The focus of this article is to review and challenge some current concepts surrounding the diagnosis and management of pre-eclampsia as well as considering where our management might head in the future. Pre-eclampsia is a syndrome defined by the new onset of hypertension in the 2nd half of pregnancy that is generally, but not always, accompanied by proteinuria. Whilst in recent times our understanding and management of this condition have improved there are some areas where evidence and opinions differ. In this review we will discuss the diagnosis of pre-eclampsia and the concept of the 'atypical' presentation. We will outline how to identify those women with pre-eclampsia who will have a poorer pregnancy outcome. We will address the question of when to deliver and how to treat if we decide to prolong the pregnancy. Finally we acknowledge that pre-eclampsia is more than a disorder of pregnancy and has lifelong implications for the mother and infant.
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