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Introduction to pre-eclampsia

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Pre-eclampsia is defined by the International Society for the Study of Hypertension in Pregnancy as gestational hypertension of at least 140/90 mmHg on two separate occasions ≥4 hours apart accompanied by significant proteinuria of at least 300 mg in a 24 hour collection of urine, arising de novo after the 20th week of gestation in a previously normotensive woman and resolving completely by the sixth postpartum week.

This hypertensive condition usually occurs during the second half of pregnancy complicating 2% to 8% of pregnancies. Pre-eclampsia is a major cause of maternal and perinatal mortality and morbidity worldwide causing 15% of all direct maternal deaths in the UK and a fivefold increase in perinatal mortality with iatrogenic prematurity being the main culprit. The World Health Organisation estimates that worldwide approximately 70 000 women die from pre-eclampsia each year. The Confidential Enquiry into Stillbirths and Deaths in Infancy (CESDI) report cites one in six stillbirths as occurring in pregnancies complicated by maternal hypertension.

Pre-eclampsia is a heterogeneous, multi-systemic disorder, which presents with varying degrees of severity. In general, maternal and perinatal outcomes are usually favourable when mild pre-eclampsia develops after 36 weeks of gestation. The risk of serious maternal and perinatal morbidity and mortality increases significantly when pre-eclampsia develops prior to 33 weeks of gestation, in those with pre-existing medical conditions and in those from developing countries. As pre-eclampsia is associated with significant maternal and perinatal morbidity and mortality, it is imperative that every effort is made to accurately classify women with hypertension in pregnancy as having chronic hypertension, non-proteinuric pregnancy induced hypertension (PIH) or pre-eclampsia, as the aetiology and management of the three conditions is very different.

Learning objectives

When you have completed this tutorial you will be able to:

  • correctly classify and diagnose hypertensive disorders of pregnancy
  • appreciate the maternal and fetal consequences of hypertensive disorders occurring in pregnancy
  • understand the aetiology and pathophysiology of pre-eclampsia
  • understand the antenatal, intrapartum and postnatal management of pre-eclampsia
  • discuss the limitations of screening and prevention of pre-eclampsia

Last updated:30/06/2011 (tutorial was revised and updated by the authors)

21/04/09 (Case study added).

06/03/09 (BJOG paper added in the Pre-eclampsia – Aetiology section).

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