Skip to main navigation
Skip notifications
Access to POEMs and Essential Evidence Plus will no longer be included in CMA membership as of Dec. 1, 2023.
Search
Maternal benefit with planned delivery for preeclampsia
Clinical Question
Is planned delivery beneficial for mothers with preeclampsia or their infants?
Bottom line
For women with preeclampsia, planned delivery from 34 weeks' onward reduces a composite outcome of maternal morbidity. For neonates, there may be a decreased risk of small for gestational age at birth, and an increase in short-term respiratory morbidity. The difference in gestational age at birth was a mean of 4 days. Rates of vaginal birth were not different. 1a
Reference
Study design: Meta-analysis (randomized controlled trials)
Funding: Government
Setting: Various (meta-analysis)
Synopsis
These authors performed a meta-analysis of individual patient data to identify benefits and harms of planned delivery versus expectant management among women with preeclampsia. They obtained participant level data (N = 1790) from 6 trials published between 2000 and 2021. Included women had singleton or multiple gestations and presented with preeclampsia or superimposed preeclampsia from 34 weeks' onward. None of the included studies enrolled women with severe preeclampsia or other indications for immediate delivery. An analysis of baseline characteristics of participants showed balance between groups, in particular for the presence of severe hypertension and suspected fetal growth restriction. Median time between enrollment and delivery was a mean 4 days shorter in the planned delivery group (95% CI 3.0 - 4.0). The primary outcome of major maternal morbidity (composite measure defined as one or more of the following: death, eclampsia, stroke, pulmonary edema, HELLP syndrome, and placental abruption) was reduced in the planned delivery group (2.6% vs 4.0%; adjusted risk ratio [aRR] 0.59; 0.36 - 0.98; P = .041). The primary neonatal outcome (composite measure of one or more of: perinatal death, neonatal death, respiratory disease, central nervous system complications, culture-proven sepsis, necrotizing enterocolitis, hypoglycemia requiring intravenous glucose or neonatal admission, and jaundice requiring neonatal admission) was higher in the planned delivery group (20.9% vs 17.1%; aRR 1.22; 1.01 - 1.47; P = .040). This was driven by neonatal respiratory disease (RR 1.41; 1.05 - 1.90) and neonatal admissions (RR 1.21; 1.08 - 1.36). However, there were fewer infants born small for gestational age in the planned delivery group (RR 0.82; 0.70 - 0.97). Rates of vaginal delivery didn’t differ between groups (RR 1.06; 0.96 - 1.18).
Reviewer
Linda Speer, MD
Professor and Chair, Department of Family Medicine
University of Toledo
Toledo, OH
Comments
Planned delivery for pre-eclampsia
Confusing: - marginal maternal benefit for worse neonatal outcomes.
preeclampsia intervention
induction reduces maternal morbidity