Outpatient management of pregnancy complicated by mild hypertensive disorders.

Introduction Antenatal day care units have been experienced as an alternative to inpatient care for women with pregnancy complications including hypertensive disorders. Objectives To assess the outcomes of outpatient management in women with gestational hypertension and mild preeclampsia and compare them to inpatient management. Methods Perinatal records of 294 patients (OUT group) attending the obstetric outpatient clinic were reviewed and compared with records of 398 women (IN group) attending the obstetric unit of the same tertiary referral center. The patients were divided as: GH, gestational hypertension (OUT: 194; IN: 244), GH with Intrauterine Growth Restriction (OUT: 52; IN: 78) and PE, mild preeclampsia (OUT: 48; IN: 76). The groups were comparable for age, parity, body mass index and gestational age at enrollment. Results When compared with patients treated in hospital, GH OUT women showed a higher gestational age at delivery (38 ± 1.7 vs 35.5 ± 2.3 weeks; p < 0.001), longer time to delivery (62.0 ± 4.8 vs 31.3 ± 5.4 days; p < 0.001), higher birthweight (3251 ± 389 vs 2271 ± 759.1 g; p < 0.001), and a lower admission to neonatal intensive care unit (21.3% vs 0%; p < 0.001) (hospitalization rate: 25%). Similarly, Mild PE women treated as out patient showed later gestational age at delivery (37 ± 1.2 vs 34.4 ± 1.7 weeks), longer time to delivery (55.4 ± 6.9 vs 35.3 ± 4.5 days), higher birthweight (3168 ± 363 vs 2196 ± 685.17 g), and a lower admission to NICU (15.6% vs 35.5%) (hospitalization rate: 55.6%), than the inpatient controls. In the gestational hypertension with IUGR no significant differences were observed between out- and in-patient management. Conclusion Women attending day care units have better or comparable perinatal outcomes than inpatients. Ambulatory management at a day-care unit is an option for monitoring and following up women with mild gestational hypertension or preeclampsia remote from term. Hospitalization remains an absolute indication if worsening of preeclampsia is diagnosed.