BMJ  2006;332:463-468 (25 February), doi:10.1136/bmj.332.7539.463

Clinical review

Management of pre-eclampsia

¹ Nuffield Department of Medicine, John Radcliffe Hospital, Oxford OX3 9DU, ² Liverpool Women's Hospital, Crown Street, Liverpool L8 7SS, ³ Centro Rosarino de Estudios Perinatales, Pueyrredon 985, Rosario, Santa Fe, Argentina 2000

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

Introduction

Pre-eclampsia is part of a spectrum of conditions known as the hypertensive disorders of pregnancy (box 1).¹ A multisystem disorder usually associated with raised blood pressure and proteinuria, pre-eclampsia is relatively common, affecting 2-8% of pregnancies. Although outcome is often good, pre-eclampsia can be devastating and life threatening for both mother and baby (box 2), particularly in developing countries.² It may also lead to an increased risk of cardiovascular disease in later life.

Although the cause is not fully understood, factors thought to have a role include genes, the placenta, the immune response, and maternal vascular disease.³ Inadequate blood supply to the placenta leads to endothelial dysfunction, which accounts for the secondary changes in maternal target systems (such as platelet aggregation and vasoconstriction) responsible for the signs and symptoms of pre-eclampsia (box 3).

Effective care includes identification and referral of women at high risk, prompt diagnosis with prevention and treatment . . . [Full text of this article]

Methods

Screening and diagnosis

Primary prevention of pre-eclampsia

Lifestyle choices
Diet and nutrition
Drugs

Secondary prevention of pre-eclampsia

Antihypertensive drugs
Other drugs

Admission to hospital or day care unit

Treatment of pre-eclampsia

Women with severe hypertension or pre-eclampsia

Choice of antihypertensive
Timing of delivery for women with early onset, severe pre-eclampsia
Other interventions for severe pre-eclampsia

Prevention and treatment of eclampsia

Prevention of eclampsia
Choice of anticonvulsant for treating eclampsia

Treatment of postpartum hypertension

Assessment and counselling after pre-eclampsia

Conclusion

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