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

doi:10.1136/bmj.330.7491.576

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

Fiona Milne, guideline coordinator¹, Chris Redman, professor of obstetric medicine², James Walker, obstetrician³, Philip Baker, director⁴, Julian Bradley, general practitioner⁵, Carol Cooper, general practitioner⁶, Michael de Swiet, professor of obstetric medicine⁷, Gillian Fletcher, president⁸, Mervi Jokinen, practice and standards development adviser⁹, Deirdre Murphy, professor of obstetrics and gynaecology¹⁰, Catherine Nelson-Piercy, obstetric physician¹¹, Vicky Osgood, consultant in obstetrics¹², Stephen Robson, obstetrician¹³, Andrew Shennan, professor of obstetrics¹¹, Angela Tuffnell, midwifery sister³, Sara Twaddle, health economist¹, Jason Waugh, consultant obstetrician¹⁴

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

Correspondence to: F Milne fionamilne@talk21.com

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 aleading cause of direct maternal deaths in the United Kingdom¹;pre-eclamptic conditions represent one in three cases of severeobstetric morbidity²; hypertension and/or proteinuria is theleading single identifiable risk factor in pregnancy associatedwith stillbirth (one in five stillbirths in otherwise viablebabies)³; and pre-eclampsia is strongly associated with fetalgrowth restriction, low birth weight, preterm delivery, respiratorydistress syndrome, and admission to neonatal intensive care.⁴

In 46% of maternal deaths¹ and 65% of fetal deaths⁵ due to pre-eclampsiareported through the Confidential Enquiries into Maternal Deathsand the Confidential Enquiry into Stillbirths and Deaths inInfancy, different management would reasonably have expectedto alter the outcome. There was a failure to identify and acton known risk factors at booking and to recognise and respondto signs . . . [Full text of this article]

What can be done?

Complementing existing recommendations

The recommendations

Day assessment units

Resource implications

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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]
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