New guideline is simple, evidence based, and clinical, and should be used

Pre-eclampsia matters. In both the developed and the developing world, pre-eclampsia is important. It remains a leading cause of maternal and perinatal mortality and extensive morbidity. The reports of the Confidential Enquiry Into Maternal Deaths1 have identified deficiencies in care in relation to pre-eclampsia in successive reports since the 1950s. In this issue, the systematic review by Duckitt and Harrington quantifies the risk of pre-eclampsia associated with different factors present at the antenatal booking visit (p 565).2 The rationale is that this risk assessment will inform allocation of the woman to a suitable surveillance routine to detect pre-eclampsia.

The risk of pre-eclampsia is increased with a previous history of pre-eclampsia, pre-existing diabetes, multiple pregnancy, a family history for pre-eclampsia, a raised body mass index before pregnancy or at booking, raised blood pressure at booking, and the presence of anti-phospholipid antibodies. These risk factors are important, with relative risks of almost threefold for nulliparity and over ninefold for antiphospholipid antibodies. With a background incidence of 2-3%, this translates to absolute risks …