Early delivery for pre-eclampsia might save lives in low-income and middle-income settings

Pre-eclampsia is a leading contributor to maternal and perinatal mortality worldwide, with the burden being disproportionately borne by those in low-income and middle-income countries (LMICs). Despite this disparity, most research in pre-eclampsia is done in high-income settings. An example is identifying the optimal timing of delivery for late preterm pre-eclampsia. Here, clinicians find themselves balancing risks. There is the potential hazard to the mother of continuing the pregnancy with a progressive disease for which the only cure is delivery, and there are competing risks for the fetus: the ongoing exposure to a potentially hostile in-utero environment versus the short-term and long-term consequences of premature birth. The dilemma regarding timing of birth is particularly pertinent for pre-eclampsia because maternal and placental vascular dysfunction can compromise both maternal and fetal wellbeing. Planned delivery or expectant management for late preterm pre-eclampsia in low-income and middle-income countries (CRADLE-4): a multicentre, open-label, randomised controlled trialClinicians can safely offer planned delivery to women with late preterm pre-eclampsia, in a low-income or middle-income country. Planned delivery reduces stillbirth, with no increase in neonatal unit admissions or neonatal morbidity and reduces the risk of severe maternal hypertension. Planned delivery from 34 weeks’ gestation should therefore be considered as an intervention to reduce pre-eclampsia associated mortality and morbidity in these settings. Full-Text PDF Open Access