Planned caesarean section versus planned vaginal birth for severe pre-eclampsia

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Clinical Trial Methodology

Background:

• Severe pre-eclampsia is a frequent pregnancy complication necessitating early delivery.
• Optimal mode of delivery (cesarean vs. vaginal birth) for severe pre-eclampsia remains unclear.
• Observational data suggest potential benefits of vaginal birth, but require confirmation.

Purpose of the Study:

• To evaluate the impact of planned cesarean section versus planned vaginal birth on maternal and infant mortality and morbidity in severe pre-eclampsia.
• To synthesize evidence from randomized controlled trials (RCTs) on delivery mode for severe pre-eclampsia.

Main Methods:

• Systematic search of major clinical trial registries and databases (Cochrane, ClinicalTrials.gov, WHO ICTRP) up to September 2017.
• Inclusion criteria focused exclusively on RCTs comparing planned cesarean section versus planned vaginal birth for severe pre-eclampsia.
• Exclusion of quasi-randomized and non-randomized studies, and studies on eclampsia.

Main Results:

• No randomized controlled trials meeting the inclusion criteria were identified.
• Two studies were excluded based on the selection criteria.
• The review currently contains no included studies.

Conclusions:

• A significant lack of high-quality RCT evidence exists regarding the optimal mode of delivery for severe pre-eclampsia.
• Further high-quality RCTs are urgently needed to guide clinical practice.
• Such trials should investigate the short- and long-term effects of cesarean section and vaginal birth in this population.