Interventionist versus expectant care for severe pre‐eclampsia between 24 and 34 weeks' gestation

David Churchill; Lelia Duley; Jim G Thornton; Leanne Jones

doi:10.1002/14651858.CD003106.pub2

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Figure 1

'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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Figure 2

'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.

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Analysis 1.1

Comparison 1 Interventionist care versus expectant (delayed delivery) care for severe pre‐eclampsia, Outcome 1 Eclampsia.

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Analysis 1.2

Comparison 1 Interventionist care versus expectant (delayed delivery) care for severe pre‐eclampsia, Outcome 2 HELLP syndrome.

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Analysis 1.3

Comparison 1 Interventionist care versus expectant (delayed delivery) care for severe pre‐eclampsia, Outcome 3 Pulmonary oedema.

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Analysis 1.4

Comparison 1 Interventionist care versus expectant (delayed delivery) care for severe pre‐eclampsia, Outcome 4 Death of the baby (all stillbirths, neonatal and infant deaths).

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Analysis 1.5

Comparison 1 Interventionist care versus expectant (delayed delivery) care for severe pre‐eclampsia, Outcome 5 Death of the baby (subgrouped by time of death).

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Analysis 1.6

Comparison 1 Interventionist care versus expectant (delayed delivery) care for severe pre‐eclampsia, Outcome 6 Intraventricular haemorrhage or hypoxic ischaemic encephalopathy.

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Analysis 1.7

Comparison 1 Interventionist care versus expectant (delayed delivery) care for severe pre‐eclampsia, Outcome 7 Renal failure.

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Analysis 1.8

Comparison 1 Interventionist care versus expectant (delayed delivery) care for severe pre‐eclampsia, Outcome 8 Caesarean section.

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Analysis 1.9

Comparison 1 Interventionist care versus expectant (delayed delivery) care for severe pre‐eclampsia, Outcome 9 Placental abruption.

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Analysis 1.10

Comparison 1 Interventionist care versus expectant (delayed delivery) care for severe pre‐eclampsia, Outcome 10 Low Apgar score at five minutes (< 7 at five minutes).

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Analysis 1.11

Comparison 1 Interventionist care versus expectant (delayed delivery) care for severe pre‐eclampsia, Outcome 11 Neonatal seizures.

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Analysis 1.12

Comparison 1 Interventionist care versus expectant (delayed delivery) care for severe pre‐eclampsia, Outcome 12 Hyaline membrane disease.

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Analysis 1.13

Comparison 1 Interventionist care versus expectant (delayed delivery) care for severe pre‐eclampsia, Outcome 13 Necrotising enterocolitis.

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Analysis 1.14

Comparison 1 Interventionist care versus expectant (delayed delivery) care for severe pre‐eclampsia, Outcome 14 Baby ventilated.

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Analysis 1.15

Comparison 1 Interventionist care versus expectant (delayed delivery) care for severe pre‐eclampsia, Outcome 15 Measures of long‐term growth & development (cerebral palsy).

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Analysis 1.16

Comparison 1 Interventionist care versus expectant (delayed delivery) care for severe pre‐eclampsia, Outcome 16 Measures of long‐term growth & development (poor hearing/hearing aid).

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Analysis 1.17

Comparison 1 Interventionist care versus expectant (delayed delivery) care for severe pre‐eclampsia, Outcome 17 Measures of long‐term growth & development (impaired vision).

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Analysis 1.18

Comparison 1 Interventionist care versus expectant (delayed delivery) care for severe pre‐eclampsia, Outcome 18 Small‐for‐gestational age.

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Analysis 1.19

Comparison 1 Interventionist care versus expectant (delayed delivery) care for severe pre‐eclampsia, Outcome 19 Gestation at birth (days).

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Analysis 1.20

Comparison 1 Interventionist care versus expectant (delayed delivery) care for severe pre‐eclampsia, Outcome 20 Length of stay in neonatal intensive care unit (days).

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Analysis 1.21

Comparison 1 Interventionist care versus expectant (delayed delivery) care for severe pre‐eclampsia, Outcome 21 Admission to neonatal intensive care unit.

