Approximately half a million infants succumb to pre-eclampsia-related complications each year, with an additional 46,000 maternal deaths attributed to this aggressive pregnancy disorder. Pre-eclampsia, characterized by high blood pressure, poses severe risks to both mother and child, affecting vital organs and potentially leading to catastrophic outcomes if left untreated.
A recent study, led by the Cradle-4 trial conducted in India and Zambia, offers promising insights. Planned early deliveries, initiated from 34 weeks even in low-resource settings, have shown a significant reduction in stillbirth risk by 75%. The trial, a randomized controlled study involving 565 women with pre-eclampsia between 34 and 37 weeks, demonstrated that planned early delivery did not increase the neonatal unit admission risk or pose additional short-term complications.
The study’s findings suggest that integrating planned early deliveries into routine care could be a pivotal step in addressing the high mortality rates associated with pre-eclampsia, especially in regions like sub-Saharan Africa and south Asia. The current maternal mortality rate worldwide is 223 per 100,000 live births, and the Sustainable Development Goals aspire to reduce this to 70 per 100,000 by 2030.
However, implementing planned early deliveries faces challenges, particularly in low- and lower-middle-income settings with strained healthcare systems. To overcome these obstacles, several crucial steps are imperative.
Firstly, early delivery should be incorporated into national and international guidelines, necessitating enhanced community engagement for increased awareness and understanding of pre-eclampsia. Initiatives such as docu-dramas, competitions, and dynamic awareness campaigns in various countries, including Sierra Leone and Zambia, demonstrate the potential impact of community involvement in disseminating critical health information.
Secondly, planned delivery should be accompanied by a comprehensive range of interventions, including early risk stratification, prediction of pre-eclampsia, safe labor and delivery care, and postnatal follow-up. Ensuring that healthcare practitioners are equipped to provide these services is vital.
Lastly, increased research in resource-stretched settings is essential. The Cradle-4 Trial serves as a model for locally-driven evidence generation, emphasizing the need for more trials in sub-Saharan African countries, where only 2% of clinical trials currently take place, and addressing the key causes of maternal mortality remains an urgent priority.
As we strive to achieve the Sustainable Development Goals, the integration of planned early deliveries into routine care emerges as a potentially transformative strategy to curb the devastating impact of pre-eclampsia on maternal and perinatal health. The path forward requires a coordinated effort, combining community engagement, healthcare practitioner empowerment, and continued research, to ensure that this intervention becomes a global standard, particularly in regions where it is most needed.
