Pre‐eclampsia: Recognition, prevention and management

Summary: Pre‐eclampsia is the most common medical disorder of pregnancy and has a large variety of clinical presentations. It is a multisystem disorder affecting maternal kidneys, coagulation system, liver, brain and the placenta. Hypertension is an important but secondary phenomenon. Methods of measuring blood pressure (BP) in hypertensive pregnant women need to be standardized. There is presently a shift towards using the 5th Korotkoff sound to record diastolic BP but this has not been adopted universally. No test or set of tests reliably predicts which pregnant women will develop pre‐eclampsia and no therapy reliably prevents pre‐eclampsia although in some populations supplemental calcium appears to be a promising treatment. Low‐dose aspirin appears to have a role only in highly selected subgroups of pregnant women. Management of ‘gestational hypertension’(mild pre‐eclampsia) requires continued monitoring to detect transformation from this relatively mild disorder to the more severe disorder of pre‐eclampsia. Such monitoring requires measurement of platelet count, proteinuria, liver function, serum creatinine and careful clinical examination (particularly reflexes, clonus and epigastric tenderness) and fetal assessment. Blood tests are generally required only twice weekly though in severe cases more frequent testing is necessary, perhaps even daily when, for example, thrombocytopenia is progressive. Conservative management is adopted initially in most cases, invoving monitoring, careful use of antihypertensives and, in selected cases, anticonvulsant therapy and/or volume expander therapy. the latter is best employed to prevent sudden hypotension following epidural anaesthesia or parenteral antihypertensive therapy. Delivery is mandatory when monitoring indicates progressive disease despite conservative treatment.