Timing of delivery

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

Reference:

• NICE (June 2019). Hypertension in pregnancy: diagnosis and management