Practice Uncertainties

Is early induction or expectant management more beneficial in women with late preterm pre-eclampsia?

BMJ 2015; 350 doi: http://dx.doi.org/10.1136/bmj.h191 (Published 10 April 2015) Cite this as: BMJ 2015;350:h191
  1. Lucy C Chappell, reader in obstetrics1,
  2. Fiona Milne, writer, with personal experience of pre-eclampsia2,
  3. Andrew Shennan, professor of obstetrics1
  1. 1Women’s Health Academic Centre, King’s College London, London SE1 7EH, UK
  2. 2Action on Pre-eclampsia, Evesham, UK
  1. Correspondence to: L C Chappell lucy.chappell{at}kcl.ac.uk
  • Accepted 4 December 2014

This is one of a series of occasional articles that highlight areas of practice where management lacks convincing supporting evidence. The series adviser is David Tovey, editor in chief, the Cochrane Library. This paper is based on a research priority identified and commissioned by the National Institute for Health Research’s Health Technology Assessment programme on an important clinical uncertainty. To suggest a topic for this series, please email us at [email protected]

The bottom line

  • We are uncertain whether planned immediate delivery or expectant management has better outcomes for a woman and her baby if she has pre-eclampsia between 34 and 37 weeks of pregnancy.

  • Offer delivery between 34 and 37 weeks of pregnancy if a woman develops severe hypertension refractory to treatment, abnormal haematological or biochemical indices, evidence of fetal compromise or other indicators of severe pre-eclampsia.

  • Give clear, accurate advice to women with pre-eclampsia to report new symptoms—for example, headache; vomiting; severe pain just below ribs; problems with vision; sudden swelling of face, hands, or feet; and reduced fetal movements.

The prevalence of hypertension during pregnancy is 10-15% in the United Kingdom, with 2-8% of all pregnant women having pre-eclampsia.1 The simplistic definition of pre-eclampsia (gestational hypertension with proteinuria) belies its complex nature. Progression of the syndrome is unpredictable, and potential outcomes include multiple maternal organ dysfunction and fetal morbidity and mortality.

The decision of when to deliver the baby is fundamental for both the clinical team and the patient. The sooner the baby is born and the placenta removed, the less likely the mother is to progress to serious or life threatening outcomes. The decision is less clear when the maternal situation is not overtly dangerous, because the benefits and risks of immediate delivery or intensive monitoring of the continuing pregnancy (expectant management) conflict for mother and baby. For …

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