BMJ  2005;330:576-580 (12 March), doi:10.1136/bmj.330.7491.576

Primary care

The pre-eclampsia community guideline (PRECOG): how to screen for and detect onset of pre-eclampsia in the community

¹ Action on Pre-eclampsia, Harrow, Middlesex HA1 4HZ, ² Nuffield Department of Obstetrics and Gynaecology, John Radcliffe Hospital, Oxford OX3 9DU, ³ St James's University Hospital, Leeds LS9 7TF, ⁴ Maternal and Fetal Health Research, St Mary's Hospital, Manchester M13 0JH, ⁵ Stonedean Practice, Stony Stratford Health Centre, Milton Keynes MK11 1YA, ⁶ Cuckoo Lane Practice, London W7 3EY, ⁷ Imperial College London, Queen Charlotte's Hospital, London W12 0NN, ⁸ National Childbirth Trust, London W3 6NH, ⁹ Royal College of Midwives, London W1G 9NH, ¹⁰ Ninewells Hospital and Medical School, Dundee DD1 9SY, ¹¹ St Thomas' Hospital, King's College, London SE1 7EH, ¹² St Mary's Hospital, Portsmouth, Hampshire PO3 6AD, ¹³ School of Surgical and Reproductive Sciences, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, ¹⁴ Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW

The first 150 words of the full text of this article appear below.

Why is a guideline needed?

Pre-eclampsia is a major cause of poor outcome in pregnancy: the category "hypertensive diseases of pregnancy" remains a leading cause of direct maternal deaths in the United Kingdom¹; pre-eclamptic conditions represent one in three cases of severe obstetric morbidity²; hypertension and/or proteinuria is the leading single identifiable risk factor in pregnancy associated with stillbirth (one in five stillbirths in otherwise viable babies)³; and pre-eclampsia is strongly associated with fetal growth restriction, low birth weight, preterm delivery, respiratory distress syndrome, and admission to neonatal intensive care.⁴

In 46% of maternal deaths¹ and 65% of fetal deaths⁵ due to pre-eclampsia reported through the Confidential Enquiries into Maternal Deaths and the Confidential Enquiry into Stillbirths and Deaths in Infancy, different management would reasonably have expected to alter the outcome. There was a failure to identify and act on known risk factors at booking and to recognise and respond to signs . . . [Full text of this article]

What can be done?

Complementing existing recommendations

The recommendations

Day assessment units

Resource implications

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    StumbleUpon    Technorati    What's this?

Relevant Articles

Assessing the onset of pre-eclampsia in the hospital day unit: summary of the pre-eclampsia guideline (PRECOG II)

Fiona Milne, Chris Redman, James Walker, Phil Baker, Rebecca Black, Jill Blincowe, Carol Cooper, Gillian Fletcher, Mervi Jokinen, Paul A Moran, Catherine Nelson-Piercy, Stephen Robson, Andrew Shennan, Angela Tuffnell, and Jason Waugh
BMJ 2009 339: b3129. [Extract] [Full Text]

Mean arterial pressure and prediction of pre-eclampsia

Colin A Walsh and Laxmi V Baxi
BMJ 2008 336: 1079-1080. [Extract] [Full Text] [PDF]

Pre-eclampsia and risk of cardiovascular disease and cancer in later life: systematic review and meta-analysis

Leanne Bellamy, Juan-Pablo Casas, Aroon D Hingorani, and David J Williams
BMJ 2007 335: 974. [Abstract] [Full Text] [PDF]

Management of pre-eclampsia

Lelia Duley, Shireen Meher, and Edgardo Abalos
BMJ 2006 332: 463-468. [Extract] [Full Text] [PDF]

... and early detection in the community is paramount
BMJ 2005 330: 0. [Full Text]

Pre-eclampsia matters

Ian A Greer
BMJ 2005 330: 549-550. [Extract] [Full Text] [PDF]

Risk factors for pre-eclampsia at antenatal booking: systematic review of controlled studies

Kirsten Duckitt and Deborah Harrington
BMJ 2005 330: 565. [Abstract] [Full Text] [PDF]

This article has been cited by other articles:

• Milne, F., Redman, C., Walker, J., Baker, P., Black, R., Blincowe, J., Cooper, C., Fletcher, G., Jokinen, M., Moran, P. A, Nelson-Piercy, C., Robson, S., Shennan, A., Tuffnell, A., Waugh, J. (2009). Assessing the onset of pre-eclampsia in the hospital day unit: summary of the pre-eclampsia guideline (PRECOG II). BMJ 339: b3129-b3129 [Full text]  
• Seepana, S., Allamsetty, S., Simon, C. (2009). Pre-eclampsia. InnovAiT 2: 284-290 [Abstract] [Full text]  
• Schatz, M. (2009). Is maternal asthma a life or death issue for the baby?. Thorax 64: 93-95 [Full text]  
• Walsh, C. A, Baxi, L. V (2008). Mean arterial pressure and prediction of pre-eclampsia. BMJ 336: 1079-1080 [Full text]  
• Ruiz-Irastorza, G, Khamashta, M. (2008). Lupus and pregnancy: ten questions and some answers. Lupus 17: 416-420  
• Bellamy, L., Casas, J.-P., Hingorani, A. D, Williams, D. J (2007). Pre-eclampsia and risk of cardiovascular disease and cancer in later life: systematic review and meta-analysis. BMJ 335: 974-974 [Abstract] [Full text]  
• Powrie, R. O. (2007). A 30-Year-Old Woman With Chronic Hypertension Trying to Conceive. JAMA 298: 1548-1558 [Abstract] [Full text]  
• Duley, L., Meher, S., Abalos, E. (2006). Management of pre-eclampsia.. BMJ 332: 463-468 [Full text]  
• Milne, F. (2005). Pe-eclampsia: how to find the needle in the haystack. The Journal of the Royal Society for the Promotion of Health 125: 209-210  
• (2005). Hit parade. BMJ 330: 1155-1155 [Full text]  
• Greer, I. A (2005). Pre-eclampsia matters. BMJ 330: 549-550 [Full text]  
• Duckitt, K., Harrington, D. (2005). Risk factors for pre-eclampsia at antenatal booking: systematic review of controlled studies. BMJ 330: 565- [Abstract] [Full text]  

Rapid Responses:

Read all Rapid Responses

Thrombophilia and preeclampsia

Raha Shojai, et al.
bmj.com, 15 Mar 2005 [Full text]

Antiphospholipid testing and Systolic BP levels

Steven M Charkin
bmj.com, 16 Mar 2005 [Full text]

PRECOG should include nutritional status

Ellen C G Grant
bmj.com, 16 Mar 2005 [Full text]

Re: Thrombophilia and preeclampsia

Fiona M Milne
bmj.com, 19 Apr 2005 [Full text]

Re: Antiphospholipid testing and Systolic BP levels

Fiona M Milne
bmj.com, 19 Apr 2005 [Full text]

Online poll

Find out more >>