Planned early induction of labor from the 34th week of pregnancy in women with high blood pressure during pregnancy reduces the risk of serious maternal complications by more than half. This is the conclusion of a recent Cochrane Review published on World Preeclampsia Day on 22 May 2026. The caesarean section rate does not increase.

The review evaluated six randomized controlled trials with a total of 3,491 pregnant women. An active strategy (early induction of labor or – if medically necessary – caesarean section) was compared with a wait-and-see approach under close monitoring. The studies included women with preeclampsia, gestational hypertension and chronic hypertension.

Without early initiation, about 47 out of 1,000 women suffered a serious complication (such as seizures, pulmonary edema, kidney failure, HELLP syndrome or death). With planned early birth, this rate decreased to about 25 out of 1,000 (relative risk 0.54; 95% confidence interval 0.37–0.77; high quality of evidence according to GRADE). It was not possible to make a reliable statement about individual complications due to too few cases.

Maternal mortality showed little or no difference, although the data available here is very limited (only four deaths in total in two studies).

Important for the consultation: The rate of caesarean sections did not change significantly (429 out of 1,000 when waiting versus 403 out of 1,000 when initiated early; RR 0.94; high quality of evidence).

In the only study from low- and low-middle-income countries (Zambia and India), there was evidence of a significant reduction in stillbirths (from about 7 to 2 per 1,000). In studies from high-income countries, no stillbirths occurred, so that transferability to Germany remains unclear. The admission rate of newborns to intensive care units remained largely unchanged.

“These results give doctors and affected women a clearer orientation,” senior author Prof. Catherine Cluver from Stellenbosch University is quoted as saying. First author Dr. Alice Beardmore-Gray from King’s College London emphasized that many women primarily ask about the caesarean section risk. This concern can now be clearly refuted.

The review supports the current German S2k guideline “Hypertensive Diseases in Pregnancy” (as of July 2024), which recommends termination of pregnancy from 37+0 weeks of gestation in the case of preeclampsia and an individual assessment from 34+0 weeks of pregnancy. For the first time, it also expands the evidence base to include data on chronic high blood pressure.

The authors recommend further research on long-term effects on child development and maternal cardiovascular health. Especially in countries with limited resources, rapid recognition of symptoms and planned early birth are of great importance.

High blood pressure during pregnancy is one of the most common causes of severe maternal and fetal complications worldwide. The Cochrane Review now provides the most comprehensive evidence to date for optimal management from the 34th week of pregnancy.

Original Paper:

Planned early birth versus expectant management for hypertensive disorders from 34 weeks’ gestation to term – Beardmore-Gray, A – 2026 | Cochrane Library

Editor: X-Press Journalistenbüro GbR

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