Effect of midwifery-led comprehensive care on perinatal outcomes among women with hypertensive disorders of pregnancy: A randomized controlled trial

Objectives: The objectives of this study are to investigate the effect of midwifery-led comprehensive care in improving perinatal outcomes among women with hypertensive disorders of pregnancy. Materials and Methods: A single-blinded randomized controlled trial was conducted among 150 pregnant women diagnosed with gestational hypertension after 20 weeks of gestation. The study was conducted between February 14, 2022, and March 15, 2024. Participants were randomly assigned (75 intervention, 75 control) through computer-generated block randomization. The intervention arm received the midwifery-led comprehensive care, while the control group received standard routine care. The intervention was provided in 5 contact points (at 20 weeks, 28 weeks, 32 weeks, 36 weeks, and before delivery) at the antenatal outpatient department (OPD). The tools used were a structured demographic questionnaire, structured tool for maternal and fetal outcomes. Data were collected at 20 weeks, 28 weeks, 32 weeks, and 36 weeks. Results: Neonatal resuscitation rate was lower in the intervention group (6.7%) than in the control group (21.3%). IUGR incidence (5.3% vs. 16%) and fetal mortality (5.3% vs. 14.7%) were also reduced. The independent sample t -test and repeated measures analysis of variance revealed that intervention arm has significantly improved key maternal and fetal parameters in terms of higher APGAR scores, better fetal heart rate at 32 weeks, and significantly lower systolic and diastolic blood pressure, maternal weight, and proteinuria levels at various gestational weeks, indicating improved perinatal outcomes compared to the control group at P < 0.05. Conclusion: Midwifery-led care positively influenced maternal health and fetal outcomes, reducing abnormal weight gain, stabilizing blood pressure, and reducing the adverse fetal outcome. As a feasible, scalable intervention, it can be generalized to diverse populations, emphasizing the need for broader implementation and further research.