Management of pre-eclampsia

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 of complications, and timely delivery (the only definitive cure). This review summarises current evidence on management of pre-eclampsia.

Methods

We searched The Cochrane Database of Systematic Reviews, the trials register of the Cochrane Pregnancy and Childbirth Group, CENTRAL and EMBASE for systematic reviews and randomised trials. Searches were updated in November 2005. Details of the search strategy are summarised on bmj.com. We also identified systematic reviews of studies assessing risk factors for pre-eclampsia. References for trials and reviews are on bmj.com.^w1-w28

Screening and diagnosis

Assessment usually begins when a woman presents to a general practitioner or midwife requesting antenatal care (box 4). Women at high risk are then offered further visits and testing, with referral for specialist care.4 Screening of low risk women is based primarily on blood pressure measurement and urine analysis. The search for additional tests continues.5 Despite initial optimism for uterine artery …