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OBJECTIVE: Our purpose was to compare the accuracy of maternal perception of preterm uterine activity by self-palpation versus home uterine activity monitoring. STUDY DESIGN: A total of 72,962 uterine activity records of 778 women receiving home uterine activity monitoring services were analyzed. Simultaneously with home uterine activity monitoring, the women indicated by an electronic marker when they felt a "contraction" through self-palpation. The perceptions of the women were compared to the tocodynamometrically measured uterine activity. RESULTS: Using self-palpation, women correctly identified 17.2% of contractions recorded by tocodynamometry. Overall mean percent correct correlation per patient was only 14.1%. Patients missed an average of 85.7% of their contractions. Patients incorrectly perceived contractions that were not present an average of 40.3% of the time. Singleton gestations had significantly better correct correlations than twin gestations. Multiparous women had improved correlations compared with primiparous women. No significant correlation was found between maternal perceptive ability and gestational age. CONCLUSION: Women were unable to perceive accurately the presence or absence of preterm uterine activity through self-palpation compared with simultaneous measurement by home uterine tocodynamometry. (AM J OBSTET GYNECOL 1996;174:672-5.)

Objective: Limited information is available regarding the progression of disease in women with mild gestational hypertension. Our purpose was to describe the prognostic signs in the natural course of mild gestational hypertension and pregnancy outcomes in women who were remote from term with mild gestational hypertension that was expectantly managed. Study Design: Women with mild gestational hypertension participating in an outpatient hypertension monitoring program were studied. Inclusion criteria were patients with a singleton pregnancy between 24 and 35 weeks' gestation who had no proteinuria by dipstick (0 or trace) on the first 2 days of program participation. Progression to preeclampsia was the primary outcome. The rate of progression to severe preeclampsia, obstetric complications, and neonatal outcomes were secondary measures. Data were compared by independent Student t and Fisher exact tests where applicable. Results: A total of 748 patients were studied during the observation period; preeclampsia (persistent proteinuria ≥1+) developed in 343 (46%), and 72 (9.6%) had antepartum progression to severe preeclampsia. No significant differences in maternal age, race, marital status, or tobacco use were observed between those women in whom persistent proteinuria developed and those in whom it did not develop. Gestational age of the infants at delivery (36.5 ± 2.4 vs 37.4 ± 2.0 weeks), birth weight (2752 ± 767 vs 3038 ± 715 g), incidence of small-for-gestational-age newborns (24.8% vs 13.8%), and duration of neonatal hospital stay (7.1 ± 10 vs 5.0 ± 9.3 days) differed significantly in the patients with versus those without proteinuria ( P Conclusions: In patients with mild gestational hypertension remote from term, 46% ultimately had preeclampsia, with progression to severe disease in 9.6%. The development of proteinuria is associated with an earlier gestational age at delivery, lower birth weight, and an increased incidence of small-for-gestational age newborns. (Am J Obstet Gynecol 2001;184:979-83.)

OBJECTIVES: Our purpose was to compare maternal and perinatal outcomes of mature women with those in younger women with pregnancies complicated by mild hypertension remote from term. STUDY DESIGN: A matched cohort design was used. A total of 379 mature pregnant women (≥35 years old) with mild hypertension remote from term were matched for race, gestational age, and proteinuria status at enrollment with 379 adult controls aged 20 to 30 years also with mild hypertension remote from term. All were enrolled in an outpatient management program that included automated blood pressure measurements and daily assessment of weight, proteinuria, and fetal movement. RESULTS: The mean gestational age at enrollment was 32.7 ± 3.0 weeks for both groups (range 24 to 36 weeks). By matching 20.6% of patients in each group had ≥1+ proteinuria on urinary dipstick at enrollment, and 77.3% of patients in each group were white. Chronic hypertension was more common in the mature group (22.4% vs 14.5%, p = 0.007). The mean gestational age at delivery (37.2 ± 2.3 vs 37.2 ± 2.2 weeks), the mean pregnancy prolongation (28.1 ± 21.0 vs 28.4 ± 22.0 days), and the mean birth weights (2864 ± 770 vs 2906 ± 788 gm) were similar between the mature and younger groups (all p > 0.05). There were no differences regarding abruptio placentae (2 vs 3 cases) or thrombocytopenia or HELLP ( h emolysis, e levated l iver enzymes, l ow p latelets) syndrome (7 vs 9 cases), and there were no cases of eclampsia. There were five stillbirths in the mature group and none in the younger group ( p = 0.063). CONCLUSION: Outpatient management of mild hypertension remote from term in the mature pregnant woman was associated with similar maternal outcomes but with a nonstatistically higher stillbirth rate compared with the younger pregnant woman. (Am J Obstet Gynecol 1997;176:1236-43.)

Our purpose was to compare maternal and perinatal outcomes of teenage and adult pregnancies with mild gestational hypertension remote from term managed with an outpatient program.A matched cohort design was used. Maternal and perinatal outcomes of 60 teenage pregnancies with mild gestational hypertension remote from term were compared with 120 adult controls 20 to 42 years old. The groups were matched for race, gestational age, and proteinuria status at enrollment. All were monitored on an outpatient basis with four times daily automated blood pressure measurement and daily assessment of weight, proteinuria, and fetal movement.The mean gestational age at enrollment was 33.5 +/- 2.6 weeks for both groups (range 27 to 36 weeks). Only 60% of teenagers had a high school degree or equivalent compared with 76% of adults (p = 0.024). The teenagers were more likely than the adults to be of single marital status (75% vs 13%, p = 0.015). The mean gestational age at delivery (37.0 +/- 2.0 vs 37.0 +/- 2.2 weeks), mean pregnancy prolongation (23.5 +/- 19.0 vs 24.5 +/- 17.4 days), and mean birth weights (2915 +/- 669 vs 2879 +/- 678 gm) were not statistically different between the teenagers and adults (all p0.05). There were no stillbirths, neonatal deaths, or cases of eclampsia in either group.In spite of a study population characterized by limited education, single marital status, and young age at enrollment, monitored outpatient management of mild gestational hypertension remote from term in teenage pregnancies is associated with maternal and perinatal outcomes similar to those observed in adults.A comparison of maternal and perinatal outcomes of 60 adolescent pregnancies remote from term with mild gestational hypertension and 120 adult controls matched for race, gestational age, and proteinuria status revealed similar responses to monitored outpatient management. The mean gestational age at enrollment was 33.5 +or- 2.6 weeks for both groups. Only 60% of teenagers, compared with 76% of adults, had a high school diploma or equivalent. Participants received education on the hypertensive disease process, instruction in use of an automated physiologic data recorder, and counseling on activity limitations. Antepartum hospitalization occurred in 43% of adolescents and 39% of adults; the mean number of pregnancy prolongation days were 23.5 and 24.5, respectively. 63% of adolescents and 68% of adults delivered at gestations of 37 weeks or more. Mean birth weight was 2915 grams in the former group and 2879 grams in the latter group. There were no stillbirths, neonatal deaths, or cases of eclampsia in either group. Managed care has placed an increased emphasis on the use of outpatient treatment. Although adolescents, especially those with low educational levels, tend to be regarded as poor candidates for outpatient regimens because of compliance concerns, the findings of the present study suggest that monitored outpatient management of mild gestational hypertension is feasible in this population.