Comment: The quality of evidence is downgraded by study limitations (lack of blinding).
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.
| Outcome | Relative effect(95% CI) | Risk with control | Risk with intervention - Planned early delivery (95% CI) | №of participants(studies) Quality of evidence |
|---|---|---|---|---|
| Composite maternal mortality and morbidity | RR 0.69(0.57 to 0.83) | 235 per 1000 | 162 per 1000(134 to 195) | 1459(2) High |
| Composite infant mortality and morbidity | Not pooled, due to heterogeneity, I²=87% | 1459 (2) | ||
| Caesarean section | RR 0.91(0.78 to 1.07) | 302 per 1000 | 275 per 1000(236 to 324) | 1728(4) Moderate |
| Duration of hospital stay after delivery for mother (days) | - | The mean duration was 0 | The 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 0 | The 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).
Date of latest search: 6 May 2020
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