Pre-eclampsia is a hypertensive syndrome that occurs in pregnant women, most often after 20 weeks' gestation, which consists of new-onset, persistent hypertension with either proteinuria or evidence of systemic involvement.
All pregnant women presenting with hypertension and either proteinuria or evidence of systemic involvement require close assessment and monitoring for pre-eclampsia and its complications.
Delivery is the definitive treatment; the decision about when and how to deliver should only be made after a thorough assessment of the risk and benefits to the mother and baby.
Other mainstays of management include antihypertensive therapy, seizure control, and fluid restriction.
Maternal mortality is highest after delivery, so vigilance should be maintained in the postnatal period.
Pre-eclampsia can occur in subsequent pregnancies; therefore, women should be counselled about the risk.
Pre-eclampsia is a disorder of pregnancy that is associated with new-onset hypertension (defined as a systolic blood pressure ≥140 mmHg and/or a diastolic blood pressure ≥90 mmHg), most often after 20 weeks' gestation and frequently near term. Although often accompanied by new-onset proteinuria, hypertension and other signs or symptoms of pre-eclampsia may present in the absence of proteinuria in some women.
HELLP syndrome is a subtype of severe pre-eclampsia characterised by haemolysis (H), elevated liver enzymes (EL), and low platelets (LP). The diagnosis and management of HELLP syndrome is not discussed in detail in this topic (see our topic on HELLP syndrome for more information).
History and exam
Key diagnostic factors
- >20 weeks' gestation
- systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg and previously normotensive
- upper abdominal pain
Other diagnostic factors
- reduced fetal movement
- fetal growth restriction
- visual disturbances
- hyper-reflexia with sustained clonus
- pre-eclampsia in a previous pregnancy
- family history of pre-eclampsia
- body mass index (BMI) >30
- maternal age >40 years
- multiple (twin) pregnancy
- gestational hypertension
- pre-existing diabetes
- polycystic ovary syndrome (PCOS)
- autoimmune disease
- renal disease
- pre-existing cardiovascular disease and chronic hypertension
- interval of ≥10 years since previous pregnancy
- high-altitude residence
1st investigations to order
- fetal ultrasound
- umbilical artery Doppler velocimetry
- amniotic fluid assessment
- fetal cardiotocography
- liver function tests
- serum creatinine
- placental growth factor
Investigations to consider
- coagulation screen
James J. Walker, MD, FRCPS (Glas), FRCP (Edin), FRCOG
Maternity Investigation Team
Healthcare Services Investigation Branch
JJW is President of the Baby Lifeline Training Company and Medical Director of Action on Pre-eclampsia. He lectures and teaches on pre-eclampsia and maternal safety both nationally and internationally, and is the author of national and local reports into safety investigations for the Healthcare Services Investigation Branch and national and local bodies.
Lara Morley, MRCOG, MBChB, BSc, PgCert
Clinical Research Training Fellow
Leeds Institute of Cardiovascular and Metabolic Medicine
University of Leeds
LM declares that she has no competing interests.
Thomas R. Easterling, MD
Department of Obstetrics & Gynecology
University of Washington
TRE declares that he has no competing interests.
Andrew Shennan, MBBS, MD FRCOG
Professor of Obstetrics
Maternal and Fetal Research Unit
St Thomas' Hospital
King's College London
- Chronic hypertension
- Gestational hypertension
- Aspirin use to prevent preeclampsia and related morbidity and mortality: preventive medication
- Gestational hypertension and preeclampsia
Pre-eclampsia: what is it?
Pre-eclampsia: what treatments work?More Patient leaflets
Venepuncture and phlebotomy animated demonstration
Central venous catheter insertion animated demonstrationMore videos
- Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer