A Cochrane systematic review has found that planned early birth from 34 weeks of gestation significantly reduces serious maternal complications in women with hypertensive disorders of pregnancy, without increasing the likelihood of caesarean section. The review, led by King’s College London, is published in the Cochrane Database of Systematic Reviews.
Hypertensive disorders of pregnancy, including pre-eclampsia, gestational hypertension, and chronic hypertension, represent the second leading cause of maternal death globally. For women with pre-eclampsia, delivery of the placenta remains the only definitive resolution of the condition.
The review pooled data from six randomised controlled trials involving 3,491 women across settings in the Netherlands, the United Kingdom, the United States, India, and Zambia, comparing planned early birth with watchful waiting.
High-certainty evidence showed that serious maternal complications were nearly halved in women who underwent planned early birth. Planned early birth also likely reduces the risk of stillbirth by approximately 75%, though this estimate is based on moderate-certainty evidence and was driven primarily by a single trial conducted in India and Zambia, where baseline stillbirth rates are higher. No stillbirths were recorded in trials from high-income countries. Neonatal unit admissions were not found to increase with planned early birth, based on moderate-certainty evidence.
The maternal benefit was consistent across both high- and low-income settings. High-certainty evidence confirmed no increase in caesarean section rates, a finding the authors highlight as particularly relevant to clinical counselling. In two of the included trials, more than half of the women allocated to watchful waiting ultimately required emergency birth within a few days, frequently with greater complications.
The authors conclude that planned early birth should be offered to women with pre-eclampsia from 34 weeks and no later than 37 weeks.
Source: Beardmore-Gray A et al. Planned early delivery versus expectant management for hypertensive disorders from 34 weeks of gestation to term. Cochrane Database of Systematic Reviews (2026). DOI: 10.1002/14651858.CD009273.pub3
