What is the optimal time for delivery in women with preterm pre-eclampsia?

This study investigated if early planned delivery has better outcomes for the mother and the newborn in women with late preterm pre-eclampsia (PPE). They found that early planned delivery reduces maternal complications and mortality.

Pre-eclampsia is a condition that can arise during pregnancy. Preterm pre-eclampsia (PPE) can be dangerous to both mother and baby. PPE leads to abnormally high blood pressure (BP). If untreated it can lead to stroke and kidney and liver dysfunction in the mother. It can also restrict the growth of the fetus. Most importantly, it can lead to death if not managed.  

Most doctors recommend that a baby is delivered at 37 weeks if the mother has PPE. This reduces the risk to the mother and does not compromise the baby’s safety. Some women do not present with PPE until late in the pregnancy. PPE diagnosed between 34 and 37 weeks of pregnancy is considered late PPE. It is unclear if early planned delivery is associated with better outcomes in women with late PPE. 

This study included 901 women with late PPE. Patients were randomly assigned to undergo early planned delivery (EPD) or expectant management (EM). EPD involved induced delivery within 48 hours of inclusion in the trial. EM involved delivery at 37 weeks or earlier if necessary. Maternal outcomes were compared. This included death and high BP. Neonatal outcomes were also compared. These included death and hospitalization after birth. 

The risk of events like death or high BP was 14% lower in the EPD group. EPD was also associated with a 26% higher risk of neonatal hospitalization. The average gestational period (GP) for EPD was 252 days. In EM patients, the average GP was 257 days. Women in the EPD group were more likely to have a vaginal birth.

The number of side effects was similar in both groups. 

The authors concluded that early planned delivery reduces maternal mortalityin women with pre-eclampsia.

This study did not examine the long-term effects of EPD on the infant. However, there were no indicators of higher newborn mortality in EPD compared to EM. Further investigation is ongoing. 

If you have any concerns regarding hypertension during pregnancy, please consult with your doctor.