Mode of Delivery in Stable Patients with Hypertensive Disorders of Pregnancy Based on the Classification Tree

Purpose It is very critical to consider features of Hypertensive Disorders of Pregnancy (HDP) when choosing mode of delivery, which are rarely reported in present studies. This study is to construct a user-friendly combination of HDP patients’ features to choose optimal mode of delivery for stable patients without other indications for cesarean section. Methods A retrospective analysis was performed in 307 stable HDP patients with clinical cure. 116 patients underwent vaginal delivery (VD) and 191 patients underwent cesarean delivery (CD). Univariate analysis was done between VD group and CD group on demographic, anthropometric and laboratory variables. Then, with classification tree, separate set of HDP features were enabled to be linked into mode of delivery. Results The levels of edema, proteinuria, systolic blood pressure (SBP), hematocrit (HCT), β-2 microglobulin and aspartate aminotransferase (AST) were higher in CD group than those in VD group (P<0.001). The classification tree was consisted of 3 layers: the first layer was edema, the second layer were β-2microglobulin and proteinuria, and the third layer was HCT. Node 3 (no edema; β-2microglobulin ≤1.71ug/ml) reached VD rate of 86.4%, which was the highest VD rate among all terminal nodes. Node 6 (edema is limited to the ankle or above,proteinuria>1+) had the lowest VD rates of 11.3%. Conclusions The classification tree explores the collection of HDP features suitable for different modes of delivery, which offers the ability of assisting obstetricians to select proper mode of delivery for HDP patients without other certain indications for cesarean section.