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Timing of Delivery

 

Severe preeclampsia

  • Mandatory obs consult

  • Immediate delivery (vaginal or c-section) - regardless of gestational age (GA)

 

Chronic HTN 

  • Offer initiation of delivery from 38+0 to 39+6 wks GA​​

  • Prior to 36+6 wks GA, expectant care unless indication for birth

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Gestational HTN 

  • If dx at <37+0 wks, offer initiation of delivery from 38+0 to 39+6 wks GA

  • If onset ≥37+0 wks GA - discuss initiation of delivery

  • Prior to 36+6 wks GA, expectant care unless indication for birth

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Pre-eclampsia

  • Prior to 33+6 wks GA, consider expectant care (only in perinatal centres w/ capacity to care for very preterm infants)

    • Previability preeclampsia associate with ++ perinatal mortality & maternal complications --> discuss termination of pregnancy

  • Discuss initiation of delivery at 34+0 to 35+6 wks GA (but increased neonatal risk)

  • Consider initiation of delivery at 36+0 to 36+6 wks GA

  • Recommended to initiate delivery if ≥37+0 wks GA

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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

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