@article{Beardmore-Gray:2022:10.1016/j.ajog.2022.04.034,
author = {Beardmore-Gray, A and Seed, PT and Fleminger, J and Zwertbroek, E and Bernardes, T and Mol, BW and Battersby, C and Koopmans, C and Broekhuijsen, K and Boers, K and Owens, MY and Thornton, J and Green, M and Shennan, AH and Groen, H and Chappell, LC},
doi = {10.1016/j.ajog.2022.04.034},
journal = {American Journal of Obstetrics and Gynecology},
pages = {218--230.e8},
title = {Planned delivery or expectant management in preeclampsia: an individual participant data meta-analysis.},
url = {http://dx.doi.org/10.1016/j.ajog.2022.04.034},
volume = {227},
year = {2022}
}

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TY  - JOUR
AB  - OBJECTIVE: Pregnancy hypertension is a leading cause of maternal and perinatal mortality and morbidity. Between 34+0 and 36+6 weeks gestation, it is uncertain whether planned delivery could reduce maternal complications without serious neonatal consequences. In this individual participant data meta-analysis, we aimed to compare planned delivery to expectant management, focusing specifically on women with preeclampsia. DATA SOURCES: We performed an electronic database search using a prespecified search strategy, including trials published between January 1, 2000 and December 18, 2021. We sought individual participant-level data from all eligible trials. STUDY ELIGIBILITY CRITERIA: We included women with singleton or multifetal pregnancies with preeclampsia from 34 weeks gestation onward. METHODS: The primary maternal outcome was a composite of maternal mortality or morbidity. The primary perinatal outcome was a composite of perinatal mortality or morbidity. We analyzed all the available data for each prespecified outcome on an intention-to-treat basis. For primary individual patient data analyses, we used a 1-stage fixed effects model. RESULTS: We included 1790 participants from 6 trials in our analysis. Planned delivery from 34 weeks gestation onward significantly reduced the risk of maternal morbidity (2.6% vs 4.4%; adjusted risk ratio, 0.59; 95% confidence interval, 0.36-0.98) compared with expectant management. The primary composite perinatal outcome was increased by planned delivery (20.9% vs 17.1%; adjusted risk ratio, 1.22; 95% confidence interval, 1.01-1.47), driven by short-term neonatal respiratory morbidity. However, infants in the expectant management group were more likely to be born small for gestational age (7.8% vs 10.6%; risk ratio, 0.74; 95% confidence interval, 0.55-0.99). CONCLUSION: Planned early delivery in women with late preterm preeclampsia provides clear maternal benefits and may reduce the risk of the infant being born small for gestational
AU  - Beardmore-Gray,A
AU  - Seed,PT
AU  - Fleminger,J
AU  - Zwertbroek,E
AU  - Bernardes,T
AU  - Mol,BW
AU  - Battersby,C
AU  - Koopmans,C
AU  - Broekhuijsen,K
AU  - Boers,K
AU  - Owens,MY
AU  - Thornton,J
AU  - Green,M
AU  - Shennan,AH
AU  - Groen,H
AU  - Chappell,LC
DO  - 10.1016/j.ajog.2022.04.034
EP  - 230
PY  - 2022///
SN  - 0002-9378
SP  - 218
TI  - Planned delivery or expectant management in preeclampsia: an individual participant data meta-analysis.
T2  - American Journal of Obstetrics and Gynecology
UR  - http://dx.doi.org/10.1016/j.ajog.2022.04.034
UR  - https://www.ncbi.nlm.nih.gov/pubmed/35487323
UR  - https://www.ajog.org/article/S0002-9378(22)00315-5/fulltext
UR  - http://hdl.handle.net/10044/1/97219
VL  - 227
ER  - 

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