, NA, Poulter, NR, Prabhakaran, D, et al.. International Society of Hypertension global hypertension practice guidelines. J Hypertens 2020;38:982–1004. https://doi.org/10.1097/hjh.0000000000002453.Search in Google Scholar

17. Brown, MA, Magee, LA, Kenny, LC, Karumanchi, SA, McCarthy, FP, Saito, S, et al.. The hypertensive disorders of pregnancy: ISSHP classification, diagnosis & management recommendations for international practice. Pregnancy Hypertens 2018;13:291–310. https://doi.org/10.1016/j.preghy.2018.05.004.Search in Google Scholar

18. Regitz-Zagrosek, V, Roos-Hesselink, JW, Bauersachs, J, Blomstrom-Lundqvist, C, Cifkova, R, De Bonis, M, et al.. ESC Guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J 20182018;39:3165–241. https://doi.org/10.1093/eurheartj/ehy478.Search in Google Scholar

19. Magee, LA, von Dadelszen, P, Stones, W, Mathai, M. The FIGO textbook of pregnancy hypertension: an evidence-based guide to monitoring, prevention and management, London. 2016:456 p.Search in Google Scholar

20. Magee, LA, Pels, A, Helewa, M, Rey, E, von Dadelszen, P. Canadian Hypertensive Disorders of Pregnancy Working G. Diagnosis, evaluation, and management of the hypertensive disorders of pregnancy: executive summary. J Obstet Gynaecol Can 2014;36:416–41. https://doi.org/10.1016/s1701-2163(15)30588-0.Search in Google Scholar

21. American College of O, Gynecologists’ Committee on Practice B-O. ACOG practice Bulletin No. 203: chronic hypertension in pregnancy. Obstet Gynecol 2019;133:e26–50. https://doi.org/10.1097/AOG.0000000000003020.Search in Google Scholar PubMed

22. Berks, D, Steegers, EA, Molas, M, Visser, W. Resolution of hypertension and proteinuria after preeclampsia. Obstet Gynecol 2009;114:1307–14. https://doi.org/10.1097/aog.0b013e3181c14e3e.Search in Google Scholar PubMed

23. Angeli, E, Verdecchia, P, Narducci, P, Angeli, F. Additive value of standard ECG for the risk prediction of hypertensive disorders during pregnancy. Hypertens Res 2011;34:707–13. https://doi.org/10.1038/hr.2011.12.Search in Google Scholar PubMed

24. Morris, RK, Riley, RD, Doug, M, Deeks, JJ, Kilby, MD. Diagnostic accuracy of spot urinary protein and albumin to creatinine ratios for detection of significant proteinuria or adverse pregnancy outcome in patients with suspected pre-eclampsia: systematic review and meta-analysis. BMJ 2012;345:e4342. https://doi.org/10.1136/bmj.e4342.Search in Google Scholar PubMed PubMed Central

25. Morgan, JL, Nelson, DB, Roberts, SW, Wells, CE, McIntire, DD, Cunningham, FG. Association of baseline proteinuria and adverse outcomes in pregnant women with treated chronic hypertension. Obstet Gynecol 2016;128:270–6. https://doi.org/10.1097/aog.0000000000001517.Search in Google Scholar

26. Shen, M, Tan, H, Zhou, S, Smith, GN, Walker, MC, Wen, SW. Trajectory of blood pressure change during pregnancy and the role of pre-gravid blood pressure: a functional data analysis approach. Sci Rep 2017;7:6227. https://doi.org/10.1038/s41598-017-06606-0.Search in Google Scholar PubMed PubMed Central

27. Abalos, E, Duley, L, Steyn, DW. Antihypertensive drug therapy for mild to moderate hypertension during pregnancy. Cochrane Database Syst Rev 2014:CD002252. https://doi.org/10.1002/14651858.CD002252.pub3.Search in Google Scholar PubMed

28. Magee, LA, von Dadelszen, P, Rey, E, Ross, S, Asztalos, E, Murphy, KE, et al.. Less-tight versus tight control of hypertension in pregnancy. N Engl J Med 2015;372:407–17. https://doi.org/10.1056/nejmoa1404595.Search in Google Scholar PubMed

29. Ratnapalan, S, Koren, G. Taking ACE inhibitors during pregnancy. Is it safe? Can Fam Phys 2002;48:1047–9.Search in Google Scholar

30. Moretti, ME, Caprara, D, Drehuta, I, Yeung, E, Cheung, S, Federico, L, et al.. The fetal safety of angiotensin converting enzyme inhibitors and angiotensin II receptor blockers. Obstet Gynecol Int 2012;2012:658310. https://doi.org/10.1155/2012/658310.Search in Google Scholar PubMed PubMed Central

