Elective delivery versus expectant management for pre-eclampsia: a meta-analysis of RCTs

Purpose To evaluate the effectiveness and safety of elective delivery versus expectant management for women with pre-eclampsia (PE) and to assess neonatal outcomes before and after 34 weeks gestation. Methods We searched Biomed Central, CINAHL, Cochrane Library, Embase, HMIC, Medline, and WHO trial registry, British Nursing Index, ClinicalTrials.gov, Current Controlled Trials, and Web of Science on 16 March, 2016. 1704 citations were identified. Randomised controlled trials comparing elective delivery with expectant management for women with PE were included. Seven studies were included ( n = 1501). There were no maternal deaths. Results Elective delivery lowered incidence of complications in women with PE or hypertension greater than 34 weeks gestation ( n = 756; RR, 0.64; 95% CI 0.51–0.80). For women with severe PE less than 34 weeks gestation, elective delivery lowered the incidence of placental abruption ( n = 483, 5 RCTs; RR, 0.43; 95% CI 0.19–0.98). For women with PE or hypertension greater than 34 weeks gestation, elective delivery also reduced the need for antihypertensive drug therapy. The need for ventilatory support and the risk of developing neonatal intraventricular hemorrhage or hypoxic ischemic encephalopathy may be increased in infants whose mothers undergo elective delivery for severe PE at less than 34 weeks gestation. However, there was no relevant evidence for women with severe PE over 34 weeks. Conclusions In women with PE or gestational hypertension beyond 34 weeks gestation, elective delivery can decrease the incidence of complications, severe hypertension and the need for antihypertensive drug therapy. Elective delivery can also lower the risk of placental abruption in women before 34 weeks gestation with severe PE, however, may be associated with increased risk of neonatal complications.