Guidelines for Delivery in Preeclampsia

Gestational Age-Based Delivery Guidelines

The American College of Cardiology and other guideline societies recommend immediate delivery for women with preeclampsia at ≥37 weeks' gestation, regardless of the presence of severe features 1, 2, 3
For women with preeclampsia between 34-37 weeks' gestation, expectant management with close monitoring is recommended in the absence of severe features, with a strength of evidence rated as moderate to high 1, 2, 4
Conservative management is recommended for women with preeclampsia at <34 weeks' gestation, with stable maternal and fetal conditions, and close monitoring by a Maternal and Fetal Medicine specialist 1, 2, 5
Counseling about possible pregnancy termination should be provided to women with preeclampsia at <24 weeks' gestation, due to high maternal risks and poor fetal outcomes, with a strength of evidence rated as high 1, 5

Immediate delivery is indicated for women with preeclampsia who develop uncontrolled severe hypertension, despite using ≥3 classes of antihypertensives in appropriate doses, with a strength of evidence rated as high 1, 2
Women with preeclampsia and maternal pulse oximetry <90% require immediate delivery, with a strength of evidence rated as moderate to high 2
Progressive deterioration in liver function, creatinine, hemolysis, or platelet count in women with preeclampsia is an indication for immediate delivery, with a strength of evidence rated as high 1, 2
Ongoing neurological features, such as severe intractable headache, repeated visual scotomata, or eclampsia, in women with preeclampsia require immediate delivery, with a strength of evidence rated as high 1, 2, 3
Pulmonary edema and placental abruption in women with preeclampsia are indications for immediate delivery, with a strength of evidence rated as high 1, 2, 3
Non-reassuring fetal status or reversed end-diastolic flow in umbilical artery Doppler in women with preeclampsia requires immediate delivery, with a strength of evidence rated as high 1, 2

Blood pressure monitoring, repeated assessments for proteinuria, and clinical assessment, including clonus, are recommended for women with preeclampsia during expectant management, with a strength of evidence rated as moderate to high 1, 3
Twice weekly blood tests for hemoglobin, platelet count, liver enzymes, creatinine, and uric acid are recommended for women with preeclampsia during expectant management, with a strength of evidence rated as moderate to high 1, 3
MgSO₄ for seizure prophylaxis is recommended for women with severe hypertension or neurological symptoms, with a strength of evidence rated as high 1, 3

The American Association for the Study of Liver Diseases recommends delivery at 34 weeks for preeclampsia with severe features, with a strength of evidence rated as high 6, 7
Expeditious delivery after maternal stabilization is recommended for women with HELLP syndrome, with a strength of evidence rated as high 6, 7
Abdominal imaging should be performed to rule out hepatic complications in women with HELLP syndrome, with a strength of evidence rated as moderate to high 7

The American College of Cardiology and other guideline societies recommend against classifying preeclampsia as mild versus severe clinically, as all cases may rapidly progress to emergencies, with a strength of evidence rated as high 1, 2
Serum uric acid and proteinuria levels should not be used as indications for delivery in women with preeclampsia, with a strength of evidence rated as moderate to high 1
Blood pressure alone is not a reliable way to stratify immediate risk in women with preeclampsia, as serious organ dysfunction can develop at relatively mild levels of hypertension, with a strength of evidence rated as high 2
Plasma volume expansion is not recommended routinely in women with preeclampsia, with a strength of evidence rated as moderate to high 1, 3