Timing of Delivery
Severe preeclampsia
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Mandatory obs consult
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Immediate delivery (vaginal or c-section) - regardless of gestational age (GA)
Chronic HTN
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Offer initiation of delivery from 38+0 to 39+6 wks GA
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Prior to 36+6 wks GA, expectant care unless indication for birth
Gestational HTN
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If dx at <37+0 wks, offer initiation of delivery from 38+0 to 39+6 wks GA
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If onset ≥37+0 wks GA - discuss initiation of delivery
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Prior to 36+6 wks GA, expectant care unless indication for birth
Pre-eclampsia
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Prior to 33+6 wks GA, consider expectant care (only in perinatal centres w/ capacity to care for very preterm infants)
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Previability preeclampsia associate with ++ perinatal mortality & maternal complications --> discuss termination of pregnancy
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Discuss initiation of delivery at 34+0 to 35+6 wks GA (but increased neonatal risk)
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Consider initiation of delivery at 36+0 to 36+6 wks GA
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Recommended to initiate delivery if ≥37+0 wks GA
Reference: Magee LA, Smith GN, Bloch C, et al. Guideline No. 426: Hypertensive Disorders of Pregnancy: Diagnosis, Prediction, Prevention, and Management. J Obstet Gynaecol Can. 2022;44(5):547-571.e1. doi:10.1016/j.jogc.2022.03.002