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

BMJ 2005; 330 doi: (Published 10 March 2005) Cite this as: BMJ 2005;330:576
  1. Fiona Milne, guideline coordinator (,
  2. Chris Redman, professor of obstetric medicine2,
  3. James Walker, obstetrician3,
  4. Philip Baker, director4,
  5. Julian Bradley, general practitioner5,
  6. Carol Cooper, general practitioner6,
  7. Michael de Swiet, professor of obstetric medicine7,
  8. Gillian Fletcher, president8,
  9. Mervi Jokinen, practice and standards development adviser9,
  10. Deirdre Murphy, professor of obstetrics and gynaecology10,
  11. Catherine Nelson-Piercy, obstetric physician11,
  12. Vicky Osgood, consultant in obstetrics12,
  13. Stephen Robson, obstetrician13,
  14. Andrew Shennan, professor of obstetrics11,
  15. Angela Tuffnell, midwifery sister3,
  16. Sara Twaddle, health economist1,
  17. Jason Waugh, consultant obstetrician14
  1. 1 Action on Pre-eclampsia, Harrow, Middlesex HA1 4HZ
  2. 2 Nuffield Department of Obstetrics and Gynaecology, John Radcliffe Hospital, Oxford OX3 9DU
  3. 3 St James's University Hospital, Leeds LS9 7TF
  4. 4 Maternal and Fetal Health Research, St Mary's Hospital, Manchester M13 0JH
  5. 5 Stonedean Practice, Stony Stratford Health Centre, Milton Keynes MK11 1YA
  6. 6 Cuckoo Lane Practice, London W7 3EY
  7. 7 Imperial College London, Queen Charlotte's Hospital, London W12 0NN
  8. 8 National Childbirth Trust, London W3 6NH
  9. 9 Royal College of Midwives, London W1G 9NH
  10. 10 Ninewells Hospital and Medical School, Dundee DD1 9SY
  11. 11 St Thomas' Hospital, King's College, London SE1 7EH
  12. 12 St Mary's Hospital, Portsmouth, Hampshire PO3 6AD
  13. 13 School of Surgical and Reproductive Sciences, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP
  14. 14 Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW
  1. Correspondence to: F Milne
  • Accepted 5 January 2005

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 and symptoms from 20 weeks' gestation.6

No guidelines exist for the screening and early detection of pre-eclampsia in the community, and there is no uniformity in referral thresholds and assessment procedures.

What can be done?

We developed the pre-eclampsia community guideline (PRECOG) under the auspices of the charity Action on Pre-eclampsia, following the National Institute for Clinical Excellence's recommendations for the development of guidelines.7 Our guideline is supported by the Royal College of Obstetricians and Gynaecologists, the Royal College of Midwives, the Royal College of General Practitioners, and the National Childbirth Trust. Box 1 lists the definitions used in the guideline; pre-eclampsia is defined as new hypertension and proteinuria (see for definition of levels of evidence).

The pre-eclampsia community guideline provides an evidence based risk assessment, with criteria for early referral for specialist input, a two tiered schedule for monitoring women in the community after …

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