Recent developments in the pathophysiology and management of pre-eclampsia.

TLDR: Pre-eclampsia is a progressive disease with a very variable mode of presentation and rate of progression; of all the features of the syndrome, hypertension, pregnancy-induced proteinuria, excessive weight gain and oedema are the classic clinical manifestations.

Abstract: Fits occurring in pregnant women were recognized and recorded as early as the 4th century BC by Hippocrates [94]. The condition was termed eclampsia—a Greek word which translates literally as ‘shine forth’—implying a sudden development. Little was known about eclampsia until 1843, when Lever of Guy’s Hospital found that many of the women who had fits also had albumin in their urine [74]. However, it was not until the widespread use of the sphygmomanometer that the condition was known to be associated with raised systemic arterial pressure. Because it was recognized that albuminuria and hypertension could precede the onset of fits, the term pre-eclampsia was coined although this nomenclature is now criticized because only a small proportion of patients with pre-eclampsia subsequently develop eclampsia. Pre-eclampsia is a multisystem disorder of unknown aetiology and unique to pregnant women after 20 weeks’ gestation. In the UK, 18.6 % of maternal deaths are caused by hypertensive diseases [42]. Hypertensive disorders of pregnancy are common, affecting 10.6 % of pregnant women [109]. Preeclampsia (i.e. proteinuric hypertension) affects 5.8 % of primigravidas, and 0.4 % of secundagravid women [84]. While premature labour is the leading cause of very low birthweight neonates, the next most common cause is hypertension which accounts for 23 % of all viable very low birthweight singleton infants [2]. Pre-eclampsia is a progressive disease with a very variable mode of presentation and rate of progression. Of all the features of the syndrome, hypertension, pregnancy-induced proteinuria, excessive weight gain and oedema are the classic clinical manifestations. Other features include, thrombocytopenia, hyperuricaemia, abnormal liver function tests, haemoconcentration, hypoalbuminaemia and eclampsia. Eclampsia is a rare but serious complication of pre-eclampsia; it complicates about 1:2000 deliveries in Europe and the developed countries [45] and from 1 : 100 to 1 : 1700 deliveries in developing