Planned Early Delivery or Expectant Management for Late Preterm Preeclampsia (PHOENIX): A Randomized Controlled Trial

Abstract

(Lancet. 2019;394:1181–1190) Preeclampsia occurs in 2% to 3% of pregnant women and is associated with substantial maternal and neonatal morbidity and mortality. Prompt delivery is the recommended management for preeclamptic women after 37 weeks’ gestation, as this will decrease the risk of maternal complications while minimally affecting risk to the neonate at this gestational age. However, it is unclear what the best management strategy is for women who develop preeclampsia between 34 and 37 weeks’ gestation. In these cases, complications related to expectant management (EM), such as stillbirth or worsening fetal growth restriction and increased maternal morbidity associated with continuing the pregnancy, must be weighed against the neonatal complications associated with early delivery (infant immaturity). Current guidelines in the UK recommend EM until 37 weeks’ gestation, with earlier delivery if severe preeclampsia or other complications arise. This study from the UK compared earlier initiation of delivery with EM in women diagnosed with preeclampsia between 34 and <37 weeks gestation.

Value of Ultrasonic Image Features in Diagnosis of Perinatal Outcomes of Severe Preeclampsia on account of Deep Learning Algorithm

“…Thus, a large number of vasoactive cytokines enter the blood circulation to induce systemic inflammatory response and result in insufficient blood perfusion in all organs of the body. The placenta, as the most important target organ of severe preeclampsia, has an important influence on the outcomes of perinatal children with severe preeclampsia [17].…”

Prospective evaluation of first‐trimester screening strategy for preterm pre‐eclampsia and its clinical applicability in China

“…The capability of the screening model to additionally identify other placenta-associated complications and the consequently improved positive predictive value of the test may promote the acceptability and cost-effectiveness of uptake of daily low-dose aspirin for screen-positive women 52 . We recommend a comprehensive management policy for high-risk women, who could benefit, in terms of both maternal and neonatal health, not only from administration of low-dose aspirin, but also from closer monitoring, calcium supplementation 53,54 , appropriate gestational weight gain 55,56 , a healthy diet, timely diagnosis and, if necessary, transfer to another hospital 57 .…”

FIGO good practice recommendations on modifiable causes of iatrogenic preterm birth

“…These rules are based on large randomized clinical trials conducted in recent years comparing induction of labor and expectant management. As is apparent from Table 1, iatrogenic delivery is not required for any of the common pregnancy conditions and appropriate monitoring is advised instead, perhaps with the exception of pre‐eclampsia, in which delivery between 34 and 37 weeks can be considered, 12,13 while for women with chronic hypertension the recommendation based on non‐randomized data is 38 weeks 14 . In pregnancies complicated by growth restriction at term, the DIGITAT study showed that the optimal timing of induction is around 38 weeks, 15 while in pregnancies with early‐onset growth restriction without fetal distress, earlier induction does not improve outcomes 16 .…”