31. Churchill, D, Beevers, GD, Meher, S, Rhodes, C. Diuretics for preventing pre-eclampsia. Cochrane Database Syst Rev 2007:CD004451. https://doi.org/10.1002/14651858.CD004451.pub2.Search in Google Scholar PubMed PubMed Central

32. Easterling, TR, Carr, DB, Brateng, D, Diederichs, C, Schmucker, B. Treatment of hypertension in pregnancy: effect of atenolol on maternal disease, preterm delivery, and fetal growth. Obstet Gynecol 2001;98:427–33. https://doi.org/10.1097/00006250-200109000-00012.Search in Google Scholar

33. Gallery, ED, Ross, MR, Gyory, AZ. Antihypertensive treatment in pregnancy: analysis of different responses to oxprenolol and methyldopa. Br Med J (Clin Res Ed) 1985;291:563–6. https://doi.org/10.1136/bmj.291.6495.563.Search in Google Scholar PubMed PubMed Central

34. Yakoob, MY, Bateman, BT, Ho, E, Hernandez-Diaz, S, Franklin, JM, Goodman, JE, et al.. The risk of congenital malformations associated with exposure to beta-blockers early in pregnancy: a meta-analysis. Hypertension 2013;62:375–81. https://doi.org/10.1161/hypertensionaha.111.00833.Search in Google Scholar

35. Duley, L, Meher, S, Jones, L. Drugs for treatment of very high blood pressure during pregnancy. Cochrane Database Syst Rev 2013:CD001449. https://doi.org/10.1002/14651858.CD001449.pub3.Search in Google Scholar PubMed PubMed Central

36. Magee, LA, Cham, C, Waterman, EJ, Ohlsson, A, von Dadelszen, P. Hydralazine for treatment of severe hypertension in pregnancy: meta-analysis. BMJ 2003;327:955–60. https://doi.org/10.1136/bmj.327.7421.955.Search in Google Scholar PubMed PubMed Central

37. Tsakiridis, I, Kasapidou, E, Dagklis, T, Leonida, I, Leonida, C, Bakaloudi, DR, et al.. Nutrition in pregnancy: a comparative review of major guidelines. Obstet Gynecol Surv 2020;75:692–702. https://doi.org/10.1097/ogx.0000000000000836.Search in Google Scholar

38. Tsakiridis, I, Bakaloudi, DR, Oikonomidou, AC, Dagklis, T, Chourdakis, M. Exercise during pregnancy: a comparative review of guidelines. J Perinat Med 2020;48:519–25. https://doi.org/10.1515/jpm-2019-0419.Search in Google Scholar PubMed

39. Rolnik, DL, Wright, D, Poon, LCY, Syngelaki, A, O’Gorman, N, de Paco Matallana, C, et al.. ASPRE trial: performance of screening for preterm pre-eclampsia. Ultrasound Obstet Gynecol 2017;50:492–5. https://doi.org/10.1002/uog.18816.Search in Google Scholar PubMed

40. Chappell, LC, Enye, S, Seed, P, Briley, AL, Poston, L, Shennan, AH. Adverse perinatal outcomes and risk factors for preeclampsia in women with chronic hypertension: a prospective study. Hypertension 2008;51:1002–9. https://doi.org/10.1161/hypertensionaha.107.107565.Search in Google Scholar

41. Chappell, LC, Duckworth, S, Seed, PT, Griffin, M, Myers, J, Mackillop, L, et al.. Diagnostic accuracy of placental growth factor in women with suspected preeclampsia: a prospective multicenter study. Circulation 2013;128:2121–31. https://doi.org/10.1161/circulationaha.113.003215.Search in Google Scholar PubMed

42. Bakker, R, Steegers, EA, Hofman, A, Jaddoe, VW. Blood pressure in different gestational trimesters, fetal growth, and the risk of adverse birth outcomes: the generation R study. Am J Epidemiol 2011;174:797–806. https://doi.org/10.1093/aje/kwr151.Search in Google Scholar PubMed

43. Tsakiridis, I, Mamopoulos, A, Athanasiadis, A, Dagklis, T. Antenatal corticosteroids and magnesium sulfate for improved preterm neonatal outcomes: a review of guidelines. Obstet Gynecol Surv 2020;75:298–307. https://doi.org/10.1097/ogx.0000000000000778.Search in Google Scholar

44. Dagklis, T, Tsakiridis, I, Papazisis, G, Athanasiadis, A. Efficacy and safety of corticosteroids’ administration for pulmonary immaturity in anticipated preterm delivery. Curr Pharm Des 2020. https://doi.org/10.2174/1381612826666201207102910 [Online ahead of print].Search in Google Scholar PubMed

45. Roberts, D, Brown, J, Medley, N, Dalziel, SR. Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth. Cochrane Database Syst Rev 2017;3:CD004454. https://doi.org/10.1002/14651858.CD004454.pub3.Search in Google Scholar PubMed PubMed Central

