CAESAREANS: Skittishness Leads to Unnecessary Procedures

      Some pregnant women may undergo unnecessary caesarean sections because they have "white-coat hypertension" -- high blood pressure only when they are around doctors. Almost one-third of pregnant women had false hypertension in a study published in today's Journal of the American Medical Association. Many such women are treated for "real hypertension" with drugs that drive down blood pressure but can also compromise the woman's ability to have normal contractions, prompting doctors to perform unnecessary C-sections (USA Today, 10/20). Dr. Gianni Bellomo of Assissi Hospital in Italy studied two groups of women during their third trimester -- 144 who had been diagnosed with hypertension and a control group of 106 with normal blood pressure. Neither group previously had been treated for high blood pressure. Of the group of 144 women, Bellomo found that 42 had white-coat hypertension after being monitored continuously for 24 hours (Bellomo et al., JAMA, 10/20 issue). Of those 42 women, 42% underwent caesareans, while 41% of the 102 women with true hypertension had caesareans. Only 12% of women with normal blood pressure underwent a C-section (USA Today, 10/20). Noting that hypertension during pregnancy could be a sign of pre-eclampsia, Bellomo also recorded the incidence of pre-eclampsia in the groups, finding that it "did not differ significantly" between white-coat hypertension (7.1%) and normal blood pressure groups(5.8%), but was much higher among those having true hypertension (61.7%). The doctors concluded that while it was difficult to provide a definite explanation, the possibility exists that "the attitude of physicians caring for women with increased office BP in their third trimester of pregnancy may have played a role" because many of those women were treated with antihypertensive drugs, which could cause complications (JAMA, 10/20 issue). Dr. Bruce Flamm, an OB/GYN with Kaiser Permanente Medical Center, agreed, saying that "U.S. doctors tend to treat even slightly high blood pressure aggressively in late pregnancy and will continue to do so because eclampsia can be quick to develop." He added that "the threat of lawsuits forces U.S. doctors to practice defensively even if a more conservative approach would be sound" (USA Today, 10/20).