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Evidence summaries

Planned Early Delivery Versus Expectant Management for Hypertensive Disorders from 34 Weeks Gestation to Term

Planned early delivery appears to be effective for reducing maternal morbidity and mortality in hypertensive disorders of pregnancy after 34 weeks compared with expectant management. However, early delivery may carry risks for the infant depending on gestational age. Level of evidence: "B"

Comment: The quality of evidence is downgraded by study limitations (lack of blinding).

Summary

A Cochrane review [Abstract] 1 included 5 studies with a total of 1819 subjects. There was a lower risk of composite maternal mortality and severe morbidity for women randomised to receive planned early delivery T1. There were no clear differences between subgroups based on our subgroup analysis by gestational age, gestational week or condition. Planned early delivery was associated with lower risk of HELLP syndrome (RR 0.40, 95% CI 0.17 to 0.93; 3 trials, n=1628). There was not enough information to draw any conclusions about the effects on composite infant mortality and severe morbidity. Planned early delivery was associated with higher levels of respiratory distress syndrome (RR 2.24, 95% CI 1.20 to 4.18; 3 trials, n=1511), and NICU admission (RR 1.65, 95% CI 1.13 to 2.40; 4 trials, n=1585). There was no clear difference between groups for caesarean section, or in the duration of hospital stay for the mother after delivery of the baby, or for the baby T1.

Planned early delivery versus expectant management for hypertensive disorders from 34 weeks' gestation to term

OutcomeRelative effect(95% CI)Risk with controlRisk with intervention - Planned early delivery (95% CI)№of participants(studies) Quality of evidence
Composite maternal mortality and morbidityRR 0.69(0.57 to 0.83)235 per 1000162 per 1000(134 to 195)1459(2) High
Composite infant mortality and morbidityNot pooled, due to heterogeneity, I²=87% 1459 (2)
Caesarean sectionRR 0.91(0.78 to 1.07)302 per 1000275 per 1000(236 to 324)1728(4) Moderate
Duration of hospital stay after delivery for mother (days)-The mean duration was 0The mean duration was 0.16 fewer (0.46 fewer to 0.15 more)925(2) Moderate
Duration of hospital stay after delivery for baby (days)-The mean duration was 0The mean duration 0.2 days fewer (0.57 fewer to 0.17 more)756(1) Moderate

A meta-analysis 2 included 1724 women. Compared with expectant management, immediate delivery reduced the composite risk of HELLP syndrome and eclampsia in all women (RR 0.33, 95% CI 0.15 to 0.73; I² = 0%) as well as in the pre-eclampsia subgroup (RR 0.39, 95% CI 0.15 to 0.98; I² = 0%). Immediate delivery increased infant´s RDS risk (RR 1.94, 95% CI 1.05 to 3.6) depending on gestational age: delivery in the 35th week of gestation increased the risk (RR 5.5, 95% CI 1.0 to 29.6), but not in the 36th week (RR 3.4, 95% CI 0.4 to 30.3).

Clinical comments

Note

Date of latest search: 6 May 2020

    References

    • Cluver C, Novikova N, Koopmans CM et al. Planned early delivery versus expectant management for hypertensive disorders from 34 weeks gestation to term. Cochrane Database Syst Rev 2017;(1):CD009273. [PubMed]
    • Bernardes TP, Zwertbroek EF, Broekhuijsen K et al. Delivery or expectant management for prevention of adverse maternal and neonatal outcomes in hypertensive disorders of pregnancy: an individual participant data meta-analysis. Ultrasound Obstet Gynecol 2019;53(4):443-453. [PubMed]

Primary/Secondary Keywords