46. Stutchfield, P, Whitaker, R, Russell, I. Antenatal Steroids for Term Elective Caesarean Section Research T. Antenatal betamethasone and incidence of neonatal respiratory distress after elective caesarean section: pragmatic randomised trial. BMJ 2005;331:662. https://doi.org/10.1136/bmj.38547.416493.06.Search in Google Scholar PubMed PubMed Central

47. Doyle, LW, Crowther, CA, Middleton, P, Marret, S, Rouse, D. Magnesium sulphate for women at risk of preterm birth for neuroprotection of the fetus. Cochrane Database Syst Rev 2009:CD004661. https://doi.org/10.1002/14651858.CD004661.pub3.Search in Google Scholar PubMed

48. Harper, LM, Biggio, JR, Anderson, S, Tita, AT. Gestational age of delivery in pregnancies complicated by chronic hypertension. Obstet Gynecol 2016;127:1101–9. https://doi.org/10.1097/aog.0000000000001435.Search in Google Scholar PubMed PubMed Central

49. Hutcheon, JA, Lisonkova, S, Magee, LA, Von Dadelszen, P, Woo, HL, Liu, S, et al.. Optimal timing of delivery in pregnancies with pre-existing hypertension. BJOG 2011;118:49–54. https://doi.org/10.1111/j.1471-0528.2010.02754.x.Search in Google Scholar PubMed

50. Ram, M, Berger, H, Geary, M, McDonald, SD, Murray-Davis, B, Riddell, C, et al.. Timing of delivery in women with chronic hypertension. Obstet Gynecol 2018;132:669–77. https://doi.org/10.1097/aog.0000000000002800.Search in Google Scholar PubMed

51. Tsakiridis, I, Mamopoulos, A, Athanasiadis, A, Dagklis, T. Induction of labor: an overview of guidelines. Obstet Gynecol Surv 2020;75:61–72. https://doi.org/10.1097/ogx.0000000000000752.Search in Google Scholar PubMed

52. ACOG Practice Bulletin No. 106. Intrapartum fetal heart rate monitoring: nomenclature, interpretation, and general management principles. Obstet Gynecol 2009;114:192–202. https://doi.org/10.1097/AOG.0b013e3181aef106.Search in Google Scholar PubMed

53. Guedes-Martins, L, Graca, H, Saraiva, JP, Guedes, L, Gaio, R, Cerdeira, AS, et al.. The effects of spinal anaesthesia for elective caesarean section on uterine and umbilical arterial pulsatility indexes in normotensive and chronic hypertensive pregnant women: a prospective, longitudinal study. BMC Pregnancy Childbirth 2014;14:291. https://doi.org/10.1186/1471-2393-14-291.Search in Google Scholar PubMed PubMed Central

54. Tsakiridis, I, Giouleka, S, Mamopoulos, A, Athanasiadis, A, Daniilidis, A, Dagklis, T. Operative vaginal delivery: a review of four national guidelines. J Perinat Med 2020;48:189–98. https://doi.org/10.1515/jpm-2019-0433.Search in Google Scholar PubMed

55. Beardmore, KS, Morris, JM, Gallery, ED. Excretion of antihypertensive medication into human breast milk: a systematic review. Hypertens Pregnancy 2002;21:85–95. https://doi.org/10.1081/prg-120002912.Search in Google Scholar

56. Wiciński, M, Malinowski, B, Puk, O, Socha, M, Słupski, M. Methyldopa as an inductor of postpartum depression and maternal blues: a review. Biomed Pharmacother 2020;127:110196.10.1016/j.biopha.2020.110196Search in Google Scholar PubMed

57. Makris, A, Thornton, C, Hennessy, A. Postpartum hypertension and nonsteroidal analgesia. Am J Obstet Gynecol 2004;190:577–8. https://doi.org/10.1016/j.ajog.2003.08.030.Search in Google Scholar PubMed

58. Wasden, SW, Ragsdale, ES, Chasen, ST, Skupski, DW. Impact of non-steroidal anti-inflammatory drugs on hypertensive disorders of pregnancy. Pregnancy Hypertens 2014;4:259–63. https://doi.org/10.1016/j.preghy.2014.06.001.Search in Google Scholar PubMed

Received: 2021-01-12
Accepted: 2021-03-18
Published Online: 2021-04-20
Published in Print: 2021-09-27

