Assessing the change and management of blood pressure in women with pre-eclampsia after the onset of labor: A single-center retrospective cohort study

Background Pre-eclampsia is a pregnancy-related disorder that potentially leads to maternal and neonatal mortality, preterm birth, and long-term health complications, thereby imposing a considerable economic burden on healthcare systems. This study aimed to investigate the change and management of blood pressure after the onset of labor in women with pre-eclampsia. Methods A retrospective cohort analysis was performed, analyzing data from 476 participants and revealing distinct blood pressure trajectories categorized into three classes on the basis of their systolic blood pressure (SBP) patterns: Class 1 (lowest SBP, n = 201), Class 2 (highest SBP, n = 30), and Class 3 (median SBP, n = 245). Treatment strategies included epidural labor analgesia (ELA), antihypertensive treatment during labor (AHTDL), antenatal antihypertensive treatment (AAHT) and prenatal magnesium sulfate treatment (MST). Multinomial logistic regression was used to analyze the relationships between different perinatal treatments and perinatal blood pressure. Generalized estimating equation described the trajectories of blood pressure and time with modifiers during the onset of labor, active labor phase, 2 h post-partum, and 6 h post-partum. Results The initiation of ELA was linked to a notable decrease in systolic blood pressure (SBP) following the onset of labor (odds ratio = 0.249, P < 0.001). Generalized estimating equation analysis indicated a significant downward trend in SBP over time (b=-4.849, P < 0.001). Among the four combination treatment strategies of ELA, AHTDL, AAHT and MST, the reduction in the SBP of the population with combined ELA was more significant during the active labor phase. Conclusion This study emphasized the importance of the ELA in treating hypertension in patients with pre-eclampsia during delivery.