MedSciNet

Pre-eclampsia in Hospital: Early Induction or Expectant Management (Phoenix)

Phoenix

MedSciNet has implemented and helped launch the online database for Phoenix, a multi-centre randomised trial to determine whether delivery in women with pre-eclampsia between 34 and 37 weeks of gestation reduces maternal complications without short and long term detriment to the infant compared to expectant management and delivery at 37 weeks of gestation.

In the UK, 10-15% of pregnant women develop hypertension in pregnancy, and 2-8% pre-eclampsia. Pre-eclampsia is a multisystem disorder, characterised by placental and maternal vascular dysfunction which is associated with significant morbidity and mortality for the mother and infant. Adverse outcomes of pre-eclampsia include severe hypertension, stroke, renal and hepatic injury, haemorrhage, fetal growth restriction, and even death.

Early delivery may be indicated to prevent maternal and infant morbidity. Standard management of pre-eclampsia involves close monitoring whilst taking into consideration the gestational age of the fetus, fetal well-being, and rate of progression of maternal disease to instigate timely delivery if needed. When a diagnosis of pre-eclampsia is made at or beyond 37 weeks of gestation, it is currently recommended that delivery be induced, since maternal and fetal risks can be significantly reduced without any apparent added risk associated with the intervention.

The optimal time to instigate delivery to prevent morbidity when pre-eclampsia occurs between 34 and 37 weeks of gestation, without increasing problems related to infant immaturity or complications, remains unclear. Current management involves close surveillance and action only when evidence of impending serious morbidity becomes apparent (e.g. deteriorating maternal or fetal conditions). As this may be rapid or unexpected, routine delivery beyond 34 weeks’ may be valuable.

The aim of The Phoenix study is to remove the uncertainty about the timing of delivery in pregnancies affected by pre-eclampsia between 34 and 37 weeks of gestation.

This multi-centre trial is co-ordinated from the National Perinatal Epidemiology Unit Clinical Trials Unit (NPEU CTU) at the University of Oxford and is co-sponsored by Kings College London and Guy’s and St Thomas’ NHS Foundation Trust. Funding is provided by the National Institute of Health Research (NIHR) Health Technology Assessment (HTA) programme.

To learn more, please visit the Phoenix study website at www.medscinet.com/Phoenix/.