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Timing of delivery

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Timing of birth

Record maternal and fetal thresholds for planned early birth before 37 weeks in women with pre-eclampsia.

*Thresholds for considering planned early birth could include (but are not limited to) any of the following known features of severe pre-eclampsia:

  • inability to control maternal blood pressure despite using 3 or more classes of antihypertensives in appropriate doses
  • maternal pulse oximetry less than 90%
  • progressive deterioration in liver function, renal function, haemolysis, or platelet count
  • ongoing neurological features, such as severe intractable headache, repeated visual scotomata, or eclampsia
  • placental abruption
  • reversed end-diastolic flow in the umbilical artery doppler velocimetry, a nonreassuring cardiotocograph, or stillbirth
  • Other features not listed above may also be considered in the decision to plan early birth.

Involve a senior obstetrician in any decisions on timing of birth for women with pre-eclampsia.

Discuss with the anaesthetic team if birth is planned in a woman with preeclampsia.

Discuss with the neonatal team if birth is planned in a woman with preeclampsia, and neonatal complications are anticipated.

Offer intravenous magnesium sulfate and a course of antenatal corticosteroids if indicated, if early birth is planned for women with preterm pre-eclampsia

Timing of birth in women with pre-eclampsia

Weeks of pregnancy

Timing of birth

Before 34 weeks

Continue surveillance unless there are indications* for planned early birth. Offer intravenous magnesium sulfate and a course of antenatal corticosteroids in line with the NICE guideline on preterm labour and birth.

From 34 to 36+6 weeks

Continue surveillance unless there are indications* for planned early birth.

When considering the option of planned early birth, take into account the woman's and baby's condition, risk factors (such as maternal comorbidities, multifetal pregnancy) and availability of neonatal unit beds. Consider a course of antenatal corticosteroids in line with the NICE guideline on preterm labour and birth.

From 37 weeks onwards

Initiate birth within 24-48 hours.

Reference:

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