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Comparison 1. Interventionist care versus expectant (delayed delivery) care for severe pre‐eclampsia

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Eclampsia Show forest plot	1	95	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

2 HELLP syndrome Show forest plot	1	95	Risk Ratio (M‐H, Fixed, 95% CI)	0.53 [0.05, 5.68]

3 Pulmonary oedema Show forest plot	1	95	Risk Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

4 Death of the baby (all stillbirths, neonatal and infant deaths) Show forest plot	4	425	Risk Ratio (M‐H, Fixed, 95% CI)	1.08 [0.69, 1.71]

5 Death of the baby (subgrouped by time of death) Show forest plot	4		Risk Ratio (M‐H, Fixed, 95% CI)	Subtotals only

5.1 Stillbirth	4	425	Risk Ratio (M‐H, Fixed, 95% CI)	0.20 [0.03, 1.16]
5.2 Perinatal death	2	68	Risk Ratio (M‐H, Fixed, 95% CI)	1.14 [0.45, 2.89]
5.3 Neonatal death	4	425	Risk Ratio (M‐H, Fixed, 95% CI)	1.33 [0.80, 2.23]
5.4 Death after 28 days	1	38	Risk Ratio (M‐H, Fixed, 95% CI)	1.8 [0.18, 18.21]
6 Intraventricular haemorrhage or hypoxic ischaemic encephalopathy Show forest plot	1	262	Risk Ratio (M‐H, Fixed, 95% CI)	1.82 [1.06, 3.14]

7 Renal failure Show forest plot	2	133	Risk Ratio (M‐H, Fixed, 95% CI)	0.30 [0.01, 6.97]

8 Caesarean section Show forest plot	4	425	Risk Ratio (M‐H, Fixed, 95% CI)	1.09 [1.01, 1.18]

9 Placental abruption Show forest plot	2	133	Risk Ratio (M‐H, Fixed, 95% CI)	0.80 [0.26, 2.40]

10 Low Apgar score at five minutes (< 7 at five minutes) Show forest plot	1	262	Risk Ratio (M‐H, Fixed, 95% CI)	1.48 [0.87, 2.50]

11 Neonatal seizures Show forest plot	1	262	Risk Ratio (M‐H, Fixed, 95% CI)	2.57 [0.27, 24.43]

12 Hyaline membrane disease Show forest plot	2	133	Risk Ratio (M‐H, Fixed, 95% CI)	2.30 [1.39, 3.81]

13 Necrotising enterocolitis Show forest plot	3	395	Risk Ratio (M‐H, Fixed, 95% CI)	2.10 [0.93, 4.79]

14 Baby ventilated Show forest plot	2	300	Risk Ratio (M‐H, Fixed, 95% CI)	1.50 [1.11, 2.02]

15 Measures of long‐term growth & development (cerebral palsy) Show forest plot	1	262	Risk Ratio (M‐H, Fixed, 95% CI)	6.01 [0.75, 48.14]

16 Measures of long‐term growth & development (poor hearing/hearing aid) Show forest plot	1	262	Risk Ratio (M‐H, Fixed, 95% CI)	0.34 [0.07, 1.74]

17 Measures of long‐term growth & development (impaired vision) Show forest plot	1	262	Risk Ratio (M‐H, Fixed, 95% CI)	4.29 [0.51, 36.22]

18 Small‐for‐gestational age Show forest plot	2	125	Risk Ratio (M‐H, Fixed, 95% CI)	0.30 [0.14, 0.65]

19 Gestation at birth (days) Show forest plot	4	425	Mean Difference (IV, Random, 95% CI)	‐9.91 [‐16.37, ‐3.45]

20 Length of stay in neonatal intensive care unit (days) Show forest plot	2	125	Mean Difference (IV, Random, 95% CI)	11.14 [1.57, 20.72]

21 Admission to neonatal intensive care unit Show forest plot	2	125	Risk Ratio (M‐H, Fixed, 95% CI)	1.35 [1.16, 1.58]

Comparison 1. Interventionist care versus expectant (delayed delivery) care for severe pre‐eclampsia

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