Hypertensive disorders of pregnancy, which include pre-eclampsia, gestational hypertension, and chronic hypertension, are the second leading cause of maternal death globally. For women with pre-eclampsia, early birth remains the only definitive treatment, as the condition is driven by the placenta and will only resolve once it is delivered.
This review, led by King’s College London, pooled data from six randomized controlled trials involving 3,491 women, comparing planned early birth after 34 weeks to watchful waiting. The trials included women with one or more types of hypertensive disorder and took place across a range of settings, including the Netherlands, UK, US, India, and Zambia.
The findings show high-certainty evidence that serious maternal complications were nearly halved in women who had a planned early birth compared to those managed with watchful waiting.
“These findings give clinicians and women clearer guidance about the timing of birth when high blood pressure develops in pregnancy,” said Prof Catherine Cluver, senior author of the review and researcher at Stellenbosch University and Tygerberg Hospital. “For women with pre-eclampsia in particular, the evidence supports offering planned early birth from 34 weeks, and no later than 37 weeks.”
“Judging when to offer birth is the question that we battle with clinically every day,” said Dr Alice Beardmore-Gray, lead author of the review and Obstetrician at King’s College London.
The authors added that in two of the trials included, over half the women allocated to watchful waiting ended up needing emergency birth before 37 weeks, typically just three to five days later than women allocated to planned early birth, and often experiencing more complications.
“A common misconception is that by waiting longer, mum and baby are gaining more time, but often what you are doing is just delaying an inevitable emergency birth, when both may be in a worse condition,” explained Dr Beardmore-Gray.
Read the review here
