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Practice Guidelines

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

BMJ 2009; 339 doi: (Published 09 September 2009) Cite this as: BMJ 2009;339:b3129
  1. Fiona Milne, APEC trustee and PRECOG coordinator1,
  2. Chris Redman, obstetric physician, professor2,
  3. James Walker, obstetrician, professor3,
  4. Phil Baker, obstetrician, professor, director4,
  5. Rebecca Black, obstetrician5,
  6. Jill Blincowe, midwife, antenatal senior midwife6,
  7. Carol Cooper, general practitioner7,
  8. Gillian Fletcher, women representative1,
  9. Mervi Jokinen, midwife, practice and standards development adviser8,
  10. Paul A Moran, obstetrician and gynaecologist9,
  11. Catherine Nelson-Piercy, obstetric physician, consultant10,
  12. Stephen Robson, obstetrician, professor11,
  13. Andrew Shennan, obstetrician, professor12,
  14. Angela Tuffnell, midwife sister13,
  15. Jason Waugh, obstetrician, consultant14
  1. 1Action on Pre-eclampsia, Syston LE7 1LD
  2. 2Nuffield Department of Obstetrics and Gynaecology, John Radcliffe Hospital Oxford OX3 9DU
  3. 3Academic Head of Paediatrics, Obstetrics and Gynaecology, St James’s University Hospital, Leeds LS9 7TF
  4. 4NIHR Biomedical Research Centre, St Mary’s Hospital, University of Manchester, Manchester M13 0JH
  5. 5John Radcliffe Hospital, Oxford OX3 9DU
  6. 6Horton Maternity Hospital, Banbury OX16 9AL
  7. 7Mourne House, Maresfield Gardens NW3 5SL
  8. 8Royal College of Midwives, London W1G 9NH
  9. 9Worcestershire Royal Hospital, Worcester WR5 1DD
  10. 10St Thomas’ Hospital, London SE1 7EH
  11. 11Fetal Medicine, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne NE2 4HH
  12. 12King’s College London, St Thomas’ Hospital, London SE1 7EH
  13. 13St James’s University Hospital, Leeds LS9 7TF
  14. 14Royal Victoria Hospital, Newcastle upon Tyne NE1 4LP
  1. Correspondence to: F Milne, Action on Pre-eclampsia, 2c The Halfcroft, Syston LE7 1LD fionamilne{at}
  • Accepted 21 July 2009

Why read this summary?

Pre-eclampsia remains a leading cause of maternal death, with 72% of pre-eclampsia cases associated with substandard care.1 One in 10 pregnant women develop partial signs or symptoms (73 000 a year in the United Kingdom); about 20% of these progress to pre-eclampsia.2 3 This article summarises recommendations from the Pre-Eclampsia Community Guideline (PRECOG) Group4 under the auspices of the charity Action on Pre-eclampsia. The recommendations cover the assessment of women with suspected pre-eclampsia by hospital midwives in day assessment units and complements our previous community based advice.5 6


PRECOG recommendations (see table 1 for definitions used) are based on systematic review of evidence and expert consensus, graded A, B, C, or D; a “good practice point”(GPP) is based on the guideline development group’s experience (box 1). The grading is shown in parentheses after each recommendation.

View this table:
Table 1

 Definitions used in the PRECOG recommendations

Box 1 Levels of evidence on which recommendations are based*†

Grading of recommendations
  • Grade A—Directly based on category I evidence

  • Grade B—Directly based on category II evidence or extrapolated recommendation from category I evidence

  • Grade C—Directly based on category III evidence or extrapolated recommendation from category I or II evidence

  • Grade D—Directly based on category IV evidence or extrapolated recommendation from category I, II, or III evidence

  • GPP (good practice point)—Based on the view of the guideline development group

Grading (level) of evidence
  • Level Ia—Evidence obtained from meta-analysis of randomised controlled trials

  • Level Ib—Evidence obtained from at least one randomised controlled trial

  • Level IIa—Evidence obtained from at least one well designed, controlled study without randomisation. Includes cohort studies

  • Level IIb— Evidence obtained from at least one other type of well designed, quasi-experimental study. Includes case-control studies

  • Level III—Evidence obtained from well designed, non-experimental descriptive studies, such as comparative studies, correlation studies, and case studies

  • Level IV—Evidence obtained from expert committee reports or …

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