Trial reportLancet (London, England)2023
Planned delivery or expectant management for late preterm pre-eclampsia in low-income and middle-income countries (CRADLE-4): a multicentre, open-label, randomised controlled trial.
Trial report in Lancet (London, England), 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 1 of them a synthesis that pooled it.
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Who cites it
16 citing papers in PubMed, 1 synthesis or guideline pooled it, 20 citations in OpenAlex.
- Hypertensive disorders of pregnancy in low- and middle-income countries: a review of antenatal interventions to improve maternal outcomes.Frontiers in global women's health · 2026Pooled it
- Differences in Factors Associated With Preterm and Term Stillbirth: A Secondary Cohort Analysis of the DESiGN Trial.BJOG : an international journal of obstetrics and gynaecology · 2025Trial
- Induction of labour versus expectant management after one previous caesarean birth maternal and neonatal outcomes in a population-based cohort study.Scientific reports · 2026Article
- Prevalence and risk factors of hypertensive disorders during pregnancy in Somalia: A multilevel analysis of the 2020 Demographic and Health Survey.International journal of cardiology. Cardiovascular risk and prevention · 2026Article
- Pre-eclampsia risk-stratified planned birth at term: A survey of women's perspectives on acceptability and risk communication.Acta obstetricia et gynecologica Scandinavica · 2026Article
- Dose-response relationship between gestational blood glucose levels and risk of pre-eclampsia in singleton pregnancies: A retrospective multicenter study.Chinese medical journal · 2026Article
- Performance of the Pre-Eclampsia Integrated Estimate of Risk-Machine Learning (PIERS-ML) model in a Kenyan cohort of women with pre-eclampsia- a retrospective test derivation validation study.BMC pregnancy and childbirth · 2026Article
- Terminal Digit Preference and Threshold Avoidance in Digital Blood Pressure Measurements During Pregnancy: Secondary Analysis of Data From the CLIP and PRECISE Cohorts.JMIR mHealth and uHealth · 2026Article
- Initial recruitment, diagnosis, conservative management, maternal and perinatal outcomes of hypertensive disorders of pregnancy.AJOG global reports · 2026Article
- Novel symptoms associated with eclampsia could improve detection and save lives.PLoS medicine · 2026Article
- Clinical Characteristics, Management, and Perinatal Outcomes of Third-Trimester Preeclampsia at a Tertiary Hospital in Vietnam: A Retrospective Descriptive Study.International journal of women's health · 2026Article
- Gestational age, birthweight, and maternal factors associated with neonatal mortality in the United States.Frontiers in public health · 2026Article
- The Escalating Inequalities in Global Maternal Mortality-Time to Act: A Commentary.BJOG : an international journal of obstetrics and gynaecology · 2025Article
- Variations in emergency care for severe pre-eclampsia in Uganda: a national evaluation study.AJOG global reports · 2025Article
- Heart disease in pregnancy and risk of pre-eclampsia: a Swedish register-based study.Open heart · 2024Article
- Implementation challenges in preeclampsia care: perspectives from health care professionals in urban Uganda.AJOG global reports · 2024Article
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Authors and funding
18 authors at 9 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundPre-eclampsia is a leading cause of maternal and perinatal mortality. Evidence regarding interventions in a low-income or middle-income setting is scarce. We aimed to evaluate whether planned delivery between 34
methodsIn this parallel-group, multicentre, open-label, randomised controlled trial, we compared planned delivery versus expectant management in women with pre-eclampsia from 34
findingsBetween Dec 19, 2019, and March 31, 2022, 565 women were enrolled. 284 women (282 women and 301 babies analysed) were allocated to planned delivery and 281 women (280 women and 300 babies analysed) were allocated to expectant management. The incidence of the primary maternal outcome was not significantly different in the planned delivery group (154 [55%]) compared with the expectant management group (168 [60%]; adjusted risk ratio [RR] 0·91, 95% CI 0·79 to 1·05). The incidence of the primary perinatal outcome by intention to treat was non-inferior in the planned delivery group (58 [19%]) compared with the expectant management group (67 [22%]; adjusted risk difference -3·39%, 90% CI -8·67 to 1·90; non-inferiority p<0·0001). The results from the per-protocol analysis were similar. There was a significant reduction in severe maternal hypertension (adjusted RR 0·83, 95% CI 0·70 to 0·99) and stillbirth (0·25, 0·07 to 0·87) associated with planned delivery. There were 12 serious adverse events in the planned delivery group and 21 in the expectant management group.
interpretationClinicians can safely offer planned delivery to women with late preterm pre-eclampsia, in a low-income or middle-income country. Planned delivery reduces stillbirth, with no increase in neonatal unit admissions or neonatal morbidity and reduces the risk of severe maternal hypertension. Planned delivery from 34 weeks' gestation should therefore be considered as an intervention to reduce pre-eclampsia associated mortality and morbidity in these settings.
fundingUK Medical Research Council and Indian Department of Biotechnology.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.