The clinical management, and therefore pregnancy outcome for women with pre-eclampsia begins with clear recognition that the disorder is arising. Living in Australia we are fortunate that antenatal care affords this opportunity in most cases and management can be effective. World-wide pre-eclampsia is responsible for about 75,000 maternal and half a million perinatal deaths per year, mortality about 40% as great as that of HIV.
Initial recognition still relies upon detection of hypertension or proteinuria, though at least 25% of cases are non-proteinuric, now recognised by most societies world-wide. Blood pressure is best measured in pre-eclamptic women by the auscultatory method using a liquid crystal sphygmomanometer rather than automated devices. Proteinuria can be immediately assessed by a spot protein/creatinine ratio and 24hr urine tests are not required. Future diagnoses may include measures of angiogenic or other factors but these should not be employed in clinical practice yet.
There is increasing support for a conservative approach in women presenting pre-term, waiting for a clear indication for delivery in these cases. RCT evidence confirms that controlling maternal BP to a target diastolic BP of 85mmHg is associated with fewer episodes of severe maternal hypertension.
IPD analysis of almost 100,000 women has confirmed a recurrence risk of 16% in future pregnancies, more likely if delivery was early in the index pregnancy. Recent surveys have found that physicians are less likely than obstetricians to appreciate the long-term cardiovascular risks of pre-eclampsia. These women have post-partum subtle features of metabolic syndrome and elevated BP but often remain untreated due to comparison of their results against usually older cohorts. Our current studies aim to determine normal physiological and BP limits for young parous women in order to help detect more subtle abnormalities in women who have had pre-eclampsia.