© 2021 Walter de Gruyter GmbH, Berlin/Boston

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Introduction to the cesarean section articles
  4. Highlight Section: Cesarean Section
  5. Three kinds of caesarean sections: the foetal/neonatal perspective
  6. The neonatal respiratory morbidity associated with early term caesarean section – an emerging pandemic
  7. Vaginal birth after cesarean (VBAC): fear it or dare it? An evaluation of potential risk factors
  8. Nationwide implementation of a decision aid on vaginal birth after cesarean: a before and after cohort study
  9. Induction of labor at 39 weeks and risk of cesarean delivery among obese women: a retrospective propensity score matched study
  10. Cervical ripening after cesarean section: a prospective dual center study comparing a mechanical osmotic dilator vs. prostaglandin E2
  11. An evidence-based cesarean section suggested for universal use
  12. Online survey on uterotomy closure techniques in caesarean section
  13. Analysis of cesarean section rates in two German hospitals applying the 10-Group Classification System
  14. Reviews
  15. Pregnancy in incarcerated women: need for national legislation to standardize care
  16. Imaging diagnosis and legal implications of brain injury in survivors following single intrauterine fetal demise from monochorionic twins – a review of the literature
  17. Mini Review
  18. Professionally responsible management of the ethical and social challenges of antenatal screening and diagnosis of β-thalassemia in a high-risk population
  19. Opinion Paper
  20. Teaching and training the total percutaneous fetoscopic myelomeningocele repair
  21. Corner of Academy
  22. Chronic hypertension in pregnancy: synthesis of influential guidelines
  23. Original Articles
  24. The effects of pre-pregnancy obesity and gestational weight gain on maternal lipid profiles, fatty acids and insulin resistance
  25. Determination of organic pollutants in meconium and its relationship with fetal growth. Case control study in Northwestern Spain
  26. Betamethasone as a potential treatment for preterm birth associated with sterile intra-amniotic inflammation: a murine study
  27. Diagnostic accuracy of modified Hadlock formula for fetal macrosomia in women with gestational diabetes and pregnancy weight gain above recommended
  28. Vasa previa: when antenatal diagnosis can change fetal prognosis
  29. Mode of delivery and adverse short- and long-term outcomes in vertex-presenting very preterm born infants: a European population-based prospective cohort study
  30. Short Communication
  31. Reference ranges for sphingosine-1-phosphate in neonates
https://doi.org/10.1515/jpm-2021-0015
Keywords for this article
antihypertensive; arterial hypertension; chronic hypertension; comparison; definition; guidelines; investigation; management; pre-existing hypertension; pregnancy

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Introduction to the cesarean section articles
  4. Highlight Section: Cesarean Section
  5. Three kinds of caesarean sections: the foetal/neonatal perspective
  6. The neonatal respiratory morbidity associated with early term caesarean section – an emerging pandemic
  7. Vaginal birth after cesarean (VBAC): fear it or dare it? An evaluation of potential risk factors
  8. Nationwide implementation of a decision aid on vaginal birth after cesarean: a before and after cohort study
  9. Induction of labor at 39 weeks and risk of cesarean delivery among obese women: a retrospective propensity score matched study
  10. Cervical ripening after cesarean section: a prospective dual center study comparing a mechanical osmotic dilator vs. prostaglandin E2
  11. An evidence-based cesarean section suggested for universal use
  12. Online survey on uterotomy closure techniques in caesarean section
  13. Analysis of cesarean section rates in two German hospitals applying the 10-Group Classification System
  14. Reviews
  15. Pregnancy in incarcerated women: need for national legislation to standardize care
  16. Imaging diagnosis and legal implications of brain injury in survivors following single intrauterine fetal demise from monochorionic twins – a review of the literature
  17. Mini Review
  18. Professionally responsible management of the ethical and social challenges of antenatal screening and diagnosis of β-thalassemia in a high-risk population
  19. Opinion Paper
  20. Teaching and training the total percutaneous fetoscopic myelomeningocele repair
  21. Corner of Academy
  22. Chronic hypertension in pregnancy: synthesis of influential guidelines
  23. Original Articles
  24. The effects of pre-pregnancy obesity and gestational weight gain on maternal lipid profiles, fatty acids and insulin resistance
  25. Determination of organic pollutants in meconium and its relationship with fetal growth. Case control study in Northwestern Spain
  26. Betamethasone as a potential treatment for preterm birth associated with sterile intra-amniotic inflammation: a murine study
  27. Diagnostic accuracy of modified Hadlock formula for fetal macrosomia in women with gestational diabetes and pregnancy weight gain above recommended
  28. Vasa previa: when antenatal diagnosis can change fetal prognosis
  29. Mode of delivery and adverse short- and long-term outcomes in vertex-presenting very preterm born infants: a European population-based prospective cohort study
  30. Short Communication
  31. Reference ranges for sphingosine-1-phosphate in neonates
Sign up now to receive a 20% welcome discount
Institutional Access
How does access work?
Have an idea on how to improve our website?
Please write us.
© 2025 De Gruyter Brill
Downloaded on 28.12.2025 from https://www.degruyterbrill.com/document/doi/10.1515/jpm-2021-0015/html
Scroll to top button