New guidelines tackle pre-eclampsia

A new guideline published in this week's BMJ will help to tackle one of the leading causes of illness and death during pregnancy.

Pre-eclampsia is a serious condition in which abnormally high blood pressure and many other disturbances develop in the second half of pregnancy. It affects about seven per cent of pregnancies and is dangerous for both mother and child.

The most important risk factor for developing pre-eclampsia is a previous history, show researchers at the John Radcliffe Hospital in Oxford. Diabetes and a high body mass index almost quadruple the risk, while mother's age and raised blood pressure are also significant.

Many fetal and maternal deaths from pre-eclampsia are associated with substandard care, claim the guideline authors. Poor management includes failure to identify or act on risk at the beginning of pregnancy or to recognise and respond to signs and symptoms after 20 weeks.

Their guideline recommends a straightforward system of early risk assessment and referral to ensure that pregnant women with pre-eclampsia are offered specialist care at the appropriate time for the best outcome for them and their baby.

It is aimed at those caring for pregnant women in the community and is a practical extension of NICE's antenatal guideline.

An accompanying editorial applauds the simplicity and practicality of the new guideline. "We cannot be complacent in the face of the recurrent deficiencies" writes Ian Greer, Professor of Obstetrics and Gynaecology at the University of Glasgow. "The pragmatic approach of PRECOG is essential because pre-eclampsia matters."

Click here to view full paper (PDF)
Click here to view full guideline (PDF)
Click here to view full editorial (PDF)